acute kidney injury 3

Question 1

what is caused by direct damage to the kidney?

Answer 1

intrinsic renal failure

Question 2

what are the 4 categories of intrinsic renal failure

hint: based on primary site of damage

Answer 2

1. tubules
2. vessels
3. interstitium
4. glomerulus

Question 3

what is the most common catergory of intrinsic renal failure?

Answer 3

acute tubular necrosis (ATN)

Question 4

what are two major causes of acute tubular necrosis?

Answer 4

ischemia and toxins

Question 5

what is the etiology of ATF?

Answer 5

1. tubular cells die
2. slough into the tubular lumen forming casts
3. tubular pressure increases

Question 6

what are the 3 most common IRF categories in order?

Answer 6

1. ATN
2. interstitial nephritis
3. acute glomerular nephritis

Question 7

hypoperfusion overtime often leads to what?

Answer 7

ischemia

Question 8

acute tubular necrosis leads to what 3 things?

Answer 8

1. loss of urine concentrating ability
2. defective distal sodium reabsorption
3. reduced GFR

Question 9

what are the phases seen in the clinical course for acute tubular necrosis

Answer 9

oliguric phase
diuretic phase
recovery phase

Question 10

what are the two endogenous causes of ATN?

Answer 10

1. myoglobin

2. hemoglobin

Question 11

what are the exogenous causes of ATN?

Answer 11

1. cisplatin
2. aminoglycosides
3. radiocontrast media
4. cyclosporine
5. heavy metals
6. amphotericin B
7. foscarnet

Question 12

rhabdomyolysis from trauma or statins can cause what problem in kidney

Answer 12

ATN due to myoglobin in blood

Question 13

what is the most common cause for allergic interstitial nephritis

Answer 13

antibiotics

Question 14

allergic interstitial nephritis can be caused by what things other than drugs

Answer 14

1. autoimmune diseases (lupus)
2. infiltrative diseases (sarcoidosis)
3. infections

Question 15

what is the MOA of allergic interstitial nephritis

Answer 15

allergic hypersensitivity response.

usually cell mediated, predominantly by T-lymphocyte infiltrate

Question 16

acute GN is typically treated by what

Answer 16

immunosuppressants or plasmapheresis

Question 17

what is the typical cause of postrenal failure

Answer 17

obstruction of urine flow

Question 18

what are 4 causes of obstruction of urine flow

Answer 18

1. bladder outlet obstruction
2. urethral obstruction
3. crystal deposition
4. drugs

Question 19

what drugs commonly obstruct urine flow

Answer 19

1. acyclovir
2. sulfonamides (Bactrim)
3. methotrexate
4. indinavir
5. vancomycin

Question 20

what are the most common causes of postrenal failure (nonpharm causes)?

Answer 20

1. benign prostatic hyperplasia (BPH)

2. malignancy

Question 21

what counseling must be given with Bactrim related to kidney disease?

Answer 21

drink lots of water

Question 22

what are 3 treatment plans for postrenal failure?

Answer 22

1. d/c drugs (if possible; antibiotics may be necessary)
2. relieve obstruction (with foley catheter)
3. immunologic therapy for GN (corticosteroids)

Question 23

at what level of SCr above baseline should ACEI’s and ARB’s be stopped

Answer 23

more than 30% above baseline

Question 24

what patients should not receive an ACEI or ARB with AKI?

Answer 24

dehydrated prerenal patients

Question 25

what is treatment for prerenal disease?

Answer 25

1. aggressive fluid replacement if dehydrated

2. manage electrolytes (usually K Mg and phosphate)

Question 26

what patients require caution when giving fluid replacement for prerenal disease

Answer 26

those with CHF or cirrhosis
pt.s who are anuric or oliguric
pt’s without hypovoemia

Question 27

what should be done with anuric or oliguric patients when treating

Answer 27

fluid restriction