Acute Kidney Injury

Question 1

What tells you it is prerenal.

Answer 1

Urine osmolarity abover 500, Urine sodium below 20, BUN creatinine: over 20, FENa Less than 1% in pre-renal

Question 2

What tells you it is ATN

Answer 2

FeNa over 2%,

Question 3

FeNa is the best for ppl on diuretic therapy

Answer 3

If its below one, you know its pre-renal

Question 4

What specific gravity is associated with ATN

Answer 4

1.010

Question 5

What specific gravity is associated with prerenal

Answer 5

greater than 1.018

Question 6

What defines acute kidney injury

Answer 6

Rapid deterioration of GFR (less than one month). It is a .5 mg/dl increase in creatinine or a greater than 50% increase from baseline

Question 7

Oliguria is what?

Answer 7

less than 400 ml a day

Question 8

Anuria is what >

Answer 8

less than 100 ml day

Question 9

Three categories

Answer 9

Pre renal, intrinsic, post

Question 10

Pre-renal urine osmolarity

Answer 10

Over 500

Question 11

Intrinsic renal urine osmo

Answer 11

Less than half of prerenal. 250 or less

Question 12

FeNa in prerenal

Answer 12

Less than 1%

Question 13

FeNa in intrinsic renal

Answer 13

Greater than 2

Question 14

Urine sediment in prerenal

Answer 14

hyaline

Question 15

Urine sediment in intrinsic

Answer 15

muddy brown granular casts

Question 16

Postrenal AKI= what?

Answer 16

Obstruction

Question 17

Causes of Prerenal

Answer 17

True volume loss (GI) etc
CHF,
Shock,
Hepatorenal syndrome,
NSAIDS, Renal artery stenosis

Question 18

Three specific types of pre-renal AKI

Answer 18

hepatorenal syndrome, renal artery stenosis and angiotensin II blockers/ACE inhibitors,
Use of NSAIDs

Question 19

What the hell is hepatorenal syndrome

Answer 19

It is caused by portal hypertension. Often associated with cirrhosis. The portal hypertension leads to splanchnic vasodilation and thus decreased circulatory volume as this blood tries to get back to the heart. Body reacts by increasing resistance through the RAAS system and you get ascites and renal vasoconstriction which causes teh renal failure

Question 20

To rule out other things andinsure it is HRS

Answer 20

Test urine sodium…It will literally be below 10

Question 21

Angiotensin II blockers cause pre-renal AKI how?

Answer 21

They block Angiotensin II production. AND when you you hear angiotensin you think what>….efferent constriction. So, if ANgiotensin is blocked, the problem is that you cant inc glomerular pressure.

Question 22

ATN can be caused by what agents

Answer 22

Aminoglycosides and Ampho B

Question 23

Acute Interstital nephritis

Answer 23

PCSN, Peniciline, cephalosporin, sulfonamides, NSAIDS

Question 24

Aminoglycosides do what

Answer 24

inhibit normal lysosome function

Question 25

How do you prevent aminoglycoside toxicity

Answer 25

Once daily dose and monitor

Question 26

Contrasts agents are a problem why

Answer 26

vasoconstrictive effects

Question 27

Acute interstitial nephritis- allergy

Answer 27

Fever, rash, eosinophils