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ClinMed II Exam 5 GU/Renal > AKI > Flashcards

AKI Flashcards

1
Q

What is oliguria?

A

Low urine output (<400mL/day)

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2
Q

What is anuria?

A

Failure of kidneys to produce urine (<100mL/day)

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3
Q

What is Azotemia?

A

Buildup of nitrogen waste products in blood (Elevated BUN/Cr)

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4
Q

What is Uremia?

A

Buildup of urea waste products in blood (clinical syndrome w/ worsening renal function)

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5
Q

What is Creatinine?

A

Waste product produced by muscles from breakdown of creatine (filtered by kidneys –> urine)

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6
Q

What is Glomerular filtration rate (GFR)?

A

Amount of blood filtered by glomeruli/min
“estimated GFR”

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7
Q

How does GFR reflect how well kidneys are functioning?

A

Uses serum Cr levels in formula to calculate a #

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8
Q

GFR will generally ______ with increased creatinine

A

Decrease

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9
Q

What is Blood Urea Nitrogen (BUN)?

A

Measure of amount of urea & nitrogen in blood

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10
Q

What is Creatinine Clearance (CrCl)?

A

Amount of creatinine excreted in urine

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11
Q

CrCl is another way to measure what?

A

GFR

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12
Q

What does CrCl compare?

A

Serum and urine creatinine levels in 24 hrs

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13
Q

What is Fractional Excretion of Sodium (FENA)?

A

Measures % of filtered sodium excreted in urine

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14
Q

What is acute kidney injury (AKI) characterized by?

A

Abrupt decrease in kidney function

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15
Q

What does decreased kidney function result in?

A

Waste excretion dysfunction, inability to maintain acid-base balance, fluid/electrolyte imbalance

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16
Q

Evidence of AKI?

A

Change in lab values

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17
Q

Definition of AKI?

A

Absolute increase in serum creatinine by 0.3 mg/dL or more in 48hrs or relative increase of >1.5x baseline, known or presumed to have occurred in 7 days

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18
Q

What are the three categories of AKI?

A

Prerenal, Intrarenal/Intrinsic, Postrenal

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19
Q

AKI accounts for what % of hospital admissions?

A

5%

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20
Q

AKI accounts for what % of hospital admissions?

A

30%

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21
Q

AKI will develop in what % of hospitalized patients?

A

25%

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22
Q

Increased mortality in what type of AKI?

A

Any type

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23
Q

What does the RIFLE classification stand for?

A

Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease

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24
Q

What does the AKIN classification stand for?

A

Acute Kidney Injury Network

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25
Q

What does the KDIGO classification stand for?

A

Kidney Disease: Improving Global Outcomes
*most recent/preferred tool

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26
Q

According to KDIGO, AKI is the presence of what?

A

-Inc. in serum creatinine by >/=0.3 mg/dL w/in 48hrs
-Inc. in serum creatinine to >/= 1.5x baseline (w/in prior 7 days)
-Urine volume <0.5 mL/kg/hr for at least 6 hrs

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27
Q

KDIGO stage 1?

A

Inc. in serum creatinine to 1.5-1.9x baseline
OR
Inc. in serum creatinine by >/= 0.3 mg/dL
OR
Reduction in urine output to <0.5 mL/kg/hr for 6-12 hrs

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28
Q

KDIGO stage 2?

A

Inc. in serum creatinine to 2.0-2.9x baseline
OR
Reduction in urine output to <0.5 mL/kg/hr for >/= 12 hrs

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29
Q

KDIGO stage 3?

A

Inc. in serum creatinine to 3x baseline
OR
Inc. in serum creatinine to >/= 4.0 mg/dL
OR
Reduction in urine output to <0.3 mL/kg/hr for >/= 24 hrs
OR
Anuria for >/= 12 hrs
OR
Initiation of renal replacement therapy
OR Patients <18 yrs, dec. in eGFR to <35 mL/min/1.73M2

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30
Q

Prerenal AKI occurs in response to what?

A

Severe volume depletion w/ nephrons structurally intact (acute drop in BP/shock, interruption of b/f from severe injury/illness)

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31
Q

What occurs in prerenal AKI?

A

GFR decreased (compromised perfusion), Tubular/glomerular function normal

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32
Q

Intrinsic AKI occurs in response to what?

A

Toxins, ischemia, inflammatory insults to kidney w/ structural & functional damage
(drugs, prolonged hypotension, infection, etc.)
***Ischemic injury MC

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33
Q

Intrinsic AKI predominantly affects what part of the kidney?

A

Glomerulus or tubule

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34
Q

Postrenal AKI occurs in response to what?

A

Obstruction to passage of urine (enlarged prostate, kidney stones, tumor, injury)

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35
Q

What occurs in Postrenal AKI?

A

Obstruction causes increased tubular pressure - decreasing filtration force

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36
Q

MC type of AKI overall?

A

Prerenal

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37
Q

Prerenal AKI is characterized by what?

A

Decreased renal perfusion

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38
Q

Causes of Prerenal AKI?

A

-Hypovolemia (bleed, GI loss, dehydration, burns)
-Dec. circulating volume (liver failure, CHF)
-Hypotension (shock, dehydration)
-Embolism, renal artery thrombosis
-NSAIDs, IV contrast (afferent arteriole vasoconstriction)

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39
Q

Prerenal AKI may lead to what if not corrected promptly?

A

Intrinsic injury (acute tubular nercrosis)

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40
Q

Prerenal AKT may rapidly respond to what?

A

Volume repletion

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41
Q

What type of AKT accounts for 50% of cases referred to nephrologists?

A

Intrinsic

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42
Q

Diagnosis of Intrinsic AKT is considered when what other conditions are excluded?

A

Pre/postrenal AKI

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43
Q

What are the three types of intrinsic AKI?

A

-Acute tubular necrosis (destruction/necrosis of tubules)
-Acute interstitial nephritis (inflammatory response)
-Acute Glomerulonephritis (immunologic inflammation of glomeruli)

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44
Q

Most common type of intrinsic AKI?

A

Acute tubular necrosis (destruction/necrosis of tubules)

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45
Q

What are the two main causes of Acute tubular necrosis?

A

Ischemia & nephrotoxin exposure

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46
Q

How can ischemia cause ATN?

A

Prolonged prerenal hypoperfusion,
Inadequate renal b/f leads to poor perfusion causing tubular damage/necrosis

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47
Q

Exogenous nephrotoxins that can cause ATN?

A

Contrast dye***, aminoglycosides, vancomycin, NSAIDs, cyclosporine

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48
Q

Endogenous nephrotoxins that can cause ATN?

A

Tumor lysis syndrome, Rhabdo, Lymphoma, Leukemia, Multiple myeloma

49
Q

Urinalysis for ATN?

A

2+ granular (muddy brown) casts or renal tubular epithelial cells
*strongly predictive

50
Q

How to manage ATN?

A

Remove offender, volume balance

51
Q

Recovery time for ATN?

A

Slower (wks - months)

52
Q

Mechanism of acute interstitial necrosis?

A

Inflammatory or allergic response in the interstitium

53
Q

Most common cause of acute interstitial necrosis?

A

Drug hypersensitivity (70%)
-NSAIDs, PCNs, cephalosporins, sulfa drugs, diuretics, phenytoin

54
Q

Other causes of acute interstitial necrosis?

A

-15% of cases caused by infection:
Strep, CMV, RMSP, histoplasmosis
-8% idiopathic
-6% autoimmune (SLE, sarcoidosis, sjorgen’s)

55
Q

Clinical features of acute interstitial necrosis?

A

Fever, eosinophilia, maculopapular rash, arthralgia

56
Q

Urinalysis of acute interstitial necrosis?

A

WBC casts, eosinophilia

57
Q

Postrenal AKI is also known as what?

A

Obstructive uropathy

58
Q

Postrenal AKi is characterized by what?

A

Obstruction of urine output: BPH, Cancer (bladder, prostate), Renal calculi, trauma

59
Q

What is the least common cause of AKI (5-10%)?

A

Postrenal AKI

60
Q

Postrenal AKI symptoms?

A

Usually asx
May have change in urine output, HTN, rarely have pain

61
Q

Management of postrenal AKI?

A

Removal of obstruction (often readily reversible if correctly quick)

62
Q

Clinical manifestations of AKI may be related to what?

A

Azotemia or underlying cause/condition

63
Q

Overall signs/sx of AKI?

A

May be asx/found incidentally or have sx of: dec. urine output, hematuria, CP/arrhythmias, platelet dysfunction, pericardial effusion, SOB, AMS, seizes/coma (severe cases), peripheral edema, fatigue, N/V, malaise

64
Q

Physical exam for skin in AKI may reveal what?

A

Butterfly rash, digital ischemia, palpable purpura, track marks

65
Q

Physical exam for eyes in AKI may reveal what?

A

Iritis, uveitis, icteric sclera, signs of: HTN, DM

66
Q

Physical exam for ears in AKI may reveal what?

A

Hearing loss

67
Q

Physical exam for cardiovascular in AKI may reveal what?

A

Pericardial friction rub, JVD, S3 sound, edema, irreg. rhythm

68
Q

Physical exam for pulm in AKI may reveal what?

A

Rales

69
Q

Physical exam for abdomen in AKI may reveal what?

A

Pain, CVA tenderness

70
Q

Physical exam for GU in AKI may reveal what?

A

Pelvic/rectal mass, bladder distention, enlarged prostate

71
Q

What may be included in H&P for AKI?

A

Fluid status, inpatient setting, Meds, prior labs, comorbidities, IV contrast exposure

72
Q

CBC for AKI may reveal what?

A

Leukocytosis, anemia, platelet dysfunction

73
Q

Electrolytes for AKI may reveal what?

A

hyperkalemia, hyperphosphatemia

74
Q

Hallmarks of AKI in renal function tests (BMP, CMP)?

A

Increased serum Cr and BUN
*But do not distinguish AKI vs. CKD
*often incidental finding

75
Q

BUN:CR ratio suggestive of prerenal AKI?

A

> 20:1

76
Q

GFR in AKI is ______?

A

Decreased

77
Q

CrCl in AKI is _______?

A

Decreased

78
Q

GFR and CrCl both rely on what to measure kidney function?

A

Serum creatinine levels

79
Q

eGFR uses factors such as _____, ______, _____ to help estimate GFR?

A

Age, gender, race

80
Q

Formulas available to calculate estimated CrCl?

A

Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)

81
Q

Serology for AKI may reveal what?

A

Autoimmune etiologies if present

82
Q

ABG for AKI may reveal what?

A

Metabolic acidosis

83
Q

What does fractional excretion of sodium (FENA) measure?

A

% of Na filtered by the kidney that is excreted in urine
*has limitations

84
Q

Preferred test to help distinguish between prerenal vs ATN AKI?

A

FENA
in Prerenal: <1%
in ATN: >2%

85
Q

FENA calculation?

A

(Urine Sodium/Serum Sodium) divided by
(Urine Creatinine/Serum Creatinine) x100

86
Q

What is visual urinalysis?

A

Gross inspection of color (cloudy, concentrated, red, clear, etc)

87
Q

Dipstick urine analysis for provides a rapid assessment of what?

A

Urine characteristics using: pH, spec. gravity, protein, hemoglobin, glucose, ketones, bilirubin, nitrites, leukocyte esterase

88
Q

What does microscopic urinalysis of urine sediment allow?

A

Confirmation/clarification of dipstick results and identifies structures that dipsticks cannot

89
Q

What are urinary casts?

A

Tube-shaped structures from accumulation of proteins w/in renal tubule
*characteristic findings of casts strongly suggestive of certain diagnoses

90
Q

What favors urinary cast formation?

A

Decreased: urine flow, urin pH
Increased: urine salt concentration

91
Q

What type of casts in CRF?

A

Waxy or broad

92
Q

What type of casts in pre-renal AKI?

A

Hyaline

93
Q

What type of casts in Acute tubular necrosis (intrinsic AKI)?

A

Muddy brown

94
Q

What type of casts in Allergic interstitial nephritis (intrinsic AKI)?

A

Urine eosinophils

95
Q

What type of casts in Glomerulonephritis (Nephritic)(intrinsic AKI)?

A

RBC

96
Q

What type of casts in Glomerulonephritis (Nephrotic)(intrinsic AKI)?

A

Fat oval bodies

97
Q

What type of casts in post-renal AKI?

A

Normal or red/white cells, crystals

98
Q

EKG in AKI may reveal what?

A

Peaked T-waves, PR prolongation, QRS widening in hyperkalemia

99
Q

Initial imaging test for signs of obstruction/hydronephrosis in AKI?

A

renal US

100
Q

What scan can be used if renal/ureteral calculi are suspected?

A

Non-contrast CT

101
Q

Is renal biopsy routine for AKI?

A

No
May be used if results will change the tx, if noninvasive strategies unable to diagnose

102
Q

Treatment for AKI is mostly _________

A

Supportive

103
Q

Goals of AKI treatment?

A

Hemodynamic stability, fluid/electrolyte balance, d/c nephrotoxic agents, adjust meds if needed

104
Q

Treatment regimen for prerenal AKI?

A

Optimize renal perfusion & cardiac function: Volume repletion (rapid response)
-Packed RBCs if blood loss
-IV fluids for dehydration
-Avoid fluid overload & hyperkalemia

105
Q

Treatment regimen for intrinsic AKI?

A

Tx underlying cause
-remove offending agents
-immunosuppressive agents
-plasmapheresis (removing plasma from blood via centrifuge and re-infusion for autoimmune dz)

106
Q

Treatment regimen for postrenal AKI?

A

Identify/remove cause of obstruction:
-catheterization
-nephrostomy tube
-ureteral stent/lithotripsy

107
Q

Dialysis is also known as what?

A

Renal replacement therapy (RRT)

108
Q

How many modalities for dialysis?

A

many

109
Q

Hemodialysis is most commonly used where?

A

the U.S.

110
Q

What does dialysis entail?

A

Filtering waste from blood when kidneys cannot
-Machine connected to large vein –> filters blood –> returns blood to large artery

111
Q

What are the “AEIOU” indications for dialysis?

A

Acidosis (severe metabolic)
Electrolyte abnormalities (uncontrolled hyperkalemia)
Intoxications/ingestions (overdose of meds)
Overload (severe fluid overload)
Uremia s/sx (pericarditis, encephalopathy, unexplained decline in MS)

112
Q

AKI prognosis is variable depending on what?

A

duration, degree of recovery, recurrence

113
Q

AKI carries a risk of progression to what?

A

CKD/ESRD

114
Q

Which types of AKI carry better prognosis?

A

Prerenal and postrenal AKI

115
Q

Does AKI increase mortality?

A

Yes

116
Q

Which population has a 40-50% mortality rate with AKI?

A

Hospitalized pts w/ AKI

117
Q

Which population has a >50% mortality rate with AKI?

A

ICU pts w/ AKI

118
Q

What can improve outcomes in AKI?

A

Nephrology referral

119
Q

Post-AKI requires what surveillance?

A

Nephrology surveillance

ClinMed II Exam 5 GU/Renal (4 decks)

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