AKD Flashcards
SEVERITY
- asymptomatic
- fatal
- sudden
- Renal function
- Retention of nitrogenous wastes
AKD
duration of AKD
- acute
- chronic
Categories of Acute Kidney Injury
- Hypovolemia
- Decreased cardiac output
- Decreased effective circulating vol
+ Congestive heart failure
+ Liver failure - Impaired renal autoregulation
+ NSAIDs
+ ACE-VARB
+ Cyclosporine
PRERENAL
Categories of Acute Kidney Injury
INTRARENAL
- Glomerular
+ Acute glomerulonephritis - tubules and interstitium= sepsis/ infection, ischemia, Nephrotoxins
- Vascular
+Vasculitis
+ Malignant hypertension
+ TTP-HUS
Categories of Acute Kidney Injury
POSTRENAL
- Bladder outlet obstruction
- Bilateral pelvoureteral obstruction (or unilateral obstruction of a solitary functioning kidney)
Factors that affect the autoregulatory response:
- Atherosclerosis
- Age
- long standing hypertension
- SBP <80 mm Hg
narrowing and
impaired vasodilation
Hyalinosis and myointimal
hyperlasia
ecreased perfusion pressure in the presence of NSAIDs
- Decreased vasodilatory prostaglandins
- increased angiotensisn II
creased perfusion pressure in the presence of ACE-I or ARB
- slightly increased vasodilatory prostaglandins
- decreased angiotensin II
- Arterial vasodilation in the splanchnic circulation despite volume overload
- Reduced systemic vascular resistance
- Vasoconstriction: Hypovolemia
HEPATORENAL SYNDROME
perturbations in the microcirculation
occlusion of small vessels
HYPOXIA
directly
generation of free radicals
CYTOTOXIC DAMAGE
Nephrotoxins: Antibiotics
Exogenous:
high trough levels
Vancomycin
Nephrotoxins: Antibiotics
Exogenous:
both cause tubular necrosis
(vasoconstriction and direct tubular injury)
Aminoglycosides & Amphotericin B
Nephrotoxins: Antibiotics
Exogenous:
tubular obstruction
Acyclovir
Nephrotoxins: Antibiotics
Endogenous
- intrarenal vasoconstriction,
- direct proximal tubular toxicity
- mechanical obstruction
- Intratubular crystals
Intrinsic: Glomerulonephritis
- glomerular podocytes
- mesangium
- endothelial cells
Where is WBC cast found in urinary?
Distal
Where is Epithelial cell cast found in urinary?
Distal
Where is hyaline cast found in urinary?
Loop of Henle
History of poor fluid intake or fluid
loss (hemorrhage, diarrhea, vomiting, sequestration into extravascular
space); NSAID/ACE-I/ARB; heart failure;
evidence of volume depletion (tachycardia, absolute or postural hypotension, low jugular Venous pressure,
dry mucous membranes), decreased ffective circulatory volume (cirrhosis,
heart failure)
Prerenal azotemia
- BUN/creatinine ratio above 20,
-FeNa <1%, - hyaline casts in urine sediment,
- urine specific gravity >1.018,
- urine osmolality >500 mOsm/kg
Prerenal azotemia
epsis, sepsis syndrome, or septic
shock. Overt hypotension not always
seen in mild to moderate AKI
Sepsis-associated AKI