AKI

Question 1

What is the testing algorithm for AKI?

Answer 1

Look for:
Prerenal
Postrenal
Intrarenal

Question 2

What do all forms of AKI cause?

Answer 2

Azotemia (increased BUN) and increased Creatinine

Question 3

What are some causes of postrenal azotema?

Answer 3

BPH
prostate cancer
Urethral stricture
Bilateral compression (pelvic cancer, stones)

Question 4

How do you diagnose Post renal AKI?

Answer 4

Catherization
RENAL U/S
> 100 mL bladder

Question 5

How do you treat postrenal AKI?

Answer 5

Catherization

Treat underlying cause

Question 6

What do you see in early obstruction?

Answer 6

Tubules still intact

FENa

Question 7

What do you see in long standing obstruction

Answer 7

Tubules start to die
Decreased BUN reabsorption
- Decreased sodium reabsorption (FENa >2%)

Question 8

What causes pre-renal azotemia?

Answer 8

Decreased blood flow

- Dec. GFR, azotemia, oliguria

Question 9

What are some diseases seen in prerenal?

Answer 9

Volume depletion
Low CO
CIrrhosis
Sepsis
Nsaids
Cyclosporine
ACEIs
ARBs

Question 10

What do you check in prerenal?

Answer 10

Check Orthostatics

• CBC
• BMP
• FENa
• FEUrea if on (diuretics)

Question 11

How does ANG-II affect kidney blood flow?

Answer 11

Ang-II preferentially vasoconstricts EFFERENT ARTERIOLE

Question 12

Prostaglandins released due to Inc. sympathetics affect which part of Renal BF?

Answer 12

Causes afferent vasodilation

Question 13

NSAIDs + Cyclosporins preferentially vasoconstrict which part of renal vasculature?

Answer 13

Afferent arteriole

Question 14

ACE inh and ARBs vasodilate which part of the renal circulation?

Answer 14

Efferent arteriole (Blocks Ang-II)

Question 15

What does the RAAS system do?

Answer 15

Increased aldosterone causes increased Na absorption

- Increased urea/NH4 reabsorption

Question 16

IF the tubules are intact what would be the FENa in dehydrated people?

Answer 16

FENa

Question 17

What are the BUN:CR of Prerenal?

Answer 17

> 20

Question 18

What is the FENa of prerenal?

Question 19

What is the FEUrea of PreRenal?

Question 20

What is the Urine Osm of Prerenal?

Answer 20

Urine Osm

Question 21

What will the SG of PreRenal be?

Answer 21

SG >1.020

Question 22

What is the BUN:Cr of Intra-Renal?

Question 23

What is the FENa of IntraREnal?

Answer 23

> 2%

Question 24

What is the FEUrea of intrarenal?

Answer 24

> 55%

Question 25

What is the Urine Osm of INtra-Renal?

Question 26

How does contrast cause prerenal aki?

Answer 26

Vasoconstricts plus Toxic

Question 27

What can cause ATN?

Answer 27

``` Prolonged Ischemia Contrast Toxins - Drugs: AGs, Vanco, amphotericin, cisplatin - Endogenous: Hbg, myoglobin - Light chain - Crystals ```

Question 28

What causes AIN?

Answer 28

Allergic: B-lactams, sulfa, NSAIDs, PPIs

Question 29

What types of vasculitidies?

Answer 29

``` PAN Cholesterol emboli Thrombotic (HUS/TTP/DIC) - Preeclampsia, Antiphospholipid syndrome - Malignant HTN - Scleroderma renal crisis ```

Question 30

What do you see in AIN and Vasculitis?

Answer 30

Urine Eosinophils (antibiotics and Chol. Emboli)

Question 31

How do you treat ATN?

Answer 31

Supportive - Severe: dialysis Takes 1-2 weeks for ATN to resolve

Question 32

How do you diagnose ATN?

Answer 32

Injury + Necrosis of tubular

Question 33

What do you see on Histo?

Answer 33

Cells detached from BM - Necrotic debris forms casts - Tubular dilation + flattening of epithelial cells - UA: Brown granular casts, Heme 4+, NO RBCs: Hbg, Myoglobin

Question 34

Whats the clinical triad of AIN?

Answer 34

Oliguria, FEVER, Rash (days to weeks after drug)

Question 35

How do you treat AIN?

Answer 35

Stop Drug | - STEROIDS

Question 36

What is the Hallmark of AIN?

Answer 36

Eosinophils

Question 37

What is the UA of AIN?

Answer 37

WBC casts WITHOUT Infection | - Eosinophils (rare)

Question 38

What do you see in Contrast induced AKI?

Answer 38

Pre-renal AKI + ATN

Question 39

How to prevent Contrast induced AKI?

Answer 39

``` Isotonic IV fluids Hold ACEI/ARB/NSAID/Diuretic - N-Acetylcysteine Cr Increase by 25% or 0.5 in 48 hours - Peaks 3-5 days - Resolves 7-10days ```

Question 40

What is Immunofluorescence of GoodPastures?

Answer 40

Linear

Question 41

What is IF of Post Strep GN, Lupus nephritis?

Answer 41

Granular

Question 42

What is seen in IF negative?

Answer 42

Pauci-immune disease

Question 43

What is seen in Mesangial IF?

Answer 43

IgA nephropathy

Question 44

What are 3 causes of Crescentic GN?

Answer 44

GoodPastures Pauci-immune disease (Wegener, Churg-Strauss, Microscopic polyangitis) - Immune complex GN

Question 45

What is the Algorithm for Nephritic Syndrome?

Answer 45

1) Nephritis vs Nephrotic 2) Serum complement - Low: Immune Complex disease - - ASO titer, ANA/dsDNA, HepB/C, BCs - Normal: ANCA + AntiGBM Ab

Question 46

What presents with subepithelial "humps"?

Answer 46

PSGN, Lupus Nephritis(MCC renal disease in lupus)

Question 47

What is the IF of Lupus nephritis?

Answer 47

IF: Granular (IgG, IgA, IgM, C3, C1a) "full-house")

Question 48

What is the complement of Lupus nephritis?

Answer 48

Low C3+C4

Question 49

What is associated with membranoproliferative GN?

Answer 49

Hep B/C | Can be nephritis or nephrotic

Question 50

What is the complement in membranoproliferative GN?

Answer 50

Low C3 in MOST PATIENTS

Question 51

What are the 3 major features of Churg Straus syndrome?

Answer 51

P-ANCA | - Granulomatous inflammation + Eosinophila + Asthma

Question 52

What is the presentation of Henoch-Schonlein Purpura?

Answer 52

Arthritis, abdominal pain, Purpuric rashes | - IgA deposits in Dermal Vessels + other locations

Question 53

What do you see in ALports syndrome?

Answer 53

Isolated Glomerular hematuria - Sensorineural deafness - Ocular disturbances

Question 54

What is the EM of Alport's Syndrome?

Answer 54

"Basket-weave" pattern | - Thickening + Splitting of glomerular BM