AKI

Question 1

What is Acute Kidney Injury (AKI)?

Answer 1

AKI is a rapid reduction in kidney function characterized by loss of kidney function over hours to days, with accumulation of nitrogenous waste, water, electrolyte, and acid-base abnormalities.

Question 2

What is the old term for AKI and why is it no longer used?

Answer 2

The old term for AKI is ‘Acute Renal Failure.’ It is no longer used as it implies irreversibility and causes anxiety for patients.

Question 3

What are the key functions affected in AKI?

Answer 3

Functions affected in AKI include excretion of extracellular fluid, regulation of electrolytes, acid-base balance, bicarbonate absorption, and waste excretion.

Question 4

What are the markers of AKI?

Answer 4

Markers of AKI include serum creatinine (a breakdown product of creatine phosphate) and blood urea nitrogen (BUN, a product of protein metabolism).

Question 5

Why is creatinine not a precise marker for kidney function?

Answer 5

Creatinine is not precise as it depends on muscle mass, gender, and age, and may also be influenced by drugs or tubular secretion competition.

Question 6

What is Azotemia?

Answer 6

Azotemia refers to the buildup of nitrogenous wastes in the blood, indicated by high BUN.

Question 7

What is Uremia?

Answer 7

Uremia is a clinical diagnosis of symptoms and signs of organ dysfunction due to retention of uremic toxins, such as encephalopathy and pericarditis.

Question 8

What are the KDIGO criteria for diagnosing AKI?

Answer 8

KDIGO criteria include an increase in serum creatinine by 0.3 mg/dL within 48 hours or a 50% increase within 7 days, or urine output <0.5 mL/kg/hour for 6 hours.

Question 9

What are the stages of AKI?

Answer 9

AKI stages range from 1 (mild) to 3 (severe), based on creatinine rise and urine output reduction, with higher stages linked to greater mortality risk.

Question 10

What are the three classifications of AKI etiologies?

Answer 10

The classifications are Prerenal (due to reduced renal perfusion), Intrinsic (due to direct kidney damage), and Postrenal (due to obstruction of urine flow).

Question 11

What is Prerenal AKI?

Answer 11

Prerenal AKI occurs due to reduced renal perfusion, commonly caused by dehydration, NSAIDs, or renal artery stenosis.

Question 12

What is Intrinsic AKI?

Answer 12

Intrinsic AKI involves direct kidney damage, including glomerulonephritis, tubular injury, and interstitial nephritis.

Question 13

What is Postrenal AKI?

Answer 13

Postrenal AKI results from obstruction to urine flow, such as by kidney stones, tumors, or prostate hyperplasia.

Question 14

What are common causes of Prerenal AKI?

Answer 14

Common causes of Prerenal AKI include dehydration, hemorrhage, NSAIDs, and renal artery stenosis.

Question 15

What are common causes of Intrinsic AKI?

Answer 15

Intrinsic AKI causes include acute tubular necrosis (ischemic or nephrotoxic), glomerulonephritis, and interstitial nephritis.

Question 16

What are common causes of Postrenal AKI?

Answer 16

Postrenal AKI causes include bladder outlet obstruction, urethral obstruction, and stones in the urinary tract.

Question 17

What is the Cardiorenal Syndrome and how is it managed?

Answer 17

Cardiorenal Syndrome is acute heart failure causing AKI, managed with inotropes (e.g., dobutamine) and diuretics for fluid overload.

Question 18

What is Hepatorenal Syndrome and its management?

Answer 18

Hepatorenal Syndrome involves AKI with liver failure, managed with albumin, midodrine, and octreotide, with definitive treatment being a liver transplant.

Question 19

What is Acute Tubular Necrosis (ATN)?

Answer 19

ATN is tubular cell death caused by ischemia, nephrotoxins, or pigment nephropathy, managed by treating the underlying cause.

Question 20

What is Acute Interstitial Nephritis (AIN)?

Answer 20

AIN is inflammation of kidney interstitium caused by drugs (e.g., NSAIDs, PPIs) or systemic diseases (e.g., SLE), managed by stopping the offending drug and using steroids.

Question 21

What are the indications for renal replacement therapy in AKI?

Answer 21

Renal replacement therapy is indicated for AKI with severe electrolyte disturbances, fluid overload, or uremic symptoms.