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Year 2 Renal > Acute kidney injury > Flashcards

Acute kidney injury Flashcards

1
Q

definition: acute kidney injury

A

reduction in glomerular filtration rate resulting in azotemia developing over a few times

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2
Q

acute kidney injury is commonly due to __________-

A

renal ischemia or toxins

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3
Q

is AKI reversible or irreversible?

A

reversible

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4
Q

diagnostic criteria for AKI

A
  • absolute increase in serum creatinine level of 0.3 mg/dL or more
  • over 50% increase in serum creatinine
  • reduction of urine output less than 500 mL in 24 hr
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5
Q

definition: azotemia

A

elevation of nitrogenous waste products related to insufficient filtering of blood by the kidneys

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6
Q

definition: oliguria

A

less than 400-500 mL / day

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7
Q

definition: anuria

A

less than 50 mL / day

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8
Q

what is the key test to understanding what is going on with the kidney?

A

UA

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9
Q

creatinine clearance can be used to estimate _____

A

GFR

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10
Q

serum creatinine levels are inversely proportional to _____

A

GFR

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11
Q

creatinine clearance _________ (underestimates / overestimates) GFR

A

overestimates

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12
Q

BUN is a less accurate indicator of GFR than creatinine due to variation in what 3 factors?

A
  • protein intake
  • catabolic rate
  • tubular reabsorption
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13
Q

what is the cause of urine casts?

A

trapping of cellular elements in a matrix of protein secreted by renal tubule cells

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14
Q

what type of casts are seen in acute tubular necrosis? what is the appearance of the urine?

A
  • granular casts

- “muddy brown” urine

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15
Q
  • age
  • NSAIDs
  • CKD

these affect which glomerular arteriole? how?

A

afferent (prevent dilation)

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16
Q
  • ACE inhibitors
  • ARBs

these affect which glomerular arteriole? how?

A

efferent (prevent angiotensin II mediated vasoconstriction)

17
Q

what are the three types of AKI?

A
  • pre-renal
  • renal
  • post-renal
18
Q

what is the etiology of pre-renal AKI? what is one major condition associated with it?

A
  • impaired effective renal perfusion

- volume depletion

19
Q

what is the etiology of renal AKI? what is one major condition associated with it?

A
  • intrinsic renal disease (glomerular, tubular, interstitial, vascular)
  • acute tubular necrosis
20
Q

what is the etiology of post-renal AKI? what is one major condition associated with it?

A
  • obstruction of urinary flow

- BPH, tumor

21
Q

prerenal AKI has decreased GFR ________ (with / without) ischemic or nephrotoxic injury to tubules

A

without

22
Q

what is the BUN : creatinine ratio for prerenal AKI?

A

over 20 : 1

23
Q

what type of casts can be seen in prerenal (volume depleted) AKI?

A

hyaline

24
Q

what is the most common cause of renal AKI?

A

acute tubular necrosis (ATN)

25
Q

what are the morphologic features of ATN?

A
  • tubular dilation
  • attenuation of tubular epithelium
  • loss of epithelial cell brush border
  • granular cast material
  • mitotic figures
26
Q

can tubule cells regenerate following ATN?

A

yes

27
Q

what is obstructive uropathy?

A

obstruction of the urinary tract at any level that affects both kidneys

28
Q

what should be ruled out in all patients with oliguria?

A

obstructive uropathy (post-renal AKI)

29
Q

what is hydronephrosis?

A

distension and dilation of the renal pelvis calyces

30
Q

what test is used to differentiate prerenal AKI from ATN?

A

assessment of urine sodium excretion

31
Q

what test do you use to exclude postrenal AKI?

A

renal imaging (US, CT)

32
Q

how is fractional excretion of sodium expressed?

A

amount of sodium excreted over amount of sodium filtered by glomeruli

33
Q

in the setting of volume depletion, urine Na reabsorption should be _________ (increased / decreased) in the proximal tubules

what would the FENa be?

A
  • increased

- FENa less than 1%

34
Q

if the proximal tubules are injured via ATN, how is sodium handling affected? what is the FENa result?

A
  • reabsorption will be impaired?

- FENa over 2%

35
Q

what lab helps to differentiate between prerenal azotemia and ATN?

A

FENa

36
Q

what is the FENa level in ATN? prerenal azotemia?

A
  • ATN: over 2%

- prerenal azotemia: less than 1%

Year 2 Renal (38 decks)

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