Acute kidney injury Flashcards
def. acute kidney injury
deterioration of the kidney that has lasted for less than 3 months
def. chronic kidney disease
persistent deterioration that has lasted longer than 3 months
3 parts to classic approach to AKI
- pre-renal
- renal
- post-renal
def. pre-renal AKI
acute injury to kidney secondary to reduced renal blood flow
3 major causes of pre-renal
- decreased ECF
- “effective” reduced ECF
- heart failure
- reduced oncotic pressure - disruption of renal hemodynamics
- drugs
3 parts of Hx and Px that suggest pre-renal
- Hx suggest ECF depletion
- Phx signs of volume depletion
- signs of reduced effective volume depletion
- reduced cardiac output
- liver failure
2 serum signs of pre-renal
- hemoconcnetration
- high Hb and albumin - low urinary flow
- high Urea/Cr ratio
urine signs of pre-renal
bland urine
- low salt
def. renal AKI
injury do to damage to the parenchyma
clue to renal AKI
- systemic features
- rash
- joint involment
- pulmonary involvment - HT
- mild-mod ECF overload
- anemia or thrombopenia
- abnormal urine sediment
what is seen in renal dipstick (4)
- albumin
- Hb
- WBCs
- other
what is seen in renal microscopy
- cells
- casts
- crystals
3 classes of of renal AKI
- tubulo-interstitial
- glomerular
- vascular
3 types of tubulo-interstitial
- acute tubular necrosis
- allergic/acute interstitial nephritis
- tubular obstruciton
what is acute tubular necrosis
injury and death of renal tubular cells
- ischemia and toxins
risk factors for tubular ecrosis
- CKD
- CV diease
- ECF volume depletion
how to diagnose ATN
labs - blood and protein
hemegranular casts
4 ways to diff. ATN from pre-renal
- dip - Hb and albumin
- micro - hemegranular casts
- unine [Na] - >20
- fractional excretion of Na - >1%
what is interstitial nephritis
interstitial inflamation resulting in AKI
3 main etiologies of nephritis
- drug reactions
- auto-immune
- infectious
what is drug induces AIN
7-10 days after exposure
WBC casts
what is tubular obstruction
AKI due to obstruciton
2 general etiologies of obstruction
- endogenous
- tumor lysis
- myleoma - exogenous
- drugs
2 main types of glomerular disease
- proliferative
- typically causes AKI - non-proliferative
- generally not AKI
features of proliferative
- rapid delcine in GFR
- HT
- anemia
- elevated inflammatory markers
- ***RBC CASTS
what are vascular causes of renal AKI
secondary to either small or large vessel disease
4 vessels and the problems with them
- arteries
- atherosclerosis
- fibromuscular dysplasia - arterioles
- atheroembolic disease - veins
- thrombosis - caps
- TTP
- hemolytic uremic syndrome
4 vessels and the problems with them
- arteries
- atherosclerosis
- fibromuscular dysplasia - arterioles
- atheroembolic disease - veins
- thrombosis - caps
- TTP
- hemolytic uremic syndrome
what is post-renal disease
inability for urine to leave
- URO
4 general goals of Tx of AKI
- remove offending toxin
- avoid further toxic therapies/investigations
- treat ECF depletion
- avoid AKI complications
Tx for pre-renal
improve hemodynamics
- ECF volume replation
- improve cardiac output
treatment for AIN
remove offending agent
- consider steroid
Tx for ATN
- remove offending agent
- correct ECF depletion
- supportive care
