Acute Kidney Injury

Question 1

parameters of acute kindey injury

Answer 1

acute onset of days-weeks
increase in serum creatinine ***
often decreased urine volume
kidney filtration and excretory functions impaired

Question 2

what patient characteristics can alter serum creatinine

Answer 2

age
sex
race
muscle mass 
catabolic rate

Question 3

how to differentiate acute kidney injury from an acute on chronic kidney injury

Answer 3

obtain most recent serum creatinine baseline (preferably one from 3 months or more before acute event)

Question 4

causes of prerenal AKIA

Answer 4

hypovolemia
decreased cardiac output
decreased ECV d/t CHF/ liver failure
impaired renal autoregulatino d/t NSAIDS - ACEI/ARBs - cyclosporine

Question 5

causes of intrinsic AKI

Answer 5

glomerular - actue GN
tubules and intersitium - sepsis/infeciton - ischemia - nephrotoxin mediated
vascular - vasculitis, malignant HTN, TTP-HUS

Question 6

causes of postrenal AKI

Answer 6

bladder outlet obstruction

bilateral pelvoureteral obstruction (or unilateral obstruction of a solitary functioning kidney)

Question 7

examples of exogenous nephrotoxins that mediate tubulointerstital damage to kidneys

Answer 7

iodinated contrast 
aminoglycosides, amphotericin b 
cisplatin 
PPIs 
NSAIDs

Question 8

examples of endogenous nephrotoxins that mediate tubulointerstitial damage to kidneys

Answer 8

hemolysis
rhabdomyolysis
myeloma
intratubular crystals

Question 9

signs and symptoms of AKIA

Answer 9

first obtain thorough history of medications/OTCs/herbals/supplements
toxin exposures at work/home/hobby
physically - dehydrated, ascities, jaundice, fluid in lungs

Question 10

best way to determine if AKI is pre, post, or intra

Answer 10

order serum na, creatinine
order urine na, creatinine
calculate FeNa
also order cmp - calculate anion gap, platelet count, liver function., ect

Question 11

pros of USG

Answer 11

START HERE

large amt of info, no contrast, less expensive, mroe easily available

Question 12

why would you want to order an EKG for an AKI pt

Answer 12

if they have a problem with potassium they could develop a deadly rhythm
as they fail k will rise

Question 13

tx for prerenal AKI

Answer 13

stop likely medication offenders such as NSAIDs, cyclosporin, acei/arb
remove/treat underlying contributing factors

Question 14

tx for postrenal AKI

Answer 14

drain urinary bladder

eliminate obstructive processes

Question 15

tx for intrarenal AKI

Answer 15

improve renal perfusion - optimize cardiac output, minimize third spacing
monitor and balance electrolytes as needed but NORMAL SALINE is preferred