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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
what does it mean when the BUN/Cr ratio is < 10:1? what condition can it indicate?
products are being excreted more than usual intra-renal
26
what kind of relationship does GFR have with BUN and serum creatinine?
inverse
27
what is not affected by muscle mass, is detected earlier, responds faster than creatinine, and is filtered by the kidneys?
cystatin C
28
what are 3 CIs to measuring a cystatin C d/t yielding inaccurate results?
inflammation thyroid meds steroids
29
what are 5 absolute contraindications to a renal biopsy?
uncorrected bleeding disorder severe uncontrolled HTN renal infection neoplasm hydronephrosis
30
what are 4 relative contraindications to a renal biopsy?
solitary kidney horseshoe kidney end stage kidney disease polycystic kidney disease
31
how much urine do the kidneys produce per hour?
30 ml/hr
32
rapid decline in renal function, oliguria/anuria, and the inability to eliminate uremic toxins, balance acid base, or maintain fluid levels
acute kidney injury
33
elevated BUN; holding onto urea
azotemia
34
what causes uremia symptoms?
build up of waste products in the blood
35
what is the most common acute kidney injury?
prerenal AKI
36
what is the patho for prerenal AKI?
decreased blood flow to kidneys = decreased GFR = increased BUN/Cr
37
why does volume depletion in prerenal AKI lead to?
activation of renin angiotensin system
38
a patient presents with hypotension, tachycardia, reduce skin turgor, thirst, and cool extremities. Dx?
hypovolemia d/t prerenal AKI
39
a patient presents with fever, hypotension, tachycardia, fatigue, dyspnea, peripheral edema, splenomegaly, ascites, caput medusa. Dx?
hypervolemia d/t prerenal AKI
40
what will be seen in UA / urine microscopy of a prerenal AKI?
bland +/- hyaline casts
41
what is the first line imaging for prerenal AKI? 2nd line?
ultrasound biopsy
42
what is the treatment for hypovolemia d/t prerenal AKI?
IV crystalloids (NS or LR) monitor ins and outs correct electrolyte disorders correct acid-base
43
what is the treatment for hypervolemia d/t prerenal AKI? (4)
lasix (cardio) albumin (liver) antibiotics (sepsis) monitor electrolytes
44
what is a possible treatment for prerenal AKI?
renal replacement therapy (consult nephrology)
45
damage to the tubules, interstitium, vasculature, or glomerulus
intrarenal AKI
46
what are the 2 causes of intrarenal AKI?
acute tubular necrosis acute interstitial nephritis
47
what is the patho for acute tubular necrosis (ATN)?
damage to tubule cells = ischemia = backing up filtrate into glomerulus drops GFR + increases BUN/Cr + increase in creatinine
48
a patient presents with uremia, decreased urine output, edema, hypo/hypertension, SOB, dyspnea on exertion, arrhythmias, anorexia, n/v, metallic taste, and bleeding. Dx?
acute tubular necrosis
49
what is the first line imaging for acute tubular necrosis?
ultrasound
50
what labs will indicate acute tubular necrosis?
hyperkalemia hypermagnesemia hyperphosphatemia hyperuricemia hypocalcemia
51
what is the treatment for acute tubular necrosis? (4)
treat cause optimize volume status w/ fluids electrolytes acid-base
52
what is the 2nd line treatment for acute tubular necrosis?
renal replacement therapy
53
what is the initial phase of ATN?
first week of injury
54
what is the maintenance phase of ATN? (3)
1-3 weeks of early treatment renal removal of debris tubular cells heal
55
what is the recovery phase of ATN?
diuresis > 3L/day increased GFR decreased BUN + SCr
56
what is the most common etiology of acute interstitial nephritis?
drug-induced
57
what is the patho for acute interstitial nephritis?
inflammation of renal tissue and tubules = activates type I/IV hypersensitivity reaction
58
what are the 2 pathologic findings in acute interstitial nephritis?
renal edema tubular cell damage
59
a patient presents with fever, rash, arthralgia, with eosinophilia. Dx?
acute interstitial nephritis
60
what is the diagnostic for AIN?
biopsy
61
what is the treatment for AIN that is proven by biopsy?
corticosteroids
62
what is the 2nd line treatment for AIN that is proven by biopsy, if does not respond to corticosteroids?
mycophenolate mofetil
63
what is the patho for postrenal AKI?
obstruction to outflow of urine = urine reflux into kidneys = increased pressure in tubules
64
what happens initially in postrenal AKI? what does it mimic?
intact tubules have increased reabsorption of sodium and water prerenal
65
what happens over time in postrenal AKI? what does it mimic?
high pressure damages tubules = less reabsorption intrarenal AKI
66
a patient presents with flank pain, hematuria, dysuria, and frequency. what could they be experiencing? (3)
postrenal AKI ureteral stones clots cancer
67
a patient presents with anuria, suprapubic pain/mass, and enlarged prostate. what could they be experiencing? (2)
bladder neck obstruction d/t BPH or cancer urethral obstruction
68
a patient presents with urinary incontinence or retention. what could be causing this? (2)
neurogenic bladder meds
69
what is the diagnostic for postrenal AKI?
bedside ultrasound
70
what is the treatment for postrenal AKI? (3) what can be done in the case of BPH? (3)
relieve obstruction reduce meds +/- stone removal in&out catheter / meds / surgery
71
when should a postrenal AKI patient be referred to nephrology?
if declining or not reversed in 1-2 weeks

Renal-Genitourinary (7 decks)

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