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nephrology > AKI > Flashcards

AKI Flashcards

1
Q

definition of AKI

A

rapid decrease in GFR (50%) in one week w/ increased creatinine & BUN

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2
Q

what stage of AKI?

baseline serum Cr increase 1.5 to 1.9x
serum Cr increase by 0.3 mg/dl in 48h OR
urine output under 0.5 ml/kg/hr for 6 hrs

A

stage 1

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3
Q

what stage of AKI

baseline serum Cr increase 2-2.9x
OR
urine output under 0.5 ml/kg/hr for 12 hrs

A

stage 2

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4
Q

what stage of AKI

baseline serum Cr increase 3x
serum Cr increase over 4.0 mg/dl
started on renal replacement therapy OR
urine output under 0.3 ml/kg/hr for 24 hrs; anuric for 12 hrs

A

stage 3

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5
Q

what is the difference between azotemia and uremia? which of the two is the indication to start dialysis

A
  • azotemia is nitrogen waste accumulation while uremia is when there is organ dysfunction d/t uremic toxin retention (aka symptomatic renal failure)
  • uremia is an indication to start dialysis
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6
Q

differentiate oliguria and anuria

A
  • oliguria is under 500ml in 24 hrs
  • anuria is under 100ml in 24 hrs
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7
Q

3 categories of causes of AKI

A

intrinsic: ATN, AIN, GN (damage to particular parts)
prerenal: decreased renal perfusion (so kidney decreases filtration in response)
postrenal: urinary obstruction

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8
Q
  • prostatic hypertrophy is most common cause in older men
  • increased serum Cr w/ bilateral involement
  • postvoid residual over 100mL
  • US usually first imaging choice to evaluate for this
A

postrenal azotemia

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9
Q

how does the nephron operate in a prerenal state

A
  • low kidney perfusion causes increased resorption of NaCl, water, Urea into the blood
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10
Q

5 general etiologies of prerenal AKI

A
  • hypovolemia– V/D, less PO intake, diuretics, etc
  • impaired cardiac function– CHF
  • peripheral vasodilation– sepsis, liver failure
  • renal vasoconstriction– NSAIDs, iodinated contrast, hyperCa, calcineurin inhibitors
  • renal vascular obstruction– renal artery stenosis
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11
Q

what two class of meds causes impaired glomerular autoregulation? how?

A

NSAID– causes Afferent vasoconstriction which decreases both renal blood flow & filtration pressure
ace/arb– causes Efferent vasodilation which increases renal blood flow but decreases net filtration pressure

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12
Q
  • most common type of intrinsic AKI
  • acute destruction & necrosis of renal tubules of the nephron
A

ATN (acute tubular necrosis)

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13
Q

differentiate ischemic from toxic ATN

A

ischemic is d/t prolonged/severe prerenal azotemia
toxic can be either exogenous (meds) or endogenous (pigments like rhabdo, tumor lysis syndrome, etc)

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14
Q

which ATN toxin causes oliguria in 58-72 hrs?
which one is non-oliguric in 5-7 days?

A
  • oliguric is radiocontrast dye
  • non oliguric is aminoglycosides
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15
Q

which ATN toxin causes hemoglobinuria w/o RBC? which one causes hypokalemia/magnesemia?

A
  • hemoglobinuria w/o RBC is rhabdo
  • hypokalemia/magnesemia is amphotericin
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16
Q

UA shows muddy brown (granular) or epithelial cell casts; low specific gravity

what is the condition

A

ATN

17
Q

urine Na & FeNA of prerenal vs ATN?

A
  • prerenal: low (under 20) Na, FeNa < 1%
  • ATN: high (over 40) Na, FeNa > 2%
18
Q

how does prerenal vs ATN respond to volume replacement tx?

A

creatinine improves fast in prerenal with IVF! w/ ATN it doesnt improve much

19
Q

what is the condition?

  • AKI in setting of medication use w/ sparing of glomeruli & blood vessels
  • 5-14 days
  • (transient maculopapular) rash, fever, eosinophilia
  • white cell casts (eosinophiluria) or white cells (sterile pyruria w/ (+) leukocyte esterase)

* non med causes are less common- cancer, infection, autoimmune, etc

A

Acute interstitial nephritis (AIN)

20
Q

what type of AKI?

  • rare but very serious– urgent renal referral & biopsy
  • lupus, IgA, ANCA, AntiGBM
  • HTN, hematuria, edema, fever, etc.
  • RBC casts & proteinuria
A

acute glomerulonephritis (AGN)– a type of intrinsic AKI

21
Q

4 main groups of meds associated w/ AIN

A
  • Abx: PCN, sulfa, ceph., cipro.
  • PPI
  • NSAIDs
  • chemotherapy
22
Q

the following elements of P.E matches what diagnosis of AKI

  • hypotension
  • rales, S3, JVD, edema
  • ascites, jaundice
  • POCUS of lungs, heart IVC
A

prerenal AKI on P.E

23
Q

FeNa is less accurate under CKD, diuretic tx, non-oliguria. otherwise if it is BELOW 1%, that means the cause of AKI is….? if ABOVE 1%, it means..?

A

under 1% means prerenal– kidney is holding onto sodium
over 1% means ATN– broken tubules, can’t properly hold onto sodium

24
Q

3 ways to diagnose postrenal/obstruction AKI

A
  • post void residual (false read in obese or ascites)
  • catheter insertion
  • renal US– most used; more info
25
Q

list 5 specific indications to start dialysis

A
  • metabolic acidosis
  • K+ over 6
  • intoxicants– toxic EtOH, lithium, metformin
  • fluid overload
  • Uremia (not azotemia)– pericarditis, progressive encephalopathy
  • refractory to meds

nephrology (13 decks)

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