Acute kidney injury

Question 1

def. AKI

Answer 1

rapid decline in renal function with increase in creat (50%)

Question 2

3 main cats. of kidney failure

Answer 2

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

Question 3

2 most common clinical findings

Answer 3

weight gain and edema

Question 4

what is azotemia

Answer 4

elevated BUN and Cr

Question 5

prog. of AKI

Answer 5

80% recover completely

• older worse
• most common cause of death is infection

Question 6

char of prerenal

Answer 6

• most common

- potentially reversible

Question 7

causes of pre-renal

Answer 7

1. hypovolemia
2. CHF
3. peripheral vasodilation
4. renal art. obstr.
5. cirrosis with hepatorenal

Question 8

pathophys of prerenal

Answer 8

low flow causes low GFR and increase in crap

Question 9

lab findings

Answer 9

1. oligouria - always
2. increased BUN to Cr - 20:1 - can reabsrob urea
3. low urine Na
4. increased urine/plasma Cr ratio
5. bland urine

Question 10

def. intrinsic renal failure

Answer 10

kidney tissue damages such that filtration and tubular function are imparied - unable to concentrate urine

Question 11

4 causes of renal

Answer 11

1. tubular - ATN due to ischemia
2. glomerular (acute clomerularnephritis)
3. vascular - renal art. occ., TTP, HUS
4. interstitial (AIN) - often due to drugs

Question 12

2 main causes of ATN

Answer 12

1. ischemic - severe decline in renal flow (shock, sepsis, heart failure)
2. nephrotoxic - due to substances

Question 13

char. of renal

Answer 13

edema, may be able to recover

Question 14

4 lab findings in renal

Answer 14

1. decreased BUN to Cr. ratio - urea less absorbed
2. increased urine Na - poor reabsorb
3. decreases urine osmolatiry - water not absorbed
4. dec. urine/plasma Cr ratio

Question 15

def. post renal

Answer 15

least common

- can’t get urine out

Question 16

course of post-renal

Answer 16

restored in functioned releived, otherwise can lead to ATN

Question 17

causes of post-renal

Answer 17

1. BPH
2. obs. of solitary kidney
3. nephrolitatiss
4. neoplasm
5. retropertioneal fibrosis

Question 18

3 basic tests for post-renal

Answer 18

1. Phx - palpate bladder
2. US look for obst
3. cath - look for urine

Question 19

See fig. 7.1 for nice summary

Answer 19

P266

Question 20

8 tests to help Dx

Answer 20

1. bloods
   - BUN and Cr
   - lytes
2. urine dip
   - proteins suggest intriunsitc
   - hyaline casts in prerenal
   - RBC casts in glomerular
   - WBC casts in parenchymal inflammation
   - fatty casts in nephrotic
3. Urine chem
   - osmolarity
   - FEN
   - renal failure index
4. urine C+S
5. US
6. CT
   - can show abnormalities
7. Renal biopsy
   - for acute GN or allergic interstitisal nephritis
8. renal arteriography

Question 21

urine sediment, protein and blood in ATN

Answer 21

• muddy brown casts, renal tubular casts, granular casts
• trace protein
• no blood

Question 22

urine sediment, protein and blood in glomerular

Answer 22

• dysmoprhic RBCs, RBC casts, WBCs with cast
• high protein
• blood

Question 23

urine sediment, protein and blood in AIN

Answer 23

-RBC, WBC, WBC with casts
- 1+ protien
2+ blood

Question 24

urine sediment, protein and blood in post renal

Answer 24

• benign
• no
• no

Question 25

urine sediment, protein and blood in prerenal

Answer 25

- benign - no - no

Question 26

4 major complications of AKI

Answer 26

1. ECF volume expansion 2. metabolic - hyperK - met acid - hypocal - hyponatremia - hyperphosphatemia 3. uremia 4. infection

Question 27

general measures to Tx AKI

Answer 27

- avoid trigger meds - adjust for renal dosing - correct fluid imbalance - correct lyte - optimize cardiac output - order dyalisis if symptomatic

Question 28

Tx for pre-renal

Answer 28

- Tx inderlying cause - give NS to maintain euvolemia - elim offending agents (NSAIDS)

Question 29

Tx for intrinsic

Answer 29

- once ATN - supportive | - furosemide if oligouroc

Question 30

Tx for post-renal

Answer 30

cath