Acute Kidney Injury

Question 1

What is acute renal failure?

Answer 1

An abrupt increase in Cr. Urine output decrease (

Question 2

What are the three categorizations of acute renal failure?

Answer 2

Pre-renal.
Intrarenal.
Post-renal.

Question 3

What are the markers of prerenal kidney failure?

Answer 3

BUN/Cr > 15-20.

UrineNa

Question 4

What does prerenal kidney failure mean conceptually?

Answer 4

Poor perfusion to the kidneys.

Question 5

What can cause prerenal kidney failure?

Answer 5

broken pump: cardiogenic shock
not enough in the pipes: hypovolemia (dehydration, burns, hemorrhage)anaphylaxis, third spacing due to nephrotic syndrome, cirrhosis, sepsis,
clogged pipes: fibromuscular dysplasia, renal artery stenosis.

Question 6

What is the treatment of prerenal kidney failure?

Answer 6

Treat underlying disease, volume replacement.

Question 7

What is postrenal kidney failure?

Answer 7

Obstruction.

Question 8

What are different kinds of postrenal kidney failure?

Answer 8

prostatic disease, stones, cancer, neurogenic bladder, kinked foley.

Question 9

How to check for postrenal kidney failure?

Answer 9

U/S for hydro. CT scan for stones.

Question 10

What are signs of bladder cancer?

Answer 10

hematuria, smoking history.

Question 11

What is the treatment for postrenal obstruction?

Answer 11

Relieve the obstruction.

Question 12

What are the three types of intra renal kidney failure?

Answer 12

1. Glomerulonephritis (problems w/ the glomerulus)
2. Acute Tubular Necrosis (problems w the tubules)
3. Acute Interstitial Nephritis
   (problems with the interstitium.)

Question 13

How to work up intrarenal kidney failure?

Answer 13

UA, rarely bx of the kidney.

Question 14

What are the findings associated with Glomerular Nephritis?

Answer 14

Red blood cell casts. r/o nephrotic syndrome (proteinuria > 3.5 g/day, chol, edema).

Question 15

What are the findings associated with acute tubular necrosis?

Answer 15

muddy brown casts, ischemia (prolonged pre-renal), exposure to toxins.

Question 16

What toxins classically cause ATN?

Answer 16

IV contrast, myoglobin.

Question 17

What are the three stages of ATN?

Answer 17

In prodrome, Cr elevates. Next, oliguria. (will need to get fluid off patient). Finally, polyuria (will need to replace fluid).

Question 18

What is the treatment of ATN?

Answer 18

Vigorous fluid replacement.

Question 19

What are the findings of Acute Interstitial nephritis?

Answer 19

WBCs, white blood cells casts, eos.

Question 20

What typically causes Acute Interstitial Nephritis?

Answer 20

Infxn.

Drugs - methoprim sulfa, penicillins, cephalosporins.

Question 21

What are the indications of acute dialysis?

Answer 21

A - acidosis
E - electrolyte abn. (K+ Ca2+)
I - intoxication/ingestion (salicylates, lithium, ethylene gycol, etc).
O - overload (volume)
U - uremic sx (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus).