AKI

Question 1

Definition AKI

Answer 1

6 hour

Question 2

Work up ?

Answer 2

H&P: meds , procedures, thirst , vitals, volume status, obstruction hesitancy urgency dribbling, vascular ischemia Urine: output, UA, sediment, electrolytes and osmoles

Question 3

pre-renal

Answer 3

decrease effective arterial volume: hypovolemia decrease cardiac contractility vasodilated renal vasoconstriction: NSAIDS, ACE, ARB, contrast, calcineurin inhib, HRS, hyper Calcemia large vessel: VTE, RAS, vasculitis,dissection, abdocompartment syndrome

Question 4

pre renal UA

Answer 4

bland, hyaline casts FeNa20 U Na 500

Question 5

post renal causes

Answer 5

bladder neck : BPH, cancer, neurogenici bladder, anticholinergic meds

ureteral: malignancy, LAN, retroperitoneal fibrosis, nephrolithiasis

Question 6

post renal UA

Answer 6

bland

nondysmorphic RBC

FeNa variable

Question 7

renal causes

Answer 7

ATN: prog pre renal,toxins(drugs, pigments, proteins,crystals) contrast decreased renal BF and toxin

AIN:allegic( B-lactam, sulfa, NSAIDS, PPI)

infections( pyelo,legionella, TB,leptospirosis)

infiltrative( sarcoid, lymphoma,leukemia)

AI( sjogrens, TINU, IgG4 SLE)

glomerular diseases

vascular(chol emboli, PAN, TMA, APS,malig HTN scleroderma renal crisis)

Question 8

ATN UA

Answer 8

muddy brown casts

RBC and proteinn from tubular damage

FeNa>2%

BUN/Cr<20

UNa >20- except pigment and CIAKI

Uosm<350

Question 9

AIN UA

Answer 9

WBC

WBC casts

+/- RBC

neg Urine culture

+urine eos

++ lymphs in NSAIDS