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Clin Med- Renal/GU > acute renal failure > Flashcards

acute renal failure Flashcards

1
Q

AKI/ARF Epidemiology

A

1% of patients admitted to hospitals have acute kidney injury (AKI) at the time of admission
Incidence rate of AKI is ~ 2-5% during hospitalization
67% of ICU patients

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2
Q

Nephritic disease are characterized by what?

A

by the presence of an active urine sediment with glomerular hematuria and often with proteinuria

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3
Q

Nephrotic disease is characterized by?

A

proteinuric with bland urine sediments (no cells or cellular cast

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4
Q

prognosis for AKI/ ARF

A

12.5% of survivors of AKI are dialysis dependent
19-31% of them have chronic kidney disease
Stage 3 AKI in patients with advanced CKD – mortality rate 40.7%

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5
Q

Pathophys of AKI/ ARF

A

Initial ischemic insult triggers a cascade
Events continue to cause cell injury even after restoration of RBF
Tubular cellular damage results in disruption of tight junctions between cells, allowing back leak of glomerular filtrate
Dying cells slough off into the tubules, forming obstructing casts, further decreasing GFR

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6
Q

Risk factors for AKI/ARF

A 
Hypertension
Congestive cardiac failure
Diabetes
Multiple myeloma
Chronic infection
CHF
blood loss
exposure
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7
Q

Prerenal Failure symptoms

A

thirst, decreased urine output, dizziness & orthostatic hypotension
mental status change–> elderly
advanced cardiac failure leading to depressed renal perfusion may present with orthopnea and paroxysmal nocturnal dyspnea
Insensible fluid losses can result in severe hypovolemia

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8
Q

ATN (acute tubular necrosis) should be suspected after period of what?

A

hypotension secondary to cardiac arrest, hemorrhage, sepsis, drug overdose, or surgery
Exposure to nephrotoxins

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9
Q

what 3 symptoms indicates glomerular etiology

A

Hematuria, edema, and HTN indicates

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10
Q

Suspect pigment-induced AKI is who?

A

in patients with possible rhabdomyolysis or hemolysis

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11
Q

Suspect allergic interstitial nephritis with what symptoms?

A

with fevers, rash, arthralgias, and exposure to certain medications (NSAIDs)

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12
Q

Postrenal failure

A

Older men with prostatic obstruction
gynecologic surgery or abdominopelvic malignancy
Flank pain & hematuria - possible renal calculi or papillary necrosis
tubular obstruction by crystals

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13
Q

Skin Physical exam for AKI/ARI

A

Livido reticularis, digital ischemia
Systemic vasculitis - butterfly rash, palpable purpura
Maculopapular rash - Allergic interstitial nephritis
Track marks Endocarditis
Petechiae, purpura

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14
Q

Eye physical exam for AKI/ ARI

A 
jaundice
kerititis
uveitis
signs of DM or HTN
ocular palsy
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15
Q

Pulm and ear physical exams for AKI/ ARI

A

hearing loss
rales
hematoptysis

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16
Q

cardiovascular exam for AKI/ ARI

A

murmurs
JVP
rales
volume status is very important– BP, pulse, edema

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17
Q

Signs of Nephrologic Disease (6)

A

reduction in glomerular filtration rate (GFR) (azotemia)
abnormalities of urine sediment
abnormal excretion of serum proteins (proteinuria)
disturbances in urine volume
presence of hypertension and/or expanded total body fluid volume (edema)
electrolyte abnormalities

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18
Q

What are the 2 hallmarks of renal failure?

A

BUN and creatinine elevations

BUN to creatinine can exceed 20:1

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19
Q

What needs to be ruled out if serum creatinine increases to more than 1.5 mg/dL/d

A

serum creatinine increases to more than 1.5 mg/dL/d, rhabdomyolysis must be ruled out

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20
Q

What are 3 specific findings based on etiology for AKI/ARF

A

Myoglobin or free hemoglobin
Increased serum uric acid level
Serum lactate dehydrogenase

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21
Q

What do serological tests show for glomerular disease

A

antinuclear antibody (ANA), ANCA, anti-GBM antibody, hepatitis, and antistreptolysin (ASO) & complement levels

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22
Q

urinanalysis results suggest the presence of myoglobin or hemoglobin

A

Reddish brown or cola-colored urine suggests the presence of myoglobin or hemoglobin

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23
Q

What urinanalysis results would be suggestive of tubular necrosis?

A

granular, muddy-brown casts

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24
Q

What results are suggestive of glomerular inflammation?

A

Dysmorphic RBCs or RBC casts

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25
Q

What results would suggest pyelonephritis or acute interstitial nephritis

A

WBCs or WBC casts

26
Q

What suggests interstitial nephritis

A

eosinophils, as visualized with Wright stain or Hansel stain

27
Q

What are Calcium oxalate crystals usually present in?

A

ethylene glycol poisoning

28
Q

FENa is useful only in what?

A

may detect extreme renal avidity for sodium

useful only in the presence of oliguria

29
Q

Exceptions to the rule (FENa

A

Diuretics within the previous 24 hours
Glucosuria
Metabolic alkalosis w/ high urinary bicarbonate, obligatory loss of Na
Chronic kidney disease with a high baseline Naexcretion

30
Q

GFR is related to what?

A

directly to the urine creatinine excretion and inversely to the serum creatinine (UCr/PCr)

31
Q

Patients that have a bladder pressure of what should be suspected of having AKI

A

bladder pressures > 25 mm Hg should be suspected of having AKI as a result of abdominal compartment syndrome

32
Q

Ultrasonography is useful for what?

A

Useful for evaluating existing renal disease and obstruction

showing small kidneys suggest chronic renal failure

33
Q

Doppler ultrasonography

A

useful for detecting the presence & nature of renal blood flow
used to diagnose thromboembolic or renovascular disease

34
Q

What are nuclear scans used for?

A

assess renal blood flow & tubular functions

Usefulness limited due to marked delay in tubular excretion of radionuclide in prerenal & intrarenal disease

35
Q

Renal Biopsy

A

In 40% of cases renal biopsy reveal an unexpected diagnosis

Acute cellular or humoral rejection in a transplanted kidney can be definitively diagnosed only by renal biopsy

36
Q

What do you correct severe acidosis with?

A

with bicarbonate administration can be important as a bridge to dialysis

37
Q

Dietary modification for AKI/ARF

A

Salt and fluid restriction in oliguric renal failure (unable to excrete toxins or fluids)
Potassium and phosphorus are not excreted optimally in patients with AKI, blood levels of these electrolytes tend to be high

38
Q

What is furosemide inhibit?

A

sodium and chloride reabsorption in the thick ascending loop of Henle and the distal renal tubule

39
Q

Nifedipine

A

relaxes smooth muscle and produces vasodilation, improves blood flow and oxygen delivery

40
Q

Indications for dialysis in patients with AKI (5)

A

Volume expansion that cannot be managed with diuretics
Hyperkalemia refractory to medical therapy
Correction of severe refractory acid-base disturbances
Severe azotemia (BUN >80-100)
Uremia

41
Q

prerenal AKI/AFI

A

Most common form of kidney injury
decreased renal perfusion
volume loss
hepatorenal syndrome

42
Q

volume depletion can be caused by?

A 
Renal losses (diuretics, polyuria)
GI losses (vomiting, diarrhea)
Cutaneous losses (burns, Stevens-Johnson syndrome)
Hemorrhage
Pancreatitis
43
Q

decreased cardic output can be caused by?

A 
Heart failure
Pulmonary embolus
Acute myocardial infarction
Severe valvular disease
Abdominal compartment syndrome
44
Q

systemic vasodilation can be caused by?

A

Sepsis
Anaphylaxis
Anesthetics
Drug overdose

45
Q

Afferent arteriolar vasoconstriction can be caused by the following

A

Hypercalcemia
Drugs
Hepatorenal syndrome

46
Q

cardiorenal syndrome signs

A

Cardiac dysfunction: signs or symptoms of heart failure, ischemic injury or arrhythmias
Kidney disease: acute or chronic, depending on type of cardiorenal syndrome.

47
Q

cardiorenal syndrome

A

disorder of the heart & kidneys wherein the acute or chronic deterioration of one organ results in the acute or chronic deterioration of the other

48
Q

initiation phase of renal damage

A

ATP depletion resulting in proximal tubule, endothelial, and smooth muscle injury & apoptosis

49
Q

extension phase of renal damage

A

occurs with persistent ischemia, vascular congestion, and ongoing hypoxia

50
Q

What is the hallmark of intrinsic AKI

A

Structural injury in the kidney

ischemic, cytotoxic

51
Q

diagnostic features interstitual nephritis

A

Fever
Transient maculopapular rash
Acute or chronic kidney injury
Pyuria (including eosinophiluria), white blood cell casts, and hematuria
Classic triad of fever, rash, and arthralgias

52
Q

Treatment/ prognosis of interstitual nephritis

A

removal of the inciting agent
Short course of corticosteroids can be given if persistent with removal of agent
Rarely progresses to ESRD

53
Q

acute tubular necrosis for diagnostic findings

A

Acute kidney injury
Ischemic or toxic insult
Urine sediment w/ pigmented granular casts & renal tubular epithelial cells is pathognomonic but not essential

54
Q

Acute Tubular Necrosis Treatment

A

Avoid volume overload and hyperkalemia
Loop diuretics
Intravenous thiazide diuretics to augment urinary output
Nutritional support preventing excessive catabolism

55
Q

Indications for dialysis in AKI from acute tubular necrosis

A

life-threatening electrolyte disturbances
volume overload unresponsive to diuresis
worsening acidosis
uremic complications
In gravely ill patients, less severe but worsening abnormalities may also be indications for dialysis

56
Q

Diagnostic features for renal artery stenosis

A

Produced by atherosclerotic occlusive disease (80–90% of patients) or fibromuscular dysplasia (10–15%)
Hypertension
Acute kidney injury in patients starting ACE inhibitor therapy
May have abdominal bruit

57
Q

What is the gold standard for renal artery stenosis?

A

Renal angiography is the gold standard for diagnosis

58
Q

Renal artery stenosis treatment

A

Medical management, angioplasty with or without stenting, and surgical bypass, intervention may be no better than optimal medical management
Angioplasty
Stenting
Angioplasty as effective and safer than surgery

59
Q

Angioplasty reduces what?

A

reduces antihypertensive medications; no change in progression of kidney dysfunction

60
Q

nephritic syndrome

A 
HTN
cola colored urine
oliguria
inflammation of the glomeruli
IgA= MC of primary glomerulonephritis
61
Q

nephrotic

A

hypoalbuminemia
hyperlipidemia
peripheral edema
massive proteinuria

Clin Med- Renal/GU (7 decks)

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