88 89 Acute Kidney Injury and rhabdo

Question 1

What are the most common causes of community acquired a KI?

Answer 1

Volume depletion, medications, infection, urinary obstruction

Question 2

Explain why sometimes progressive a KI occurs after initial recovery from a KI

Answer 2

Because if the number of nephrons drop a lot of critical number, continued hyperfiltration results and progressive glomerulosclerosis eventually Leading to nephron loss. A vicious cycle of nephron loss then and Sue’s until complete a KI occurs.

Question 3

List the major causes of intrinsic AKI

Answer 3

ATN from pre-renal, crystal induced nephropathy, rhabdo my lysis, Goodpasture’s syndrome or Wagner’s granulomatosis, acute interstitial nephritis, acute glomerulonephritis

Question 4

What is the pathognomonic Clinical presentation of urinary obstruction?

Answer 4

Alternating oliguria and polyuria

Question 5

Name to a KIN stages by GFR decrease?

Answer 5

Stage one is a decrease of 25 to 50%, stage two is a GFR decrease of 50 to 75% stage III is GFR decrease of greater than 75% after that is an stage renal disease

Question 6

List of major diagnostic test for the work up of a cute kidney injury?

Answer 6

CBC, chemistry including magnesium and phosphorus, liver function test, blood cultures. UA, urine osmolality, urine sodium, urea levels, EKG, bedside ultrasound for urinary bladder volume and inferior vena cava

Question 7

Define contrast induced nephropathy.

Answer 7

A relatively small change in stream creatinine of 25% increase from baseline 48 to 72 hours in fusion

Question 8

Why Have ER doctor to become Cavalier about contrast induced nephropathy?

Answer 8

Because after using propensity scoring matching to reevaluate the studies they fail to find a statistically higher incidence of a KIA and no differences in mortality, development of chronic kidney disease, or need for dialysis or transplant Tatian in the future.

Question 9

List the major causes of Crystal induce nephropathy?

Answer 9

Tumor lysis syndrome in the setting of elevated uric acid, medications in particular acyclovir, sulfonamides, Indinacir, triamterene

Question 10

What, antihypertensive medication is a common cause of community acquired a KI?

Answer 10

Hason have it is because they preferentially dilate the E Farrant artery causing a 10 to 20% increase and see him creatinine

Question 11

In what condition can ace in Hibbett her’s precipitate a serious AKI?

Answer 11

Bilateral renal artery stenosis

Question 12

Name the three major causes of prerenal acute kidney injury

Answer 12

Hypovolemia, hypotension, renal artery and small vessel effects : Medications, hypercalcemia, embolus, thrombosis, dissection, micro vascular thrombosis

Question 13

Described The nephrotic syndrome?

Answer 13

Edema, protein urea, hypoalbuminemia, hyperlipidemia, hypercoagulability from loss of anti-thrombin three

Question 14

Describe the nephritic syndrome?

Answer 14

He met your Reared blood cell cast, decreased urine output, and hypertension

Question 15

And patient with no renal function, how fast is your creatinine increase?

Answer 15

1 to 3 mg/dL a day And if it is less, that indicates residual renal function

Question 16

What does it mean if a patient has zero GFR but creatinine increase is less than one per day? Three per day?

Answer 16

If it’s less than one and that indicates residual renal function, if it’s faster that indicates rhabdo my lysis

Question 17

How long does it normally take for CM creatinine level to elevate?

Answer 17

And healthy people, it may take 48 hours and you may have to lose more than half of the functioning nephrons before creatinine elevated to an abnormal level

Question 18

BUN to creatinine ratio and pre-renal versus intrinsic renal injury?

Answer 18

Greater than 20 and pre-renal less than 20 and intrinsic

Question 19

Fractional excretion of sodium and intrinsic versus pre-renal injury?

Answer 19

Fractional excretion of sodium is greater than 1% due to an inability to dilute urine. If you have this problem and you’re not getting enough fluid to the kidneys in the first place, this suggests Pre-renal injury with the fractional excretion of sodium of lesson 1%

Question 20

What does it tell you if you have hemoglobin and urine dipstick but no red blood cells on microscopy?

Answer 20

Myoglobinuria

Question 21

What is the imaging test of choice for urologic imaging in the setting of a KI?

Answer 21

Reno ultrasound approximately 90% sensitivity and specificity for Hydro nephrosis due to mechanical obstruction

Question 22

At what kidney size do you suspect chronic kidney disease?

Answer 22

Less than 9 cm suggest chronic kidney disease.

Question 23

What ultrasound finding other than size and the kids to fuse parenchymal disease in the kidney?

Answer 23

Hyperechogenicity

Question 24

Preferred fluid for kidney injury?

Answer 24

There has been a small advantage shown for LR, have her look out for hyperkalemia

Question 25

What do you far level should you avoid IV contrast studies?

Answer 25

Yeah definitely try to avoid when GFR isless than 30

Question 26

How do you prepare patients for contrast studies if they have abnormal kidney function?

Answer 26

Pre-hydrate them with 500 to 1000 mL of LR a normal Celine

Question 27

How long does it take for complete obstruction to cause permanent loss of renal function?

Answer 27

About 10 to 14 days in the setting of complete. Also worse if UTI present

Question 28

What is a furosemide stress test?

Answer 28

It can be used in the setting of mild AKA to determine diuretic responsiveness as well as to predict worsening renal function. Administer 1 mg per kilogram of Lasix and patient I haven’t had it before or 1.5 mg per kilogram’s in those with prior exposure. Are you an apple of less than 200 mL over to ours has a sensitivity to 87% and specificity of 84% to predict progression to stage 3AKI

Question 29

Can I roast be used in the setting of a KI?

Answer 29

Although they don’t have the a.k.a. itself, worm fluid overload his present you can use it in the setting of mild to moderate AKI

Question 30

Alternative Lasixfor fluid overload patients With acute kidney injury?

Answer 30

Dialysis

Question 31

At what pH level would you consider dialysis in the setting of and urea or fluid overload?

Answer 31

PH of less than or equal to 7.1

Question 32

When should you use dialysis?

Answer 32

Acidosis of less than 7.1, electrolyte disorders intoxicants, fluid overload, uremia

Question 33

What is an important consideration for diabetics with IV contrast?

Answer 33

They are taking met Forman, there is an increased risk for Met Forman associated lactic acidosis especially in patients with a GFR between 30 and 60.

Question 34

How to manage patients with renal disease taking met Forman that require IV contrast

Answer 34

For patients with a GFR of less than 30, Met Forman should be withheld at the time of contrast in fusion and 448 hrs. after the procedure renal function to be reassessed 48 hours

Question 35

What is the most common cause of rhabdomyolysis

Answer 35

Alcohol and drugs of abuse. Also medications and muscle disease is trauma and MS seizures and mobility, infection, strenuous physical activity and heat related illness

Question 36

Why is alcohol a risk factor for rhabdo my lysis

Answer 36

In addition to, induced muscle and immobility, it has a direct toxic affect to the muscle.

Question 37

Which cars of rhabdo is least likely to cause acute kidney injury?

Answer 37

Strenuous activity and athletes military recruits for marathon runners

Question 38

Name the major clinical features of rhabdo my lysis?

Answer 38

Muscle pain, weakness, malaise, fever, dark brown urine. And severe rhabdo, nausea, vomiting, abdominal pain, tachycardia

Question 39

At what level of Serum creatinine kinase can you really diagnose rhabdo my lysis?

Answer 39

At about five times or greater increase above the upper threshold so around 5000

Question 40

Describe the timeline of onset and resolution of elevation and creatine kinase for rhabdo

Answer 40

The level begins to rise approximately 2 to 12 hours after injury, peace within 24 to 72 and then the clients relatively constant of 39% of the previous days value

Question 41

What is the sensitivity and specificity of myoglobinuria and diagnosing rhabdo my lysis?

Answer 41

Quite low because the levels of myoglobin return to baseline quickly so it does not rule in or out the diagnosis

Question 42

Laughs order to evaluate for rhabdo?

Answer 42

UA, electrolytes to value it for hypercalcemia, hyper kalemia hyper you’re a senior, hyperphosphatemia. Obtain EKG. CM creatinine and BUN levels. Obtain a baseline CBC and PT, PTT, February GEN level, federal split products to evaluate for DIC

Question 43

Treatment of rhabdo For crush injury in the prehospital setting?

Answer 43

Early and vigorous IV fluid resuscitation to prevent kidney injury. Once a limb is extricated, IV normal Celine should be initiated at 1 L per hour.

Question 44

What should be the initial fluid of choice in rhabdo resuscitation

Answer 44

Use normal sailing to make sure you’re not exacerbating hyperkalemia by using lactated ringer’s

Question 45

Emergency treatment of rhabdo?

Answer 45

IV rehydration for the next 24 to 72 hours. Rapid infusion of 4 mL per kilogram per hour with the goal of maintaining your an output of 3 to 4 mL per kilogram per hour. Or 200 to 300 mL of urine per hour

Question 46

What things have been found in effective for rhabdo?

Answer 46

Mannitol infusion, loop diuretics, bicarb, differing fluid choices

Question 47

Disease complications of rhabdo?

Answer 47

Acute kidney injury, Acid-based arrangements, electrolyte disturbances, DIC, mechanical complication such as compartment syndrome.

Question 48

What is the McMahon score

Answer 48

It’s a score used to determine the need for aggressive resuscitation or dialysis when faced with a patient who is at risk for complications of resuscitation such as a patient with heart failure.
A.k.a. who is at risk for dying or permanent real injury from rhabdo

Question 49

Dispo for patients with rhabdo?

Answer 49

The majority of healthy patients that present with exertional rhabdo and without court comorbidities can we do the PO and IV hydration, observed in ED and then released. Anyone else should be admitted for IV hydration