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Internal Med > AKI > Flashcards

AKI Flashcards

1
Q

What is the testing algorithm for AKI?

A

Look for:
Prerenal
Postrenal
Intrarenal

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2
Q

What do all forms of AKI cause?

A

Azotemia (increased BUN) and increased Creatinine

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3
Q

What are some causes of postrenal azotema?

A

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

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4
Q

How do you diagnose Post renal AKI?

A

Catherization
RENAL U/S
> 100 mL bladder

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5
Q

How do you treat postrenal AKI?

A

Catherization

Treat underlying cause

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6
Q

What do you see in early obstruction?

A

Tubules still intact

FENa

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7
Q

What do you see in long standing obstruction

A

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

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8
Q

What causes pre-renal azotemia?

A

Decreased blood flow

- Dec. GFR, azotemia, oliguria

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9
Q

What are some diseases seen in prerenal?

A 
Volume depletion
Low CO
CIrrhosis
Sepsis
Nsaids
Cyclosporine
ACEIs
ARBs
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10
Q

What do you check in prerenal?

A

Check Orthostatics

  • CBC
  • BMP
  • FENa
  • FEUrea if on (diuretics)
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11
Q

How does ANG-II affect kidney blood flow?

A

Ang-II preferentially vasoconstricts EFFERENT ARTERIOLE

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12
Q

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

A

Causes afferent vasodilation

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13
Q

NSAIDs + Cyclosporins preferentially vasoconstrict which part of renal vasculature?

A

Afferent arteriole

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14
Q

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

A

Efferent arteriole (Blocks Ang-II)

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15
Q

What does the RAAS system do?

A

Increased aldosterone causes increased Na absorption

- Increased urea/NH4 reabsorption

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16
Q

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

A

FENa

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17
Q

What are the BUN:CR of Prerenal?

A

> 20

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18
Q

What is the FENa of prerenal?

A
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19
Q

What is the FEUrea of PreRenal?

A
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20
Q

What is the Urine Osm of Prerenal?

A

Urine Osm

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21
Q

What will the SG of PreRenal be?

A

SG >1.020

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22
Q

What is the BUN:Cr of Intra-Renal?

A
23
Q

What is the FENa of IntraREnal?

A

> 2%

24
Q

What is the FEUrea of intrarenal?

A

> 55%

25
Q

What is the Urine Osm of INtra-Renal?

A
26
Q

How does contrast cause prerenal aki?

A

Vasoconstricts plus Toxic

27
Q

What can cause ATN?

A 
Prolonged Ischemia
Contrast
Toxins 
- Drugs: AGs, Vanco, amphotericin, cisplatin
- Endogenous: Hbg, myoglobin
- Light chain
- Crystals
28
Q

What causes AIN?

A

Allergic: B-lactams, sulfa, NSAIDs, PPIs

29
Q

What types of vasculitidies?

A 
PAN
Cholesterol emboli
Thrombotic (HUS/TTP/DIC)
- Preeclampsia, Antiphospholipid syndrome
- Malignant HTN
- Scleroderma renal crisis
30
Q

What do you see in AIN and Vasculitis?

A

Urine Eosinophils (antibiotics and Chol. Emboli)

31
Q

How do you treat ATN?

A

Supportive
- Severe: dialysis

Takes 1-2 weeks for ATN to resolve

32
Q

How do you diagnose ATN?

A

Injury + Necrosis of tubular

33
Q

What do you see on Histo?

A

Cells detached from BM

  • Necrotic debris forms casts
  • Tubular dilation + flattening of epithelial cells
  • UA: Brown granular casts, Heme 4+, NO RBCs: Hbg, Myoglobin
34
Q

Whats the clinical triad of AIN?

A

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

35
Q

How do you treat AIN?

A

Stop Drug

- STEROIDS

36
Q

What is the Hallmark of AIN?

A

Eosinophils

37
Q

What is the UA of AIN?

A

WBC casts WITHOUT Infection

- Eosinophils (rare)

38
Q

What do you see in Contrast induced AKI?

A

Pre-renal AKI + ATN

39
Q

How to prevent Contrast induced AKI?

A 
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
40
Q

What is Immunofluorescence of GoodPastures?

A

Linear

41
Q

What is IF of Post Strep GN, Lupus nephritis?

A

Granular

42
Q

What is seen in IF negative?

A

Pauci-immune disease

43
Q

What is seen in Mesangial IF?

A

IgA nephropathy

44
Q

What are 3 causes of Crescentic GN?

A

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

45
Q

What is the Algorithm for Nephritic Syndrome?

A

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

46
Q

What presents with subepithelial “humps”?

A

PSGN, Lupus Nephritis(MCC renal disease in lupus)

47
Q

What is the IF of Lupus nephritis?

A

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

48
Q

What is the complement of Lupus nephritis?

A

Low C3+C4

49
Q

What is associated with membranoproliferative GN?

A

Hep B/C

Can be nephritis or nephrotic

50
Q

What is the complement in membranoproliferative GN?

A

Low C3 in MOST PATIENTS

51
Q

What are the 3 major features of Churg Straus syndrome?

A

P-ANCA

- Granulomatous inflammation + Eosinophila + Asthma

52
Q

What is the presentation of Henoch-Schonlein Purpura?

A

Arthritis, abdominal pain, Purpuric rashes

- IgA deposits in Dermal Vessels + other locations

53
Q

What do you see in ALports syndrome?

A

Isolated Glomerular hematuria

  • Sensorineural deafness
  • Ocular disturbances
54
Q

What is the EM of Alport’s Syndrome?

A

“Basket-weave” pattern

- Thickening + Splitting of glomerular BM

Internal Med (4 decks)

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