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MHD V: Renal > 11.2: Clinical I > Flashcards

11.2: Clinical I Flashcards

1
Q

Definition of AKI?

A

Any of the following renal changes within 48 hours:

  1. Serum Cr. increase > .3 mg/dl
  2. % increase serum Cr. > 50%
  3. Oliguria 6 hours
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2
Q

What is RRT?

A
  • Renal replacement therapy: Dialysis
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3
Q

What is AKI often associated with?

A
  1. Critically ill patients
  2. Septic patients: 50% with bacteremic septic shock
  3. MSOD: mult. syst. organ dysfunction
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4
Q

3 categories of AKI?

A
  1. Prerenal
  2. Intrinsic renal
  3. Postrenal
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5
Q

Types of prerenal failure / azotemia?

A
  1. Absolute decrease in BV: hemorrhage / depletion
  2. Low ECV: relative decrease in BV: CHF / cirrhosis
  3. Renal stenosis / occlusion
  4. Impaired autoregulation: NSAID/ACEI/ARB
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6
Q

Types of intrinsic renal failure?

A
  1. Vascular
  2. Acute glomerular disease
  3. AIN: acute interstitial nephritis
  4. ATN: acute tubular necrosis
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7
Q

Types of postrenal failure

A
  1. Bladder outlet obstruction
  2. Bilateral ureteral obstruction
  3. Unilateral ureteral obstruction
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8
Q

Most common causes of AKI?

A
  1. Prerenal azotemia
  2. Ischemic ATN
    * **75% of all cases
    - Thought that prerenal azotemia becomes ischemic ATN
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9
Q

What is prerenal azotemia?

A
  • Appropriate physiologic response to renal hyperperfusion: success not failure
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10
Q

What does prerenal azotemia progress to?

A

Ischemic ATN

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11
Q

What is normal renal autoregulation in response to drop in BP? What mediates this?

A
  1. Dilation of afferents: NO and prostaglandins

2. Constriction of efferents

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12
Q

What antagonizes auto dilation of renal afferents? efferents

A

Affernets: COX I/II inhibitors: NSAIDS
Efferents: ACEI / ARBs

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13
Q

What is the NSAID effect?

A
  • NSAIDs cause tonic constriction of renal afferent
  • If volume / ECV drops, kidney is compromised as cannot respond
  • Drop in GFR
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14
Q

Who is at greatest risk for postrenal failure?

A
  1. Older men with prostate disease
  2. Solitary kidney
  3. Intra abdominal pelvic cancer
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15
Q

What is post renal intervention sequelae?

A
  1. Post obstructive diuresis > 4L / day
    - Lose ability to concentrate urine
  2. Hyper K / Cl RTA that can become chronic
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16
Q

How do diagnose postrenal failure?

A
  1. Physical exam: dullness to percusion in superpubic area, fullness / discomfort here
    - Easier in skinny ptn.
    - Urge to urinate when push in area
  2. Increased post void residual volume: ultrasound
    - Hard to tell with ascites
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17
Q

Two types of ATN?

A
  1. Ischemic
  2. Nephrotoxic
    * *Sepsis surgery and toxic exposures can cause
18
Q

Two types of AIN?

A
  1. Drug associated

2. Non drug associated

19
Q

Vascular causes of intrinsic renal failure?

A
  1. Malignant Htn.
  2. HUS / TTP
  3. Vasculitis
20
Q

Definition of malignant HTN?

A
  • BP > 180 / 120

- Evidence of end organ damage must be occurring

21
Q

What is hypertensive urgency?

A

High BP but not yet any sign of end organ injury

22
Q

Two general types of glomerular diseases?

A
  1. Nephritic: Inflammatory, sedimentation, blood, casts

2. Nephrotic: Proteinuria

23
Q

Main causes of drug related acute interstitial nephritis?

A

Medications:

  1. PPIs
  2. NSAIDs
  3. Antimicrobials
24
Q

Classic triad of Acute interstitial nephritis?

A
  1. Fever
  2. Rash
  3. Peripheral eosinophilia: urine too
25
Q

What is urine eosinophils indicative of?

A

Acute interstitial nephritis

26
Q

What is abdominal jugular reflex?

A
  • Ptn at 30 degrees

- Push on abdomen sustained, if it goes up by 4cm means they are over loaded on fluids

27
Q

What are S3 gallop and abdominal jugular reflux highly predictive of?

28
Q

What are two highly predictive exam findings for CHF?`

A
  1. S3

2. Abdominal jugular reflux

29
Q

Urinalysis in PRA vs. ATN?

A

ATN: abnormal, tubular epithelial casts
PRA: usually normal, maybe non specific hyaline casts

30
Q

Urine osmolality in PRA vs. ATN?

A

PRA: Very high
ATN: middle of road

31
Q

Urine Na and FENa and FE urea in PRA and ATN?

A

PRA: low
ATN: high

32
Q

Should Cr. be measured in AKI?

A
  • No, is only reliable in steady states

- AKI is not a steady state

33
Q

What does BUN ration > 10:1 indicate?

A

Prerenal Azotemia

34
Q

What BUN:Cr. ration means prerenal azotemia?

35
Q

What does BUN ration 10:1 indicate?

A

ATN

- Also can be normal or chronic kidney disease

36
Q

What BUN:Cr. ration means ATN?

37
Q

What nutritional support is given in AKI?

A
  1. Ensure carb intake to prevent protein breakdown
38
Q

General indications for hemodialysis?

A

“AEIOU”

  1. Acidosis
  2. Electrolyte imbalance: usually HYPER K
  3. Intoxication syndrome
  4. Overload: pulmonary edema
  5. Uremia
39
Q

AKI prognosis?

A
  1. Most recover

2. 10% Irreversible

40
Q

How to prevent AKI?

A
  1. Manage volume status and CO
  2. Avoid nephrotoxins
  3. Give prophylaxis with radiographic contrast
  4. Prophylaxis for chemotherapy

MHD V: Renal (28 decks)

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