Acute Kidney Injury

Question 1

what are the criteria for injury to the kidney in the rifle criteria?

Answer 1

creatinine 2xbaseline
GFR decrease >50%

Question 2

how can you diagnose acute kidney injury?

Answer 2

azotemia
isosthenuria or inappropriate concentrating ability
hyperkalemia
hyper/hypocalcemia
hyperphosphatemia
acidosis

Question 3

what are the causes of pre renal or fluid responsive AKI?

Answer 3

hypovolemia
hypotension
prolonged hypotension
cardiac disease
renal artery or vein obstruction

Question 4

what is a post renal AKI?

Answer 4

blockage of urine flow or abdominal leakage

Question 5

what are the general AKI etiologies?

Answer 5

infectious agents
ischemia
nephrotoxin
systemic disease

Question 6

what drugs cause toxic nephropathies?

Answer 6

aminoglycosides
non steroidal anti-inflammatories

Question 7

how do aminoglycosides cause nephrotoxicity?

Answer 7

necrosis of renal tubular epithelial cells

Question 8

what is the principle toxicity of non steroidal anti-inflammatory drugs?

Answer 8

nonoliguric ischemic nephrosis

Question 9

how do non steroidal anti-inflammatories decrease renal perfusion?

Answer 9

inhibition of prostaglandin I2 and E2 synthesis

Question 10

when does AKI occur after non steroidal anti-inflammatory exposure?

Answer 10

3-5 days after exposure

Question 11

in whom is lily toxicity observed?

Answer 11

cats

Question 12

what does lily toxicity cause?

Answer 12

renal tubular necrosis

Question 13

when will death occur if lily toxicity is not treated?

Answer 13

3-7 days

Question 14

if treatment is delayed for longer than ____________ from lily ingestion, acute kidney injury will develop

Answer 14

18 hours

Question 15

what is the toxic component of grape and raisin toxicity?

Answer 15

tartaric acid

Question 16

what does toxicity from ethylene glycol develop from?

Answer 16

actions of metabolites on tubular epithelium and deposition of calcium oxalate crystals in tubular lumens and interstitium

Question 17

what signs are seen in 12-24 hours after ethylene glycol ingestion?

Answer 17

severe metabolic acidosis: tachypnea, tachycardia, maybe pulmonary edema and congestion

Question 18

how can you diagnose ethylene glycol toxicity?

Answer 18

severe metabolic acidosis, high anion gap
serum hyperosmolality
hypocalcemia
azotemia
calcium oxalate monohydrate crystalluria

Question 19

when is dialysis indicated for ethylene glycol toxicity?

Answer 19

if metabolites already formed

Question 20

what is pyelonephritis usually secondary to?

Answer 20

ascending lower urinary tract infections

Question 21

what is the most common organism of pyelonephritis?

Answer 21

E. coli

Question 22

what can you monitor for an AKI for volume overload?

Answer 22

chemosis, serous nasal discharge, peripheral edema
pulmonary edema

Question 23

what fluids should you give if a patient is anuric?

Answer 23

replace insensible losses only

Question 24

how is acute kidney injury diagnosed?

Answer 24

abrupt change in serum creatinine and/or urine output
creatinine increase >0.3 mg/dl or >50% from baseline

Question 25

what are the causes of pre-renal AKI?

Answer 25

hypovolemia hypotension prolonged hypotension cardiac disease renal artery or vein obstruction

Question 26

what are the causes of post-renal AKI?

Answer 26

blockage of urine outflow abdominal leakage

Question 27

what are some causes of toxic nephropathies?

Answer 27

drugs plants ethylene glycol food contaminants vitamin D

Question 28

how long should you give aminoglycosides for to prevent aminoglycoside nephrotoxicity?

Answer 28

<5-7 days give once daily

Question 29

are NSAID kidney lesions usually reversible?

Answer 29

yes: ischemic nature

Question 30

what dose of ibuprofen causes an AKI in dogs?

Answer 30

200-300 mg/kg

Question 31

what host factors contribute to lily toxicity?

Answer 31

gastrointestinal absorption preexisting kidney disease

Question 32

how can you diagnose lily toxicity?

Answer 32

severe azotemia normocalcemia urinalysis changes

Question 33

what is the estimated toxic dose of grapes?

Answer 33

32 g/kg 11-30 g/kg raisins

Question 34

what are the most common clinical signs of grape and raisin toxicity?

Answer 34

vomiting diarrhea excessive thirst excessive urination lethargy dehydration

Question 35

when do AKI signs show with ethylene glycol toxicity?

Answer 35

24-72 hours

Question 36

how can you treat ethylene glycol toxicity?

Answer 36

ethanol 4-MP (fomepizole) dialysis

Question 37

what does vitamin D cause?

Answer 37

hypercalcemia acute tubular damage

Question 38

what is a significant risk factor for AKI?

Answer 38

volume depletion

Question 39

between what blood pressures can kidneys autoregulate blood flow?

Answer 39

80-160 mmHg

Question 40

how quickly should you restore kidney perfusion in an AKI?

Answer 40

2-4 hours 12-24 hours if heart disease

Question 41

what can you give to convert oliguria to nonoliguria?

Answer 41

loop diuretics bolus CRI of furosemide mannitol if hydrated fenoldopam

Question 42

are initial BUN and creatinine values in an AKI prognostic?

Answer 42

no