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renal > Acute kidney injury > Flashcards

Acute kidney injury Flashcards

1
Q

Acute kidney injury is the abrupt decline in ____manifested by an acute rise in __________

A

Acute kidney injury is the abrupt decline in GFR manifested by an acute rise in serum creatinine

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2
Q

true or false: high mortality rate in AKI

A

true: 21%

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3
Q

mesurement of GFR

A
  1. inulin is the gold standard since it is freely filtered and not secreted or reabsorbed but…
  2. creatinine is more convenient but while it is freely filtered and not reabsorbed it is s secreted and thus overestimates GFR
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4
Q

low mol weight protein released by all nucleated cells at constant rate

A

cystatin C

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5
Q

Cystatin C is affected by

A

thyroid dz

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6
Q

oliguric AKI

A

low urine output portend worse prognosis

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7
Q

non-oliguric AKI

A

nml urine output despite inadequate clearance– may have severely reduced GFR with well-maintained urine output

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8
Q

Pre-renal AKI

A

perfusion related

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9
Q

intra-renal AKI

A

intrinsic

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10
Q

post-renal

A

obstructive AKI

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11
Q

risk factors for AKI

A
  1. advanced age
  2. preexisting chronic kidney disease
  3. DM
  4. underlying heart or liver disease
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12
Q

in perfuison related AKI we see a decline in kidney perfusion due to a __________

A

true intravascular volume depletion

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13
Q

decreased kidney perfusion can be caused by

A
  1. decreased effective plasma volume such as in hepatic failure, sepsis
  2. renal artery stenosis
  3. hypovolemia such by diuretics, trauma, diarrhea or vomiting
  4. decreased cardiac output like CHF or massive PE
  5. interference with autoregulation
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14
Q

what exacerbates reduced kidney perfusion in patients with volume depletion

A

NSAIDs or ACE inhibitors

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15
Q

As kidney perfusion decreases, GFR is maintained via autoregulation involving _______ (potent efferent ________) and __________(__________the afferent arteriole and ameliorate the effect of AII)

A

As kidney perfusion decreases, GFR is maintained via autoregulation involving angiotensin II (potent efferent vasoconstrictor) and prostaglandins (vasodilate the afferent arteriole and ameliorate the effect of AII)

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16
Q

is a high or low FeNa (<1%) consistent with perfusion-related AKI

A

low

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17
Q

obstructive causes of AKI

A
  1. obstruction of bladder outlet
  2. nephrolithiasis
  3. retroperitoneal fibrosis
  4. intratubular obstruction
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18
Q

obstruction AKI can lead to

A

hydronephrosis

19
Q

intrinsic AKI

A
  1. acute tubular necrosis
  2. interstitial nephritis
  3. Glomerular disease
  4. Small vessel disease
20
Q

acute tubular necrosis is caused by

A

prolonged ischemia or toxin exposure

21
Q

what do we see in the pathology of acute tubular necrosis

A

denuding of tubular epithelial cells that most prominently in the PCT and loop of Henle

22
Q

what is the most common cause of AKI in hospital patients

A

ischemic ATN

23
Q

pathophysiology of ischemic ATN:

  1. intratubular obstruction causes a
  2. _________across injured tubular cells allows filtered toxins to return to blood
  3. there is a reduction in kidney ______ due to either increased _____ or reduction in _______
A
  1. intratubular obstruction causes a rise in tubular pressure
  2. Backleak of glomerular filtrate across injured tubular cells allows filtered toxins to return to blood
  3. there is a reduction in kidney blood flow due to either increased vasoconstrictors or reduction in vasodilators
24
Q

toxic ATN (4)

A
  1. radiocontrast dye
  2. aminogluycoside antibiotics
  3. amphotericin
  4. Myoglobin (rhabdomyolysis)
25
Q

intersitial nephritis causes

A
  1. drugs such an antibiotics (70%)
  2. infections
  3. autoimmune
26
Q

clinical findings of AIN

A
  1. fever
  2. rash
  3. eosinophilia
  4. UA- WBCs, WBC casts
27
Q

hallmark of glomerulonephritis

A

proteinuria

28
Q

what do we see in the urine in glomerulonephritis

A

RBCs and RBCs casts

29
Q

thrombotic microangipathy is caused by damage to the

A

endothelial cells

30
Q

in thrombotic microangiopathy, _____ constituents enter wall of renal arterioles and results in narrow lumens and ________in small vessels and _____ AKI. It is often accompanied by __________

A

in thrombotic microangiopathy, plasma constituents enter wall of renal arterioles and results in narrow lumens and thrombi in small vessels and ischemic AKI. It is often accompanied by microagiopathic hemolytic anemia

31
Q

causes of thrombotic microangiopathy

A
  1. autoimmune disease
  2. malignant HTN
  3. drugs
  4. infection
  5. idiopathic
32
Q

urinalysis of thrombotic microangiopathy

A
  1. bland

2. maybe some RBCs or granular casts

33
Q

urinary findings in ATN

A

muddy brown casts

34
Q

urinalysis findings in interstitial nephritis

A
  1. WBC

2. WBCs casts

35
Q

urinalysis findings in glomerulonephritis

A
  1. proteinuria
  2. dysmorphic RBCs
  3. RBC casts
36
Q

why would you do an ultrasound?

A
  1. rule out obstruction

2. evaluate kidney size

37
Q

radionucleotide is done to determine if it wither

A

ATN or Renal infarct

38
Q

management of patients with AKI

A
  1. treat underlying cause
  2. discontinue all non-essential nephrotoxins
  3. modify drug dosages
39
Q

metabolic complications of AKI

A
  1. hyperkalemia
  2. metabolic acidosis
  3. hypocalcemia
  4. avoid hypermagnesemia
40
Q

true or false:

volume expansion frequent in patient with oliguric AKI

A

yep

41
Q

diuretic management in AKI

A

important but pt. may be unresponsive even to large doses diuretics

42
Q

uremic complications

A
  1. platelet dysfunction
  2. pericarditis
  3. uremia is catabolic state
  4. CNS complications
  5. Anemia
43
Q

newer/experimental therapies for AKI

A
  1. natriuretic peptides
  2. designer Ab
  3. vasodilators

renal (21 decks)

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