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Renal-Genitourinary > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

how many nephrons does one kidney have?

A

1 million

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2
Q

the functional filtering unit of the kidney that also works in reabsorption and secretion

A

nephrons

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3
Q

what are the 2 types of nephrons?

A

cortical nephrons
juxta-medullary nephrons

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4
Q

each nephron has a renal _____ and a renal _____

A

corpuscle
tubule

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5
Q

what is the renal corpuscle comprised of? (2)

A

bowman’s capsule
glomerular capillaries

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6
Q

what supplies the renal tubules with blood?

A

peritubular capillaries

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7
Q

the kidney is the only organ that has:

A

2 sets of arterioles + 2 sets of capillaries

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8
Q

what is the 3-layer filtration barrier present in the glomerulus?

A

endothelial cells
basement membrane
podocytes

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9
Q

if a spot/random urine is abnormal, what should we get? (2)

A

albumin/creatinine ratio (ACR)
protein/creatinine ratio (PCR)

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10
Q

benign proteinuria that occurs with a fever or exercise

A

functional

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11
Q

proteinuria during the day but not with the morning urine

A

orthostatic

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12
Q

what is the assessment of kidney function if urine sodium concentration is over 20?

A

intrarenal

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13
Q

what is the assessment of kidney function if urine sodium concentration is 20?

A

prerenal or postrenal

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14
Q

why will high sodium cause low osmolality?

A

water follows sodium = low concertation (dilute)

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15
Q

in what 4 situations are hyaline casts present?

A

concentrated urine
fever
exercise
diuretics

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16
Q

which condition is associated with RBC casts and dysmorphic RBCs?

A

glomerulonephritis (GN)

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17
Q

which conditions are associated with WBC and WBC casts? (2)

A

pyelonephritis
interstitial nephritis (AIN)

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18
Q

which condition is associated with pigmented/muddy brown casts?

A

acute tubular necrosis (ATN)

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19
Q

which condition is associated with granular casts?

A

acute tubular necrosis (ATN)

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20
Q

which condition is associated with broad, waxy casts?

A

chronic kidney disease

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21
Q

where does BUN come from? should BUN or creatinine be higher?

A

protein breakdown
BUN

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22
Q

where does creatinine come from?

A

muscle break down

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23
Q

what does the BUN/Cr ratio of 20:1 mean?

A

for every 20 units of BUN that is lost, only 1 unit of creatinine is lost

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24
Q

what does it mean when the BUN/Cr ratio is > 20:1? what 2 conditions can it indicate?

A

products are not being filtered

prerenal
dehydration

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25
Q

what does it mean when the BUN/Cr ratio is < 10:1? what condition can it indicate?

A

products are being excreted more than usual

intra-renal

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26
Q

what kind of relationship does GFR have with BUN and serum creatinine?

A

inverse

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27
Q

what is not affected by muscle mass, is detected earlier, responds faster than creatinine, and is filtered by the kidneys?

A

cystatin C

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28
Q

what are 3 CIs to measuring a cystatin C d/t yielding inaccurate results?

A

inflammation
thyroid meds
steroids

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29
Q

what are 5 absolute contraindications to a renal biopsy?

A

uncorrected bleeding disorder
severe uncontrolled HTN
renal infection
neoplasm
hydronephrosis

30
Q

what are 4 relative contraindications to a renal biopsy?

A

solitary kidney
horseshoe kidney
end stage kidney disease
polycystic kidney disease

31
Q

how much urine do the kidneys produce per hour?

A

30 ml/hr

32
Q

rapid decline in renal function, oliguria/anuria, and the inability to eliminate uremic toxins, balance acid base, or maintain fluid levels

A

acute kidney injury

33
Q

elevated BUN; holding onto urea

A

azotemia

34
Q

what causes uremia symptoms?

A

build up of waste products in the blood

35
Q

what is the most common acute kidney injury?

A

prerenal AKI

36
Q

what is the patho for prerenal AKI?

A

decreased blood flow to kidneys = decreased GFR = increased BUN/Cr

37
Q

why does volume depletion in prerenal AKI lead to?

A

activation of renin angiotensin system

38
Q

a patient presents with hypotension, tachycardia, reduce skin turgor, thirst, and cool extremities. Dx?

A

hypovolemia d/t prerenal AKI

39
Q

a patient presents with fever, hypotension, tachycardia, fatigue, dyspnea, peripheral edema, splenomegaly, ascites, caput medusa. Dx?

A

hypervolemia d/t prerenal AKI

40
Q

what will be seen in UA / urine microscopy of a prerenal AKI?

A

bland +/- hyaline casts

41
Q

what is the first line imaging for prerenal AKI? 2nd line?

A

ultrasound
biopsy

42
Q

what is the treatment for hypovolemia d/t prerenal AKI?

A

IV crystalloids (NS or LR)
monitor ins and outs

correct electrolyte disorders
correct acid-base

43
Q

what is the treatment for hypervolemia d/t prerenal AKI? (4)

A

lasix (cardio)
albumin (liver)
antibiotics (sepsis)
monitor electrolytes

44
Q

what is a possible treatment for prerenal AKI?

A

renal replacement therapy (consult nephrology)

45
Q

damage to the tubules, interstitium, vasculature, or glomerulus

A

intrarenal AKI

46
Q

what are the 2 causes of intrarenal AKI?

A

acute tubular necrosis
acute interstitial nephritis

47
Q

what is the patho for acute tubular necrosis (ATN)?

A

damage to tubule cells = ischemia = backing up filtrate into glomerulus drops GFR + increases BUN/Cr + increase in creatinine

48
Q

a patient presents with uremia, decreased urine output, edema, hypo/hypertension, SOB, dyspnea on exertion, arrhythmias, anorexia, n/v, metallic taste, and bleeding. Dx?

A

acute tubular necrosis

49
Q

what is the first line imaging for acute tubular necrosis?

A

ultrasound

50
Q

what labs will indicate acute tubular necrosis?

A

hyperkalemia
hypermagnesemia
hyperphosphatemia
hyperuricemia
hypocalcemia

51
Q

what is the treatment for acute tubular necrosis? (4)

A

treat cause
optimize volume status w/ fluids
electrolytes
acid-base

52
Q

what is the 2nd line treatment for acute tubular necrosis?

A

renal replacement therapy

53
Q

what is the initial phase of ATN?

A

first week of injury

54
Q

what is the maintenance phase of ATN? (3)

A

1-3 weeks of early treatment
renal removal of debris
tubular cells heal

55
Q

what is the recovery phase of ATN?

A

diuresis > 3L/day
increased GFR
decreased BUN + SCr

56
Q

what is the most common etiology of acute interstitial nephritis?

A

drug-induced

57
Q

what is the patho for acute interstitial nephritis?

A

inflammation of renal tissue and tubules = activates type I/IV hypersensitivity reaction

58
Q

what are the 2 pathologic findings in acute interstitial nephritis?

A

renal edema
tubular cell damage

59
Q

a patient presents with fever, rash, arthralgia, with eosinophilia. Dx?

A

acute interstitial nephritis

60
Q

what is the diagnostic for AIN?

A

biopsy

61
Q

what is the treatment for AIN that is proven by biopsy?

A

corticosteroids

62
Q

what is the 2nd line treatment for AIN that is proven by biopsy, if does not respond to corticosteroids?

A

mycophenolate mofetil

63
Q

what is the patho for postrenal AKI?

A

obstruction to outflow of urine = urine reflux into kidneys = increased pressure in tubules

64
Q

what happens initially in postrenal AKI? what does it mimic?

A

intact tubules have increased reabsorption of sodium and water

prerenal

65
Q

what happens over time in postrenal AKI? what does it mimic?

A

high pressure damages tubules = less reabsorption

intrarenal AKI

66
Q

a patient presents with flank pain, hematuria, dysuria, and frequency. what could they be experiencing? (3)

A

postrenal AKI

ureteral stones
clots
cancer

67
Q

a patient presents with anuria, suprapubic pain/mass, and enlarged prostate. what could they be experiencing? (2)

A

bladder neck obstruction d/t BPH or cancer
urethral obstruction

68
Q

a patient presents with urinary incontinence or retention. what could be causing this? (2)

A

neurogenic bladder
meds

69
Q

what is the diagnostic for postrenal AKI?

A

bedside ultrasound

70
Q

what is the treatment for postrenal AKI? (3) what can be done in the case of BPH? (3)

A

relieve obstruction
reduce meds
+/- stone removal

in&out catheter / meds / surgery

71
Q

when should a postrenal AKI patient be referred to nephrology?

A

if declining or not reversed in 1-2 weeks

Renal-Genitourinary (7 decks)

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