304 - Acute Kidney Injury

Question 1

AKI can be defined by one of the following 3 criteria:

1. Nitrogen retention (___ and ___ increase in the blood
2. Oliguria (

Answer 1

BUN
Cr
400
Electrolytes
Acid base

Question 2

AKI is responsible for ___ of the acute hospitalizations and up to 30% of admissions to the ___

Answer 2

5-7%

ICU

Question 3

Main causes for AKI in developing countries include: (3)

Answer 3

Diarrhea
Infectious disease
Rhabdomyolysis

Question 4

Most of the community acquired AKI are due to: (3)

Answer 4

Hypovolemia
Iatrogenic (drugs)
Urinary track blockage

Question 5

Most nosocomial AKI are due to: (4)

Answer 5

Post surgery
Sepsis
Contrast fluids
Nephrotoxic drugs

Question 6

Most cases of AKI are defined as pre-renal (__%), intrinsic ARF is responsible to ___% of the cases, and post renal to ___%

Answer 6

55%
40%
5%

Question 7

Pre renal azotemia is usually due to ____

Answer 7

Kidney hypoplasia

Question 8

Intrinsic ARF is caused by ____ disease

Answer 8

Kidney parenchyma

Question 9

Post renal ARF is usually caused by ____

Answer 9

Urinary tract obstruction

Question 10

Pre renal azotemia is defined by ___ or ___ levels increase due to ____ - disturbance of glomeruli filtration. It is by definition ___ once hemodynamic status return to normal. No ____ damage occur.

Answer 10

BUN
Cr
Tissue hypoplasia
Reversible 
Parenchymal

Question 11

The common causes to prerenal azotemia are: (5)

Answer 11

Hypovolemia
Cardiac output decrease
Iatrogenic agents leading to auto regulation disturbance (ACEi/ARB/NSAIDs)

Question 12

The main causes for intrinsic AKI include ___, ___, and ___.

Answer 12

Ischemia
Sepsis
Nephrotoxins

Question 13

In ___ of sepsis cases we might end up with ____. It increases the rate of ___

Answer 13

50%
Intrinsic AKI
Mortality

Question 14

In Intrinsic AKI due to ___ we might find ___ and ___ in the urine

Answer 14

Sepsis
Tubular debris
Casts

Question 15

Normal kidneys receive ___ of the CO and consume ___ of the oxygen while at rest.

Answer 15

20%

10%

Question 16

Vascular disease may lead to renal ischemia. We can divide them into small vessels (5) and large vessels.

Answer 16

APLA
TTP/HUS
Radiation nephritis
Scleroderma
Cholesterol emboly

Question 17

Vascular disease may lead to renal ischemia. We can divide them into small vessels, and large vessels (4)

Answer 17

Renal artery dissection
Emboly
Thrombi
Renal vein pressure

Question 18

___ and acute ____ may also lead to intrinsic AKI

Answer 18

Burns (in 25% of patients with > 10% body surface burn)

Pancreatitis

Question 19

Contrast nephropathy will first show ___ and ___ increase ___ hours after contrast fluids were given. Pick levels are reached after ___ days, and return to normal after ___ days

Answer 19

Cr
BUN
24-48
3-5
7

Question 20

Contrast nephropathy is defined by a sharp decrease in ___, unspecified urine sediments and low ___

Answer 20

GFR

FENa

Question 21

Contrast nephropathy is unlikely, beside in the following patients: (5). Remember also-: age>80, single kidney

Answer 21

1. Diabetic
2. CRF
3. CHF
4. Hypovolemia/ dehydration
5. MM

Question 22

Which Abx may lead to intrinsic AKI? (4)

Answer 22

1. Vancomycin
2. Aminoglycosides
3. Amphotericin
4. Acyclovir

Question 23

Which chemotherapeutic agents may lead to intrinsic AKI? (4)

Answer 23

Cisplatin
Carboplatin
Ifosfamide
Bevacizumab

Question 24

____ released after rhabdomyolysis due to: trauma/muscles ischemia/vascular surgery/etc… may lead to ___ AKI

Answer 24

Myoglobin

Intrinsic

Question 25

Beside myoglobin, other endogenic toxins that nay lead to intrinsic AKI include: (4)

Answer 25

Hemolysis MM TLS Hypercalcemia

Question 26

Post renal AKI etiologies include: (3)

Answer 26

Urethral neck obstruction Urethral obstruction Urethra obstruction

Question 27

Oliguria is defined by

Answer 27

400 Rhabdomyolysis Hemolysis

Question 28

In pre renal urine analysis we will ___ see cells, but ___ casts (hyaline and transparent) are possible

Answer 28

Not | Tamm Horsfall

Question 29

In intrinsic urine analysis we will ___ see WBC/RBC cells. ___ ___ and are possible

Answer 29

Might Hematuria Pyuria

Question 30

In intrinsic urine analysis we will see ____ casts. Light ___ is possible. Only ___% of cases do not have ___

Answer 30

Muddy brown Proteinuria 20-30% Casts

Question 31

To summarize: 1. Hyaline casts->___ 2. Muddy brown casts ->___ 3. RBC casts ->___ 4. WBC casts ->___ 5. Broad granular casts ->___

Answer 31

1. Pre renal 2. Intrinsic 3. Glomerular damage (IS nephritis is possible) 4. IS nephritis 5. CKD

Question 32

Uric acid crystals are found in ___ AKI for different reasons including ____

Answer 32

Pre renal | TLS

Question 33

Oxalate a crystals are found after exposure to ____

Answer 33

Ethylene glycol

Question 34

Which CBC results may suggest HUS/TTP? (5)

Answer 34

``` Anemia Thrombocytopenia Schistocytes LDH increase Haptoglobin decrease ```

Question 35

When suspecting HUS/TTP we must include tests for: (2)

Answer 35

1. ADAMTS13 | 2. Shiga toxin (E.coli producing)

Question 36

In AKI usually hyper___, hyper___, and hypo___ are seen.

Answer 36

Kalemia Phosphotemia Calcemia

Question 37

High AG will suggest ___ intoxication

Answer 37

Ethylene glycol

Question 38

Low AG will suggest ___.

Answer 38

MM

Question 39

GN and vasculitis are to be suspected when the seeing low complement factors and high titer of ___, ___, ___, ___.

Answer 39

ANA ANCA AGBM Cryoglobulins

Question 40

FENa (fractional Excretion of Sodium) < 1% than ___, beside when: (4)

Answer 40

``` Pre renal Diuretic CKD Salt wasting syndrome Adrenal insufficiency ```

Question 41

FENa > 1% than ____

Answer 41

ATN (acute tubular necrosis)

Question 42

Pre renal azotemia: 1. FENa ___ 3. UCr/PCr > ___ 4. BUN/Cr > ___ 5. Urine Na < ___

Answer 42

1. 1% 2. 500 3. 40 4. 20 5. 20

Question 43

Uremia is when ___ levels are increased due to accumulation of ___. when > ___ ml/dL- mental status changes and hemostasis disturbance

Answer 43

BUN Nitrogen waste products 100

Question 44

How FENa is calculated?

Answer 44

FENA= ((UNA X PCr) / (UCr X PNa)) X 100