Acute kidney injury

Question 1

def. acute kidney injury

Answer 1

deterioration of the kidney that has lasted for less than 3 months

Question 2

def. chronic kidney disease

Answer 2

persistent deterioration that has lasted longer than 3 months

Question 3

3 parts to classic approach to AKI

Answer 3

1. pre-renal
2. renal
3. post-renal

Question 4

def. pre-renal AKI

Answer 4

acute injury to kidney secondary to reduced renal blood flow

Question 5

3 major causes of pre-renal

Answer 5

1. decreased ECF
2. “effective” reduced ECF
   - heart failure
   - reduced oncotic pressure
3. disruption of renal hemodynamics
   - drugs

Question 6

3 parts of Hx and Px that suggest pre-renal

Answer 6

1. Hx suggest ECF depletion
2. Phx signs of volume depletion
3. signs of reduced effective volume depletion
   - reduced cardiac output
   - liver failure

Question 7

2 serum signs of pre-renal

Answer 7

1. hemoconcnetration
   - high Hb and albumin
2. low urinary flow
   - high Urea/Cr ratio

Question 8

urine signs of pre-renal

Answer 8

bland urine

- low salt

Question 9

def. renal AKI

Answer 9

injury do to damage to the parenchyma

Question 10

clue to renal AKI

Answer 10

1. systemic features
   - rash
   - joint involment
   - pulmonary involvment
2. HT
3. mild-mod ECF overload
4. anemia or thrombopenia
5. abnormal urine sediment

Question 11

what is seen in renal dipstick (4)

Answer 11

1. albumin
2. Hb
3. WBCs
4. other

Question 12

what is seen in renal microscopy

Answer 12

1. cells
2. casts
3. crystals

Question 13

3 classes of of renal AKI

Answer 13

1. tubulo-interstitial
2. glomerular
3. vascular

Question 14

3 types of tubulo-interstitial

Answer 14

1. acute tubular necrosis
2. allergic/acute interstitial nephritis
3. tubular obstruciton

Question 15

what is acute tubular necrosis

Answer 15

injury and death of renal tubular cells

- ischemia and toxins

Question 16

risk factors for tubular ecrosis

Answer 16

1. CKD
2. CV diease
3. ECF volume depletion

Question 17

how to diagnose ATN

Answer 17

labs - blood and protein

hemegranular casts

Question 18

4 ways to diff. ATN from pre-renal

Answer 18

1. dip - Hb and albumin
2. micro - hemegranular casts
3. unine [Na] - >20
4. fractional excretion of Na - >1%

Question 19

what is interstitial nephritis

Answer 19

interstitial inflamation resulting in AKI

Question 20

3 main etiologies of nephritis

Answer 20

1. drug reactions
2. auto-immune
3. infectious

Question 21

what is drug induces AIN

Answer 21

7-10 days after exposure

WBC casts

Question 22

what is tubular obstruction

Answer 22

AKI due to obstruciton

Question 23

2 general etiologies of obstruction

Answer 23

1. endogenous
   - tumor lysis
   - myleoma
2. exogenous
   - drugs

Question 24

2 main types of glomerular disease

Answer 24

1. proliferative
   - typically causes AKI
2. non-proliferative
   - generally not AKI

Question 25

features of proliferative

Answer 25

- rapid delcine in GFR - HT - anemia - elevated inflammatory markers * ***RBC CASTS

Question 26

what are vascular causes of renal AKI

Answer 26

secondary to either small or large vessel disease

Question 27

4 vessels and the problems with them

Answer 27

1. arteries - atherosclerosis - fibromuscular dysplasia 2. arterioles - atheroembolic disease 3. veins - thrombosis 4. caps - TTP - hemolytic uremic syndrome

Question 28

4 vessels and the problems with them

Answer 28

1. arteries - atherosclerosis - fibromuscular dysplasia 2. arterioles - atheroembolic disease 3. veins - thrombosis 4. caps - TTP - hemolytic uremic syndrome

Question 29

what is post-renal disease

Answer 29

inability for urine to leave | - URO

Question 30

4 general goals of Tx of AKI

Answer 30

1. remove offending toxin 2. avoid further toxic therapies/investigations 3. treat ECF depletion 4. avoid AKI complications

Question 31

Tx for pre-renal

Answer 31

improve hemodynamics - ECF volume replation - improve cardiac output

Question 32

treatment for AIN

Answer 32

remove offending agent | - consider steroid

Question 33

Tx for ATN

Answer 33

- remove offending agent - correct ECF depletion - supportive care