Acute Kidney Injury

Question 1

Acute kidney injury

Answer 1

Rapid reduction in glomerular filtration rate manifested by a rise in plasma creatinine (Pcr) concentration, urea, and other nitrogenous waste products.

Question 2

Azotemia

Answer 2

Increased nitrogen in blood (caused by reduced clearance of nitrogenous waste products)
Increased BUN and serum creatinine

Question 3

3 types of disorders that cause acute kidney injury (AKI)

Answer 3

Pre-renal azotemia
post-renal azotemia or obstructive nephropathy
intrinsic renal disease

Question 4

Pre-renal azotemia

Answer 4

Decrease in GFR due to decreases in renal plasma flow and/or renal perfusion pressure

Question 5

Post-renal azotemia or obstructive nephropathy

Answer 5

Decrease in GFR due to obstruction of urine flow

Question 6

Intrinsic renal disease

Answer 6

Decrease in GFR due to direct injury to kidneys

Question 7

Uremia

Answer 7

Constellation of signs and symptoms of multiple organ dysfunction caused by retention or “uremic toxins” and lack of renal hormones due to acute or chronic kidney injury
S/S: nausea, vomiting, abdominal pain, diarrhea, weakness, fatigue

Question 8

Oliguria

Answer 8

Urine volume

Question 9

Anuria

Answer 9

Urine volume is

Question 10

most common cause of abrupt fall in GFR in a hospitalized patient

Answer 10

prerenal azotemia

Question 11

prerenal azotemia
hypovolemic
causes?

Answer 11

renal losses
third space losses
GI losses
Hemorrhage

Question 12

prerenal azotemia
hypervolemia
reduced cardiac output
causes?

Answer 12

CHF
MI
Valvular disease
Pericardial tamponade

Question 13

prerenal azotemia
hypervolemia
systemic arterial vasodilation
causes?

Answer 13

cirrhosis
sepsis
medication
autonomic neuropathy

Question 14

Renal tubule function in prerenal?

Answer 14

NORMAL: concentrate urine, reabsorb sodium

=low urine sodium concentration ( 20)

Question 15

Fractional Excretion of Sodium (FENa)

Answer 15

FENa=(Una/Pna)/(Ucr/Pcr) x 100

Question 16

FENa in AKI

Answer 16

FENa 2% when AKI is caused by other pathologies

Exceptions: radiocontrast and rhabdomyolysis can cause FENa

Question 17

Post-renal Azotemia (Obstruction)

Causes

Answer 17

Obstruction of ureters
--extraureteral
--intraureteral
Bladder outlet obstruction
Urethral obstruction

Question 18

Extraureteral obstruction

Answer 18

carcinoma of cervix; endometriosis; retroperitoneal fibrosis; ureteral ligation

Question 19

intraureteral obstruction

Answer 19

stones, blood clots, sloughed papilla

Question 20

bladder outlet obstruction

Answer 20

bladder carcinoma, urinary infection, neuropathy

Question 21

urethral obstruction

Answer 21

posterior urethral valves, prostatic hypertrophy or carcinoma

Question 22

Diagnosing obstruction

Answer 22

Renal ultrasound

Foley

Question 23

Intrinsic Renal Disease

Causes?

Answer 23

Vascular
Glomerular
Interstitial
Tubular