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Nephrology Fellowship Reviewer > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

contrast media assoc with lower incidence of aki

A

Low osmolar, isosmolar

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2
Q

acute decline in gfr in cin occurs in ___ and peak crea concentration in ____

A

24 to 48 hours

3 to 5 days

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3
Q

most nephrotoxic amino glycosides

A

neomycin

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4
Q

kidney hypoperfusion resulting from reductions in actual or effective arterial blood volume

A

prerenal AKI

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5
Q

autoregulation works only to a mean sytemic MAP of

A

75 to 80 mmHg

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6
Q

idiosyncratic allergic response to different pharmacologic agents

A

Acute interstitial nephritis

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7
Q

hallmark of AIN

A

inflammatory infiltrates within the interstititium

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8
Q

2nd most common cause of intrinsic AKI

A

nephrotoxic ATN

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9
Q

pathophysiology of CIN
(3)

A

hypoxic and renal tubular damage +
endothelial dysfunction +
altered microcirculation

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10
Q

to limit cast formation and preventive measure in tubular disease with endogenous nephrotoxins
(2)

A

volume expansion, alkalinization of urine

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11
Q

what will accelerate and aggravate light chain cast nephropathy

A

reduction in GFR

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12
Q

most common cause for post renal azotemia

A

structural or functional obstruction of the bladder neck

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13
Q

major and most commonly injured epithelial cell involved in AKI related to ischemia, sepsis and or nephrotoxins

A

proximal tubular cell

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14
Q

most susceptible to ischemic injury

A

S3 proximal tubule in the outer stripe of the medulla

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15
Q

primarily responsible for the extension phase of AKI

A

endothelial cell injury and dysfunction

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16
Q

passive non-energy dependent process that develops secondary to severe ATP depletion from toxic or ischemic insult

A

epithelial cell necrosis

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17
Q

form of regulated nonapoptotic cell death in ischemic/cisplatin induced AKI

A

necroptosis

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18
Q

Folic acid induced AKI

A

ferroptosis

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19
Q

highly inflammatory form of regulated cell death

A

pyroptosis

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20
Q

facilitate the restoration of normal function by assisting in the refolding of denatured proteins/appropriate folding of newly synthesized proteins

A

heat shock proteins

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21
Q

significant reduction in blood vessel density after ischemic injury

A

vascular dropout

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22
Q

One of the major risk factors for the development of dialysis requiring AKI

A

Preexisting kidney disease

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23
Q

iodinated contrast agents

What type of aki

A

prerenal acute kidney injury

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24
Q

history of atrial fibrillation or recent MI, nausea, vomiting, flank or abdominal pain; mild proteinuria occasional rbcs; elevated LDH, normal transaminase levels

A

renal artery thrombosis

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25
Q

recent manipulation of aorta, retinal plaques, subcutaneous nodules, purpura, livedo reticularis; eosinophiluria; eosinophilia, hypocomplementemia

A

atheroembolism

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26
Q

nephrotic syndrome; pulmonary embolism; flank pain; proteinuria, hematuria

A

Renal vein thrombosis

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27
Q

typical urinalysis findings in HUS/TTP (3)

A

RBCs, mild proteinuria, rarely RBC or granular casts

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28
Q

urine findings in rhabdomyolysis, hyperK, hyperphos, hypocalcemia, increased CK, myoglobin

A

positive for heme in absence of RBCs

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29
Q

urine findings in hemolysis, hyperK, hyperphos, hypocal, hyperuricemia and free circulating hgb

A

pink and positive for heme in absence of RBCs

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30
Q

urine findings in
tumor lysis,
myeloma,
ethylene glycol
(3)

A

urate crystals,
dipstick proteinuria,
oxalate crystals

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31
Q

Intoxication from what would cause
calcium oxalate crystals

A

ethylene glycol intoxication

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32
Q

lafbp is detected in the urine within how many hours to ischemic or nephrotoxic injury

A

6 hours

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33
Q

mL of post void residual volume indicative of bladder outlet obstruction

A

100-150 ml

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34
Q

Cairo Bishop definition of tumor lysis syndrome
(4)

A

2 of the following achieved in the same 24h interval from 3 days before to 7 days after chemo:
uric acid > 8,
K >6,
phos > 4.6,
calcium < 7 mg/dL

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35
Q

Diagnostic criteria for HRS (5)

A
  1. cirrhosis with ascites
  2. AKI
  3. no improvement of AKI after 2 days of diuretic withdrawal and volume expansion
  4. absence of shock
  5. absence of parenchymal kidney disease
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36
Q

definitive therapy for abdominal compartment syndrome

A

surgical laparotomy

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37
Q

at risk hospitalized patients for contrast associated AKI rate of isotonic sodium chloride

A

1 ml/kg per hr for 6-12 hours prior and after procedure

38
Q

at risk outpatients for contrast associated AKI, rate of isotonic sodium chloride

A

3 ml/kg 1 hour prior to procedure then 6 ml/kg per hr over 2-6 hours after procedure

39
Q

used to limit uric acid generation with acute urate nephropathy

A

allopurinol 100 mg/m2 every 8 hours (max 800 mg/day)

40
Q

effective prophylaxis and treatment for acute uric acid mediated tumor lysis syndrome

A

rasburicase

41
Q

corticosteroids in AIN if considered dose

A

Methlypred 250-500 mg/day for 3-4 days then oral pred 1 mkd over 8-12 weeks

42
Q

if the duration of AKI is short, not extremely catabolic and does not require RRT; dietary protein requirement is

A

0.8-1 g/kg bw/day

43
Q

If duration of AKI is prolonged, with hypercatabolism or on RRT, dietary protein intake

A

1-1.5 kg/bw/day

44
Q

total caloric intake with prolonged AKI

A

20-30 kcal/kg/by/day

45
Q

transfusion threshold

A

7 g/dL

46
Q

Kt/V recommended for RRT in AKI

A

3.9/week

47
Q

effluent volume during CRRT

A

20-25 ml/kg/hr

48
Q

FeNa in Radio Contrast Induced Nephrotoxicity

A

<1%

49
Q

AKI resolves within

A

1-2 weeks

50
Q

biomarker of AKI associated with reducing apoptosis and enhancing normal proliferation of renal tubular cells

A

NGAL

51
Q

Diagnosis of Clinical Tumor lysis syndrome

A

laboratory + at least one of the ff: 1. Crea more than 1.5x, cardiac arrhythmia/sudden death, seizure

52
Q

acute worsening of heart function leads to AKI
Crs type?

A

Acute CRS Type 1

53
Q

chronic abnormalities in heart function result in kidney dysfunction

A

Chronic CRS Type 2

54
Q

AKI precedes cardiac dysfunction
Crs type?

A

Acute renocardiac (Type 3)

55
Q

CKD leads to cardiac dysfunction

A

Chronic renocardiac (Type 4)

56
Q

Systemic conditions result in simultaneous cardiac and renal dysfunction

A

secondary CRS (Type 5)

57
Q

rapid progressive AKI with doubling of the serum crea to > 2.5 in < 2 weeks

A

Type 1 HRS

58
Q

Moderate renal dysfunction (Crea 1.5-2.5) with steady or slowly progressive course

A

Type 2 HRS

59
Q

initial management of volume resuscitation

A

isotonic saline 0.9%

60
Q

amount of albumin per Liter of ascites drained when paracentesis volume exceeds 5L

A

6 to 8 g albumin

61
Q

vasoconstrictive agent combined with volume expansion that may improve kidney function in hrs

A

terlipressin

62
Q

Early Goal Directed therapy for sepsis(4)

A

MAP > 65,
CVP 10-12,
UO > 0.5 ml/kg/hr,
CVO2 > 70%

63
Q

Relative indications for RRT in AKI

A

progressive azotemia without uremic manifestations, persisitent oliguria

64
Q

cardinal manifestation of AKI

A

decreased urine output

65
Q

nonoliguric uo

A

uo > 400 ml/day

66
Q

oliguric uo

A

UO < 400 ml/day

67
Q

anuric

A

uo < 100 ml/day

68
Q

AKI RIFLE

A

increase of > 50% developing over 7 days

69
Q

AKI AKIN (2)

A

Increase of > 0.3 mg/dL or
> 50% developing over < 48 hours

70
Q

KDIGO AKI (2)

A

Increase of > 0.3 mg/dL over <48 hours or
an inc of > 50% developing over < 7 days

71
Q

urine output in AKI definition

A

< 0.5 ml/kg/hr for > 6 hours

72
Q

More than 50% (> 0.3 mg/dL) increase in crea stage

A

Risk, Stage 1

73
Q

More than 100% increase in crea stage
Rifle, Akin

A

Injury, Stage 2

74
Q

More than 200% increase in crea stage

A

Failure Stage 3

75
Q

need for RRT for >4 weeks stage of AKI

A

Loss

76
Q

need for RRT for > 3 months stage of AKI

A

End Stage

77
Q

UO in Risk or Stage 1 AKI

A

< 0.5 ml/kg/h for > 6 h

78
Q

UO in Injury or Stage 2 AKI

A

< 0.5 ml/kg/h for > 12 h

79
Q

UO in Failure or Stage 3 AKI

A

< 0.3 ml/kg/h for ? 24h or anuria for >12 h

80
Q

most common cause of AKI

A

prerenal

81
Q

hallmark feature in ATN

A

loss of the apical brush border of PTC

82
Q

FeNa in ATN

A

> 2

83
Q

UNa in Prerenal vs ATN

A

<20 vs >40

84
Q

Urine-Plasma Crea ratio Prerenal vs ATN

A

> 40 vs < 20

85
Q

UOsm prerenal vs ATN

A

> 500 vs 300

86
Q

Plasma BCr (pre renal vs renal)

A

> 20 vs <10-15

87
Q

organic thiophosphate to ameliorate cisplatin toxicity

A

Amifostine

88
Q

limits acetaminophen induced renal injury if given within 24H of ingestion

A

NAC

89
Q

Chelating agent that may prevent heavy metal nephrotoxicity

A

Dimercaprol

90
Q

inhibits ethylene glycol metabolism to oxalic acid

A

Ethanol

91
Q

inhibitor of alcohol dehydrogenase that decreases production of ethylene glycol metabolites

A

Fomepizole

Nephrology Fellowship Reviewer (29 decks)

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