Acute Renal Failure

Question 1

AKI definitions

Answer 1

1.Increase in S.Cr by≥ 0.3 mg/dl(≥26.5
micromol/l) within 48 hours or
2.increase in S.Cr to ≥ 1.5 times of baseline ,
which is known or presumed to have
occurred within the prior 7 days or
3.Urine volume < 0.5 ml/kg/hr for 6 hours

Question 2

AKI is reversible (T/F)

Answer 2

True

Question 3

AKI develops within hours (T/F)

Answer 3

True

Question 4

MCC of AKI

Answer 4

ATN

Question 5

Mechanisms of AKI

Answer 5

 Tubular damage
 Interstitial damage
 Blood vessel damage (vasculitis)
 Glomerular damage

Question 6

fully reversible damages causing AKI

Answer 6

Tubular damage

Question 7

Causes of AKI

Answer 7

Pre - renal failure
Intrinsic failure
Post- renal failure

Question 8

types of pre renal failure

Answer 8

systemic - heart failure, blood or fluid loss
Local- renal artery occlusion/ stenosis

Question 9

types of intrinsic renal failure

Answer 9

ATN
glomerular disease

Question 10

types of post- renal failure

Answer 10

Obstruction - prostate enlargement, cervical CA

Question 11

Intrinsic renal failure can also occur from

Answer 11

uncorrected pre- renal and post- renal failure

Question 12

Polyuric ARF cause

Answer 12

transient tubular damage

Question 13

Polyuric ARF does not need dialysis (T/F)

Answer 13

false. 20% of cases require

Question 14

Serum K levels trend on AKI

Answer 14

Keeps increasing on the oliguric phase and plateaus and reduces in the polyuric phase

Question 15

Creatinine levels trend on AKI

Answer 15

Keeps on increasing from the oliguric phase and to polyuric phase

Question 16

UOP in AKI trend

Answer 16

reduces and becomes almost anuric and becomes polyuric

Question 17

Oliguria

Answer 17

<400cc/d

Question 18

Anuria level

Answer 18

<100cc/d

Question 19

Fluid challenge in AKI

Answer 19

Patient with a russel’s viper bite. No UOP for 6hours. BP is 110/60. JVP is not elevated. Lungs are clear. Patient says he hasn’t taken any fluids since the bite because he was scared. We don’t know if his no UOP for 6hours is due to renal or renal AKI. To find that, we give fluids in a carefully monitored rate. If it’s renal AKI, patient will show fluid overload Sx (Increased JVP, crepts in lungs)
If it’s a pre-renal AKI , the patient will have UOP.

Question 20

Sr.Cr is high even in polyuric phase (T/F)

Answer 20

True

Question 21

Why is there a poluyric phase in AKI

Answer 21

New tubular cells cannot concentrate urine yet.

Question 22

Parameters of oliguric phase

Answer 22

 Fluid overload
 Acidosis
 Increased potassium
 Increased blood urea/ creatinine
(uraemia)

Question 23

Indications for urgent dialysis

Answer 23

 Acidosis
 Hyperkalaemia
 Fluid overload with pulmonary
oedema
 Rapidly rising serum creatinine
 A high absolute value of serum
creatinine
 Presence of uraemic encephalopathy

Question 24

parameters of Polyuric phase in AKI

Answer 24

 Hypovolaemia
 Hypokalaemia
 Hyponatraemia
 Treatment is symptomatic

Question 25

AKI prognosis depends on

Answer 25

the number of organs involved
pre- morbid function of the kidneys