Acute Kidney Injury Flashcards
What are the types AKI
Prerenal AKI, intrinsic, Postrenal
What are the 3 types of Intrinsic AKI
acute glomerulonephropathy, acute tubular necrosis, acute interstitial nephritis
When does AKI become CKD
established renal dysfunction for three or more months
What are non preventable risk factors for AKI
Chronic kidney disease, age greater than 75, heart failure, liver disease, diabetes
What are preventable risk factors for AKI
Medications, hypotension, sepsis,cirrhosis
What can cause pre renal AKI causes
intravascular volume delpletion (dehydration), reduced cardiac output, vascular obstruction
What is a marker than is affected by AKI, what happens
increased SCr
What are some labs and urine tests that can evaluate for AKI
BUN: Scr greater than 20, urine specific gravity greater than 1.015
What are the characteristics of urine for a patient with pre-renal AKI
Highly concentrated urine with low sodium
What is the best way to check for post renal AKI
kidney ultrasound
What is the best way to check for pre renal AKI, what should the change be , what does it mean if there is not change
Give Normal Saline bolus, if the SCr significantly improves the AKI is prerenal, if there is no change in SCr the AKI is likely intrinsic
What does FENA stand for
Fractional Excretion of Sodium
What are the circumstances when the FENA can be used
only accurate in oliguric (urine output less than 400ml/day) AKI
What are values for FENA and what do they mean
< 1 : suggests pre renal AKI, 1-2: either prerenal or intrinsic, >2: suggests intrinsic AKI
When would the FENA be falsely high, why, If it is still low what does this mean
If the patient is on diuretics, diuretics should cause a large excretion of Sodium, if FENA is low despit being on diuretics there is likely pre renal AKI
What is usually the cause of glomerulonephropathies
autoimmune disease
What is a characteristic finding of GN
Proteinuria
What is the best way to check for GN
Protein to creatinine Ratio
What is a hallmark feature of nephrotic syndrome
Facial edema and frothy urine
What can be given for treatment of proteinuria
ACEIs or ARBs with salt restriction as well
T/F: ACEIs and ARBS cause efferent vasodilation that causes less filtration leading to more retention of protiens
True
What is the most common of cause of AKI
Acute tubular necrosis
What can lead to Acute tubular necrosis
Prolonged or severe pre-renal AKI leading to ischemia
What can cause Acute Interstital nephritis
Drug allergy or autoimmune diseases
What are the 4 ways to manage AKI
removal of cause if possible, immunosuppresion if autoimmune, prevent hypotension and/or hypovolemia, avoid nephrotoxins
What are the indications for dialysis
Metabolic Acidosis (ph less than 7.1), Electrolytes (K greater than 6.5), Intoxication, Refractory fluid Overload, uremia- confusion (A,E,I,O,U)
T/F: Starting dialysis is more likely to better patient’s renal function in the future
False: Starting dialysis earlier in the coure of renal failure does not improve outcomes
What is the most common cause of post renal AKI
Kidney stones or obstruction
Whatis hydronephrosis
backup of urine into kidneys
What are the most common stones
calcium and oxalate
What is the reatement for stones
Usually pass on its own or give fluids
What drugs can be used to pass big stones
Tamsulosin
What are ways to prevent stones
increase fluid intake (urine output to 2 to 2.5 liters per day), avoid calcium, sodium restriction, avoid dark colas
What meds can prevent calcium stones
thiazide diuretics and potassium citrate
