Acute Kidney Injury Flashcards
Acute kidney injury (AKI) is a clinical syndrome that _____ the course and _____ the outcome in a significant number of hospitalised patients.
complicates
worsens
Acute kidney injury (AKI)
Recent evidence, in both basic science and clinical research, is beginning to change our view for AKI from a _________ syndrome to a syndrome where the kidney plays an active role in the progress of ________
single organ failure
multi-organ dysfunction.
The concept of Acute Renal Failure (ARF) has undergone significant re-examination in recent years.
T/F
T
Acute Renal Failure (ARF)
Traditionally, emphasis was given to the most severe acute reduction in kidney function, as manifested by _________ and often by ______ or _____
severe azotaemia
oliguria or anuria.
Acute Renal Failure (ARF)
However, recent evidence suggests that even relatively mild injury or impairment of kidney function manifested by ____________ in _______ or _______ , is a predictor of serious clinical consequences
small changes in serum creatinine (sCr) and/or urine output (UO)
Acute _______ is the term that has recently replaced the term Acute ________.
Kidney Injury (AKI)
Renal failure (ARF)
Acute Kidney Injury (AKI)
AKI is defined as an abrupt (within _____ ) decrease in ______, which encompasses both _____ (___________) and _______ (__________).
hours
kidney function
injury; structural damage
impairment; loss of function
Acute Kidney Injury (AKI)
is a syndrome that often has a sole and distinct pathophysiology.
T/F
F
rarely
Acute Kidney Injury (AKI)
Furthermore the syndrome is quite (common or rare?) among patients without ______ and it is essential that health care professionals, particularly those without specialisation in renal disorders, detect it easily
Common
critical illness
Classification of AKI includes _______,______, and ______
pre-renal AKI, acute post-renal obstructive nephropathy and intrinsic acute kidney diseases.
Classification of AKI
Of these, only ‘________’ AKI represents true kidney disease, while _______ and ______ are the consequence of _________ diseases leading to the decreased glomerular filtration rate (GFR).
intrinsic
pre- renal and post-renal AKI
extra-renal
Classification of AKI
If these pre- and/or post-renal conditions persist, they will eventually evolve to ————- and hence __________ disease.
renal cellular damage
intrinsic renal
Epidemiology of AKI
In urban areas of developing countries, main causes of AKI are _______ acquired (renal ischaemia, sepsis and nephrotoxic drugs)
while in rural areas it is more commonly a consequence of _______ acquired disease (diarrhoea, dehydration, infectious diseases, animal venoms etc.).
hospital
community
Epidemiology of AKI
__________ of AKI especially in developing countries is also a major problem that relates with the true knowledge of its impact in many parts of the world
Under-reporting
Epidemiology of AKI
In developed countries the prevalence of AKI is _____easing.
In hospital in-patients it is estimated to occur up to ____% and is more common
in critically ill patients, in whom its prevalence is estimated to be up to ___%.
incr
15
60
Epidemiology of AKI
On the other hand, community AKI is usually (common or uncommon?) although a recent study estimated its incidence at _____% among all hospital admissions.
However even this incidence remains an underestimate of the true impact of community acquired AKI due to ______________________
Uncommon
4.3
non-referral of patients to hospitals.
Epidemiology of AKI
The majority of AKI cases in children are secondary to ________ mechanisms (e.g.___,_________ after surgery) and secondary to _____.
volume responsive
diarrhoea, renal hypoperfusion
Sepsis
Epidemiology of AKI
Multiple studies have shown that AKI in the elderly (usually defined as older than _____ years) is increasingly common and that there is an age- dependent relationship between AKI and older age.
This has been attributed in part to anatomic and physiologic changes in the ___ kidney and in part to various _______ as that may require procedures and/or medications that act as ________ and alter renal haemodynamics or are nephrotoxic.
65
ageing
comorbidities; kidney stressors
Classification of AKI
In 2002 a system for diagnosis and classification of acute impairment of kidney function was developed through a broad consensus of experts, resulting in the _______ criteria.
RIFLE
Classification of AKI: the RIFLE criteria.
With this system three severity grades are defined (___,_____, and ______) and two outcome classes (______ and _______ ).
Risk, Injury and Failure
Loss and End-Stage Renal Disease (ESRD)
Classification of AKI: the RIFLE criteria
The severity criteria of AKI are defined on the basis of the changes in _____ or ______ where the worst of each criterion is used.
The outcome criteria are defined by the _____________ of kidney function.
serum creartinie (sCr) or urine output (UO)
duration of impairment
Classification of AKI
The importance of RIFLE criteria is that they ____________________.
move beyond ARF
Classification of AKI
The term “acute kidney injury/impairment” has been proposed to encompass the “entire spectrum of the syndrome from ___________________ to _______________”.
minor changes in markers of renal function to requirement for renal replacement therapy (RRT)
Classification of AKI
AKI encompasses ______ and ____ as well as other, less severe conditions. It includes patients (with or without?) actual damage to the kidney but with _______ relative to _______
ATN and ARF
Without
functional impairment
physiologic demand.
the RIFLE definition is free of ambiguities.
T/F
F
the RIFLE definition is not free of ambiguities.
Classification of AKI; RIFLE
Pickering et al showed that there was a mismatch between ______ in ____, and _____ in _____ (estimated with MDRD or Cockroft-Gault formulae)
increases in sCr concentration
decreases in GFR
Classification of AKI
In 2007, the _________ (AKIN) group proposed a modified version of the RIFLE criteria, which aimed to improve the ______ of AKI diagnostic criteria.
Acute Kidney Injury Network
sensitivity
Classification of AKI: AKIN definition
There were several changes: an absolute increase in sCr of at least 0.3 mg/dL (26.5 μmol/L) was added to stage 1; the _____ criterion was removed; patients starting _______ were classified as stage 3, irrespectively of ____ values; and _______ were removed.
GFR
RRT
sCr
outcome classes
Classification of AKI: the AKIN definition
Only _____ criterion (___________) has to be fulfilled in order to qualify for a stage.
one
sCr or UO
Classification of AKI: the AKIN definition
____ becomes more important for AKI diagnosis in the AKIN definition: changes between two sCr values within a ______ period are required, while _____ was proposed in the original RIFLE criteria.
Time
48-hour
one week
Classification of AKI: the AKIN definition
Severity of AKI in AKIN is staged over the course of ______ by the fold-change in sCr from baseline.
7 days
