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Renal - Gupta > Acute Kidney Injury > Flashcards

Acute Kidney Injury Flashcards

1
Q

What are some general indicators of renal failure?

A
  • Impairment of GFR
  • Elevation of BUN/Creatinine

general accumulation of substances typically excreted by the kidney including Drugs, K+, PO4 etc.

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2
Q

What defines Acute Kidney Injury?
• what labs are you looking for?
• what signs are you looking for?

A

Rapid Deterioration of Renal Function:
• HOURS to LESS THAN one month

Labs:
• Creatinine increase 50% over baseline value

Signs:
• Decreased urine output (NOT ALWAYS SEEN)
• Kidney becomes inable to regulate electrolytes and water

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3
Q

What defines oliguria?

• Anuria?

A

Oliguria:
Less than 400 ml urine output in 24 hours

Anuria:
Less than 100 ml urine output in 24 hours

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4
Q

T or F: Acute Kidney Injury is usually asymptomatic and discovered in labs.

A

True, we USUALLY JUST SEE THE ELEVATION in Creatinine

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5
Q

Are most cases of Acute Kidney Injury Reversible or Irreversible?

A

Most are REVERSIBLE (you can just stop giving the drug you were giving or put in a catheter etc.)

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6
Q

What are 5 key things you want to look for when evaluating someone who you suspect may have renal failure?

A
  • Careful History
  • Review of Hospital Chart
  • Medications
  • Physical Examination
  • Examination of the Urine
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7
Q

What are you looking for on physical exam that suggests acute renal failure (ARF)?

A

• Look for Volume Overload or Depletion

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8
Q

In what type of Acute Renal Failure are Brown Granular Casts seen?

A

• Intrisic Renal Failure tends to produce the Brown Granular Casts

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9
Q

What 3 KEY URINE (not serum) values do we look at to determine if someone is in acute renal failure?

A
  • Urine Osmolarity
  • Fractional Excretion
  • Urine Sediment
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10
Q

Postrenal Acute Renal Failure
• Key complaints
• Causes
• Diagnosis

A

CC:
• “I can’t pee”

Causes:
• Prostate Hypertrophy
• Pelvic or Retroperitoneal Malignancies
• Neurogenic bladder

Dx:
• ULTRASOUND is used to see Dialated (hypoechoic) calyces in the Hilum

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11
Q

T or F: Urinalysis is usefule in diagnosing post-renal ARF.

A

FALSE, Labs here don’t tell us much

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12
Q

What is the chain reaction that happens in response to changes that causes pre-renal failure?

A

Pre-renal Failure = poor perfusion of Kidney

Step 1:
• Low Effective Circulatory Volume causes…

Step 2:
• Baroreceptor Activation

Step 3:
• RAAS
• ADH (vasopressin)
• Sympathetic NS

Step 4: 
• Vasoconstriction
• Mesangial Cell Contraction
• Na+ and H2O reabsorption
• Reduced Sweating
• Thirst and Na+ appetite

Step 5:
• ACUTE pre-renal Failure

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13
Q

Are urinalysis findings useful in Acute pre-renal failure?

• if so what do you expect to see?

A

YES, you would expect to see Hyaline Casts

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14
Q

What urinary labs are useful in Acute PRE-Renal Failure?
• what does this suggest about hormone function in the kidney?
• what are you looking for?

A

Urine Osmolarity:
• Greater than 500 - ADH is working because you’re concentrating urine

Urinary Na:
• Less than 25 - ALDOSTERONE is working by sparing Na+

FeNa:
• Less than 1% suggests pre-renal failure

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15
Q

What are the 3 types of Acute Pre-renal Kidney Failure?

A
  • Hepatorenal Syndrome
  • Renal Artery Stenosis
  • Drugs Preventing Autoregulation
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16
Q

What characterizes Hepatorenal Syndrome?
• Blood Pressure.
• Kidney Function.
• Urinalysis

A
  • Decreased BP (systolic in 80s and 90s) in spite of Increased ECFV
  • Kidneys Structurally intact but have AZOTEMIA (bun and cr. inc.) and progressive oliguria

Urinalysis:
• Normal

17
Q

What is the Px. of someone with hepatorenal syndrome?

• what is the best treatment option?

A

Poor unless pt. receives LIVER TRANSPLANT

18
Q

What 2 things must you do before giving a final Dx of Hepatorenal Sydrome?

A
  1. Rule out other Causes (this is a dx. of exclusion) - rule out nephrotoxic drugs, contrast etc.
  2. URINE Na+ very low (less than 10) so you need to give an INFUSION OF SIMPLE SALINE to rule out simple pre-renal condition
19
Q

Explain the effect of the Folling drugs on the Afferent and Efferent Arterioles:
• NSAIDs:
• ARBs/ACE Is

A

NSAIDs:
• NSAIDs block PGs.
• PGs are typically used to dialate AFFERENT arteriole
• Blockage here = Decreased Blood FLow in the Kidney

ARBs/ACE Is:
• Typically the kidney Constricts the Efferent arteriole to maintain GFR
• ACE Is/ARBs block Angiotensin II from binding and affecting the efferent arteriole
•Net Effect w/ ACE = Reduced GFR

20
Q

NSAID use that is concurrent with what conditions can lead to acute renal injury?

A

Acute Renal Injury with NSAIDS may occur in pts. with:
• True Volume Depletion
• CHF
• Cirrhosis

Cox-2 Inhibitors have similar intra-renal effects

21
Q

What are 3 general structures that may be damaged leading to Intra-renal acute renal failure?
• which is the most common causes

A

Glomerulus
Tubular***MOST COMMON
Vascular (vasculitis)

22
Q

What tubular problem makes the Tubule the most common cause of Intra-renal Acute renal failure?
• what factors contribute to this cause?

A

• Acute Tubular Necrosis (ATN)

Necrosis is 2º to:
• Ischemic Injury
• Toxic injury from RADIOCONTRAST or medications

23
Q

What is seen histologically in Acute Tubular Necrosis?

A
  • Denuding of Tubular Epithelial Cells
  • PARTICULARLY in the Px. tubules and THICK ascending limb of the lOH
  • Muddy Brown Granular Casts occlude the tubular lumen
24
Q

What urine labs tell you that you’re dealing with Acute Tubular Necrosis?
• Compare these to Pre-renal failure.
• why the difference?

A

(Intra-renal causes) Acute Tubular Necrosis:
• Urine Osmole between 300-350 (close to plasma conc.)
• Na+ greater than 20
• FeNa+ greater than 1%

Acute Pre-renal failure:
• Urine Osm greater than 500
• Na+ less than 25
• FeNa+ less than 1%

The first situation indicates a problem concentrating urine despite the fact that ADH and Aldosterone are elevated

25
Q

How do you measure Ischemic Acute Tubular Necrosis?

A
  • Restore Perfusion
  • Avoid Nephrotoxins
  • Supportive Care
26
Q

What are some key drugs that cause Pre-Renal Failure?

• what about post renal failure?

A

Pre-renal:
• NSAIDS
• Ace-Inhibitors

Intrarenal:
• Aminoglycosides
• Amphotericin B

27
Q

Aminoglycoside Toxicity
• part of tubule that it accumulates in
• Prevention

A

Accumulates in Proximal Tubule

Prevent toxicity by using ONCE DAILY DOSING

28
Q

How does Contrast dye cause Intra-renal ARF?

• risk factors

A
  1. Direcet Vasoconstrictive effects on arterioles
  2. Tubular Toxicity
Risk Factors: 
• Pre-exisiting renal disease
• Hrt Failure
• Hypovolemia
• High dose Contrast
29
Q

How is Contrast Nephropathy prevented?

A
  • Lower Dose Contrast
  • Avoid Closely Spaced Studies
  • Avoid volume depletion by giving IV fluids
  • Avoid other nephrotoxins
30
Q

What is Acute Interstitial Nephritis?

• what is often the cause?

A

Allergic Reaction and infiltration of the kidney with granulocytes OFTEN EOSINOPHILS

Drugs like…
• BETA-Lactams and NSAIDs often cause this

31
Q

What key findings do you look for in a case of Acute interstitial Nephritis?

A
  • Pyuria

* Eosinophils

32
Q

If someone has been vomiting there brains out and you need to do a contrast study, what should you do first?

A

• GIVE them IV FLUIDS to prevent contrast toxicity

Renal - Gupta (17 decks)

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