ACUTE KIDNEY INJURY AND RELATED SYNDROMES Flashcards
What is the definition of Acute Kidney Injury (AKI)?
Sudden decrease in kidney function over hours to days.
What are the three main causes of Acute Kidney Injury (AKI)?
- Prerenal: Hypovolemia, heart failure, liver disease
- Intrinsic: Acute tubular necrosis (ATN), glomerulonephritis, interstitial nephritis
- Postrenal: Obstruction (e.g., stones, tumors)
What criteria are used for the diagnosis of AKI?
- RIFLE
- AKIN
- KDIGO criteria
- Biomarkers: Cystatin C, NGAL, KIM-1
What is the primary management strategy for AKI?
- Fluid resuscitation: Isotonic saline
- Avoid nephrotoxins: NSAIDs, contrast agents
- Dialysis: Indicated for severe cases (hyperkalemia, acidosis, fluid overload)
What is Sepsis-Associated AKI (SA-AKI)?
AKI in the setting of sepsis.
What are the pathophysiological changes in Sepsis-Associated AKI?
- Hemodynamic changes: Renal vasoconstriction, microcirculatory dysfunction
- Inflammatory mediators: Cytokines, oxidative stress
What is a key management strategy for Sepsis-Associated AKI?
- Early goal-directed therapy: Fluids, vasopressors, antibiotics
What is Rhabdomyolysis?
Muscle injury leading to myocyte necrosis and release of intracellular contents.
List some causes of Rhabdomyolysis.
- Trauma
- Excessive exercise
- Drugs (statins, alcohol)
- Infections
What are the management strategies for Rhabdomyolysis?
- Fluid resuscitation: Aggressive hydration with isotonic saline
- Alkalinization: Sodium bicarbonate (controversial)
- Dialysis: For severe hyperkalemia, acidosis, or fluid overload
What is Contrast-Induced Nephropathy (CIN)?
AKI following administration of iodinated contrast media.
What are the risk factors for Contrast-Induced Nephropathy (CIN)?
- CKD
- Diabetes
- High contrast volume
- Hypotension
How can Contrast-Induced Nephropathy (CIN) be prevented?
- Hydration: Isotonic saline (1 mL/kg/hr pre- and post-contrast)
- Avoid nephrotoxins: NSAIDs, ACE inhibitors
- Low-osmolal contrast agents: Preferred in high-risk patients
What is Acute Glomerulonephritis (AGN)?
AKI syndrome with hematuria, proteinuria, and red cell casts.
What are the primary causes of Acute Glomerulonephritis (AGN)?
- Primary: IgA nephropathy, anti-GBM disease
- Secondary: Lupus, vasculitis, post-infectious (e.g., streptococcal)
What is the definitive diagnosis method for Acute Glomerulonephritis (AGN)?
Kidney biopsy.
What management strategies are used for Acute Glomerulonephritis (AGN)?
- Immunosuppression: Steroids, cyclophosphamide, rituximab
- Plasmapheresis: For severe cases (e.g., anti-GBM disease)
What is Hepatorenal Syndrome (HRS)?
Functional AKI in cirrhosis with portal hypertension.
What are the types of Hepatorenal Syndrome (HRS)?
- Type 1: Rapid progression (AKI-HRS)
- Type 2: Chronic, moderate kidney dysfunction
What management strategies are used for Hepatorenal Syndrome (HRS)?
- Vasoconstrictors: Terlipressin, norepinephrine
- Albumin: Volume expansion
- Liver transplant: Definitive treatment
What are the types of Cardiorenal Syndrome (CRS)?
- Type 1: Acute heart failure leading to AKI
- Type 2: Chronic heart failure leading to CKD
- Type 3: AKI leading to acute heart failure
- Type 4: CKD leading to heart failure
- Type 5: Systemic disease causing both heart and kidney dysfunction
What are common nephrotoxic drugs?
- NSAIDs
- ACE inhibitors/ARBs
- Contrast agents
- Statins
- Proton pump inhibitors (PPIs)
What is a key point regarding the management of nephrotoxicity?
Discontinue offending drug.
True or False: AKI is multifactorial.
True
