8 GFR proteinuria, AKI

Question 0

Normal GFR/CKD grading

Answer 0

>100 ml/min normal
90 - Stage 1
90-60 Stage 2
60- 30 Stage 3
30-15 Stage IV
15-10 Stage V
<10 DIALYSIS

Question 1

Normal Creat

Answer 1

Men 0.9-1.3 mg/dl or 79-114 micromol/L
Women 0.8 to 1mg/dl or 70-88 micromol/L
Kiddos 0.5 to 1mg/dl or .44-88 micromol/L

Question 2

About how much urine excreted per day?

Answer 2

1-2 liters

Question 3

Lower limit of UA protein testing

Answer 3

150 mg/ day normal and undetected on UA

Question 4

Microalbuminuria

Answer 4

30-300mg albumin 24 hrs
20-200 mcg/min
30-300MG albumin/gram creatnine

Question 5

Diabetic proteinuria GBM

Answer 5

DN with proteinuria have increased GBM thickness

Question 6

Non kidney proteinuria

Answer 6

Overproduction of proteins by other organs- i.e. Multiple myeloma.

Question 7

AKI Diagnostic criteria

Answer 7

48 HRS change in:

• increased serum creat of 0.3mg/dl
• 50% increase in creatnine ([creat]1.5)
• oliguria (<400-500) per day

Question 8

Define:
Oliguria
Azotemia
Uremia

Answer 8

Oliguria <400-500 ml urine/day
Azotemia- Elevated nitrogenous wastes in the blood 2/2 isufficeint filtering
Uremia- Syndrome of toxic effects of nnitrogenous wastes in the blood

Question 9

Muddy brown casts

Answer 9

Trapping of cellular elements in tubular matrix proteins

Seen in Glomerulitis and Acute tubular necrosis

Question 10

AKI differentiation

Answer 10

Prerenal: impaired perfusion
Renal: Intrinsic disease (glomerular, tubular, interstitial, vascular)
PostRenal: Obstruction

Question 11

PRErenal AKI

Answer 11

Dcr renal perfusion -> INC ANGII -> oliguria and sodium retention

• increased urea resorpton - BUN increases 20x creatnine in preAKI
• Reversable if treated within 3-4 days

Question 12

Prerenal AKI histo

Answer 12

LM: Normal histo

Question 13

Renal AKI causes

Answer 13

• ATN: ischemic, toxic, mixed
• Inflammatory: GN, tubulointerstitial nephritis, vasculitis
• Embolism, thrombosis, thrombotic microangiopathy
• neoplasm

Question 14

ATN causes

Answer 14

Ischemia->

• endothelial dysfunction and vasoconstriction
• Tubular injury- Tubuloglomerular feedback, cast obstruction, tubular backleak

Question 15

ATN histo

Answer 15

Injury and loss of tubular epithelial cells

• Tubular dilation
• thin epithelium
• loss of brush border
• granular casts
• mitosis
• flattening of tubular cells
• necrosis/loss of nuclei

Question 16

PostRenal AKI/ Obstructive uropathy

Answer 16

• Needs to be ruled out in all patients with oliguria

* Hydronepphrosis

Question 17

Prerenal Azotemia vs. ATN

Answer 17

FENa

• > 2% is ATN
• normally about 1%
• volume depletion <1%

Question 18

BUN levels

Answer 18

Normal is 7-20 mg/dL

Question 19

Prostaglandins in the kidney

Answer 19

Released by macula densa in response to decreased NaCl delivvery, causing vasodilitation of afferent arteriole and release of Renin