Acute Kidney Disease Flashcards by Luke Hayek

what is the length threshold between chronic and acute kidney disease?

3 months

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will CKD present with large small or regular sized kidneys?

small kidneys

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name the three classes of AKD?

pre post and intra renal

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what is the least common type of AKD?

post renal

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name the two mechanisms to get pre renal AKD?

decreased blood volume

adjusted blood flow or hemodynamics

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name three ECF volume losses that can cause pre renal AKD

diuretics
GI loss
hemorrhage

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what is a drug that commonly leads to pre renal AKD?

NSAIDS…constricts afferent arteriole

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what type of AKD do sepsis and heart failure cause?

pre renal AKD

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what are the three main classes of intra renal AKD?

acute interstitial nephritis
tubular block
acute tubular necrosis

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what are two common causes of acute tubular necrosis

ischemia

nephrotoxic drugs

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what are three common causes of acute interstitial nephritis?

medications…hypersensitivity
autoimmune
infections

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acute tubular necrosis caused by nephrotoxic drugs includes three common drug types…name them

aminoglycosides
iodinated radiocontrast
heme pigments

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name three common post renal AKD causes

stones
prostate enlargement
uterine canal enlargement

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if a patient has signs of low ECF volume…what type of AKD is most likely?

pre renal

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what do we use to rule out post renal AKD?

foley catheter insertion and ultrasound

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in acute tubular necrosis or ATN…what can be seen in urine?

granular muddy brown casts from sloughing off of cells

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specific gravity in pre renal is above what number?

1.020

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specific gravity in intra renal is equal to what?

1.010

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is urine osmolality higher or lower than 500 in pre renal?

higher

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is urine osmolality higher or lower than 500 in intra renal?

lower

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is urine sodium higher or lower than 20 in pre renal?

lower

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is urine sodium higher or lower than 20 in ATN?

higher than 30

what is the FENa cutoff for pre renal?

always less than 1%

what is the FENa cutoff for ATN?

above 2%

what is the FEurea cutoff for pre renal

less than 35%

what is the FEurea cutoff for ATN

greater than 50%

in prenal what is the BUN:creatinine ratio?

greater than 15

in intra renal what is the BUN:creatinine ratio?

less than 15

what are the two most common sites of ischemic intra renal ATN?

PCT and ascending thick limb of the loop

name three common causes of nephrotoxic ATN?

ethylene glycol aminoglycosides radiocontrast dye

acute interstitial nephritis is associated with three drug classes...name them

NSAIDS penicillin diuretics

with acute interstitial nephritis...what can you have in the urine that is a sign?

eosinophils

eosinophils are a sign of what AKD if in urine?

acute interstitial nephritis

what is renal papillary necrosis?

necrosis and sloughing off of the papillae from blood flow impairment

name three things that are associated withe renal papillary necrosis

sickle cell disease NSAIDs use diabetes mellitus

with renal papillary necrosis...what does the urine look like?

cloudy

patient has flank pain...high NSAID use...blood in urine....protein in urine...and urine is cloudy....what do they have?

renal papillary necrosis

name three histologic changes seen in ischemic tubular necrosis

dilated tubules proteinaceous fluid filling the tubules brush border lost

name the histologic changes seen in nephrotoxic tubular necrosis

epithelial sloughed off and killed | dead cells filling the tubules

are nephrotoxic tubular necrosis and ischemic tubular necrosis reversible or irreversible?

reversible

what can light chains cause if they accumulate?

they can accumulate in the tubules of the kidney and cause light chain cast nephropathy

what is the histologic finding in pyelonephritis?

lots of neutrophils in the interstitium of the cortex...including the glomerulus

is pyelonephritis reversible or irreversible? what does it leave behind?

it is irreversible and leaves scar tissue

what are the histologic changes seen in acute hypersensitivity tubulointerstitial nephritis?

eosinophils accumulation | WBC infiltration

is acute hypersensitivity tubulointerstitial nephritis reversible or irreversible?

reversible

what can cholesterol emboli lead to if prolonged?

ischemic tubular necrosis and inflammation

what is thrombotic microangiopathy?

small blood vessel disease that causes thrombosis and microangiopathis hemolytic anemia

what is a common cell seen in thrombotic microangiopathy?

schistocytes

what is the most common infectious agent related to thrombotic microangiopathy?

e coli

what is HUS? when is HUS most common?

hemolytic uremic syndrome...most common cause of ARF in children

what is the triad of HUS?

hemolytic anemia thormbocytopnenia uremia

what happens to blood vessels in HUS?

they get blocked off due to infection of endothelial cell leading to intimal proliferation

if you have TMA (thrombotic microangiopathy) or HUS (hemolytic uremic syndrome) what can that lead to?

ischemic tubular necrosis