304 - Acute Kidney Injury Flashcards
AKI can be defined by one of the following 3 criteria:
- Nitrogen retention (___ and ___ increase in the blood
- Oliguria (
BUN Cr 400 Electrolytes Acid base
AKI is responsible for ___ of the acute hospitalizations and up to 30% of admissions to the ___
5-7%
ICU
Main causes for AKI in developing countries include: (3)
Diarrhea
Infectious disease
Rhabdomyolysis
Most of the community acquired AKI are due to: (3)
Hypovolemia
Iatrogenic (drugs)
Urinary track blockage
Most nosocomial AKI are due to: (4)
Post surgery
Sepsis
Contrast fluids
Nephrotoxic drugs
Most cases of AKI are defined as pre-renal (__%), intrinsic ARF is responsible to ___% of the cases, and post renal to ___%
55%
40%
5%
Pre renal azotemia is usually due to ____
Kidney hypoplasia
Intrinsic ARF is caused by ____ disease
Kidney parenchyma
Post renal ARF is usually caused by ____
Urinary tract obstruction
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.
BUN Cr Tissue hypoplasia Reversible Parenchymal
The common causes to prerenal azotemia are: (5)
Hypovolemia
Cardiac output decrease
Iatrogenic agents leading to auto regulation disturbance (ACEi/ARB/NSAIDs)
The main causes for intrinsic AKI include ___, ___, and ___.
Ischemia
Sepsis
Nephrotoxins
In ___ of sepsis cases we might end up with ____. It increases the rate of ___
50%
Intrinsic AKI
Mortality
In Intrinsic AKI due to ___ we might find ___ and ___ in the urine
Sepsis
Tubular debris
Casts
Normal kidneys receive ___ of the CO and consume ___ of the oxygen while at rest.
20%
10%
Vascular disease may lead to renal ischemia. We can divide them into small vessels (5) and large vessels.
APLA TTP/HUS Radiation nephritis Scleroderma Cholesterol emboly
Vascular disease may lead to renal ischemia. We can divide them into small vessels, and large vessels (4)
Renal artery dissection
Emboly
Thrombi
Renal vein pressure
___ and acute ____ may also lead to intrinsic AKI
Burns (in 25% of patients with > 10% body surface burn)
Pancreatitis
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
Cr BUN 24-48 3-5 7
Contrast nephropathy is defined by a sharp decrease in ___, unspecified urine sediments and low ___
GFR
FENa
Contrast nephropathy is unlikely, beside in the following patients: (5). Remember also-: age>80, single kidney
- Diabetic
- CRF
- CHF
- Hypovolemia/ dehydration
- MM
Which Abx may lead to intrinsic AKI? (4)
- Vancomycin
- Aminoglycosides
- Amphotericin
- Acyclovir
Which chemotherapeutic agents may lead to intrinsic AKI? (4)
Cisplatin
Carboplatin
Ifosfamide
Bevacizumab
____ released after rhabdomyolysis due to: trauma/muscles ischemia/vascular surgery/etc… may lead to ___ AKI
Myoglobin
Intrinsic
Beside myoglobin, other endogenic toxins that nay lead to intrinsic AKI include: (4)
Hemolysis
MM
TLS
Hypercalcemia
Post renal AKI etiologies include: (3)
Urethral neck obstruction
Urethral obstruction
Urethra obstruction
Oliguria is defined by
400
Rhabdomyolysis
Hemolysis
In pre renal urine analysis we will ___ see cells, but ___ casts (hyaline and transparent) are possible
Not
Tamm Horsfall
In intrinsic urine analysis we will ___ see WBC/RBC cells. ___ ___ and are possible
Might
Hematuria
Pyuria
In intrinsic urine analysis we will see ____ casts. Light ___ is possible. Only ___% of cases do not have ___
Muddy brown
Proteinuria
20-30%
Casts
To summarize:
- Hyaline casts->___
- Muddy brown casts ->___
- RBC casts ->___
- WBC casts ->___
- Broad granular casts ->___
- Pre renal
- Intrinsic
- Glomerular damage (IS nephritis is possible)
- IS nephritis
- CKD
Uric acid crystals are found in ___ AKI for different reasons including ____
Pre renal
TLS
Oxalate a crystals are found after exposure to ____
Ethylene glycol
Which CBC results may suggest HUS/TTP? (5)
Anemia Thrombocytopenia Schistocytes LDH increase Haptoglobin decrease
When suspecting HUS/TTP we must include tests for: (2)
- ADAMTS13
2. Shiga toxin (E.coli producing)
In AKI usually hyper___, hyper___, and hypo___ are seen.
Kalemia
Phosphotemia
Calcemia
High AG will suggest ___ intoxication
Ethylene glycol
Low AG will suggest ___.
MM
GN and vasculitis are to be suspected when the seeing low complement factors and high titer of ___, ___, ___, ___.
ANA
ANCA
AGBM
Cryoglobulins
FENa (fractional Excretion of Sodium) < 1% than ___, beside when: (4)
Pre renal Diuretic CKD Salt wasting syndrome Adrenal insufficiency
FENa > 1% than ____
ATN (acute tubular necrosis)
Pre renal azotemia:
- FENa ___
- UCr/PCr > ___
- BUN/Cr > ___
- Urine Na < ___
- 1%
- 500
- 40
- 20
- 20
Uremia is when ___ levels are increased due to accumulation of ___. when > ___ ml/dL- mental status changes and hemostasis disturbance
BUN
Nitrogen waste products
100
How FENa is calculated?
FENA= ((UNA X PCr) / (UCr X PNa)) X 100
