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Clin Med 3- Exam 2 > AKI > Flashcards

AKI Flashcards

1
Q

Define AKI.

A

Abrupt decline in renal function manifesting as reversible acute inc in nitrogenous wastes over hours to weeks

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2
Q

What 6 conditions are at a higher risk for developing AKI?

A

(1) HTN
(2) congestive cardiac failure
(3) diabetes
(4) multiple myeloma
(5) chronic infection
(6) myeloproliferative disorders

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3
Q

What are the 3 big etiologies of AKI?

A

1) renal blood flow (prerenal azotemia): MAP <80mmHg then steep decline in GFR
2) intrinsic renal diseases-affecting small vessels, interstitium, glomeruli or tubules
Toxic, ischemic, obstructive acute tubular necrosis
3) postrenal processes-obstruction to urine flow in ureters, bladder, or urethra

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4
Q

What are 4 etiologies of prerenal AKI?

A

(1) hypovolemia
(2) dec CO
(3) dec effective circulating volume
(4) impaired renal autoregulation

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5
Q

T/F: prerenal injuries are the most common cause of renal failure.

A

True

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6
Q

What is the BUN:Creatinine ratio in prerenal injuries?

A

> 20:1

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7
Q

What does a urinalysis often reveal in prerenal injuries?

A

hyaline casts

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8
Q

What does a FeNA <1% suggest?

A

Prerenal azotemia

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9
Q

What does a FeNA >1% suggest?

A

Intrinsic renal failure

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10
Q

What does a FeNA >4% suggest?

A

Postrenal failure

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11
Q

What is influenced by diuretics, FeNa or FeUrea?

A

FeNa (FeUrea is not)

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12
Q

What does a FeUrea < 35% or FeUA < 9-10% suggest?

A

Prerenal etiology

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13
Q

What does a FeUrea > 50% or FeUA > 10-12% suggest?

A

ATN (acute tubular necrosis)

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14
Q

What are 3 findings on prerenal labs?

A

(1) volume depletion (hemoconcentration, elevated Na, BUN, Cr)
(2) dec CO/effective arterial volume (edema, low Na, albumin)
(3) urine output altered (oliguria or anuria, high specific gravity, normal sediment or hyaline casts, low urine Na)

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15
Q

How do you tx volume depletion in prerenal injury?

A

Free water deficit in L

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16
Q

How do you tx dec CO/effective circulating volume in prerenal injury?

A

Diuretics, nitrates, dobutamine

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17
Q

What are 7 types of intrinsic renal diseases?

A

(1) AIN
(2) ATN
(3) glomerular diseases
(4) pyelonephritis
(5) multiple myeloma
(6) renal artery thrombus/embolism
(7) vasculitis

18
Q

What is acute interstitial nephritis (AIN) caused by most commonly?

A

Allergic reaction to medication

19
Q

What are 5 findings of classic presentation of AIN?

A

(1) recent new drug exposure
(2) fever
(3) oliguria
(4) skin rash
(5) peripheral eosiniophilia

20
Q

What are 4 classes of medications (and the drug names) that are associated with AIN?

A

(1) antibiotics: vancomycin, beta-lactams, sulfonamides, rifampin, erythromycin
(2) acyclovir
(3) NSAIDs
(4) anticonvulsants (phenytoin, valproate, carbamazepine)

21
Q

What are 2 findings on UA of AIN?

A

(1) pyuria- WBCs (2) hematuria

22
Q

What are 2 tx for AIN?

A

(1) d/c offending agent (2) glucocorticoid therapy-may accelerate renal recovery

23
Q

What is acute tubular necrosis (ATN) and its causes?

A

Acute tubular cell injury that is usually reversible unless severe and prolonged; ischemia, sepsis and toxins (exogenous and endogenous nephrotoxins)

24
Q

What are 3 endogenous nephrotoxins associated with ATN?

A

(1) myoglobinuria
(2) hemoglobinuria
(3) uric acid

25
Q

What is the main finding on UA of ATN?

A

pigmented granular casts (muddy-brown casts)

26
Q

List the 5 tx options of ATN (and what cause of ATN they are associated with).

A

(1) aggressive volume replacement if nephrotoxic agent
(2) high dose loop-diuretic if oliguria present and extracellular
(3) protein restriction
(4) d/c offending agent
(5) dialysis

27
Q

What are the 10 glomerular diseases and which 5 are associated w/chronic renal failure?

A

(1) infectious disease associated syndromes-post-streptococcal glomerulonephritis
(2) nephrotic syndrome-minimal change disease
(3) membranous glomerulonephritis
(4) IgA nephropathy
(5) Henoch-Schonlein Purpura

Associated with chronic renal failure:

(1) goodpasture syndrome (2) diabetic nephropathy (3) hypertensive nephropathy
(4) progressive glomerulonephritis
(5) polycystic kidney disease

28
Q

What causes post-strep glomerulonephritis (PSGN)?

A

Immune-mediated disease: an immune complex containing strep Ag deposited in affected glomeruli (7-12 days post sore throat/impetigo)

29
Q

What are 7 sx of PSGN?

A

(1) oliguria (2) cola colored urine (3) edema (4) HTN (5) malaise (6) anorexia (7) flank pain

30
Q

How do you tx PSGN?

A

Antibiotics and sx tx

31
Q

What 4 things do you find on UA of PSGN?

A

(1) hematuria
(2) proteinuria
(3) pyuria
(4) RBC casts

32
Q

What causes IgA nephropathy and what are 3 tx options for it?

A

IgA deposition in glomerulus

tx: ACEI/ARBs, steroids, renal transplant

33
Q

What are 4 classic findings on clinical presentation of Henoch Schonlein Purpura?

A

(1) rash-especially LE’s and butt
(2) abdominal pain/vomiting
(3) arthralgias-knees, ankles
(4) edema-hands, feet, scalp, ears

34
Q

What are 3 major findings of nephrotic syndrome?

A

(1) heavy proteinuria
(2) hypoalbuminemia
(3) peripheral edema

35
Q

What is the characteristic histologic finding of minimal change disease?

A

Diffuse effacement of the epithelial cell foot processes on electron microscopy

36
Q

What is the first line tx of minimal change disease?

A

Prednisone

37
Q

What is the tx of postrenal AKI?

A

Bladder catheterization or nephrostomy tube (b/c d/t obstruction, so tx based on where obstruction is)

38
Q

What is polycystic kidney disease?

A

Multisystem and progressive genetic disorder w/cyst formation and enlargement of the kidney

39
Q

What are 2 big si/sx of polycystic kidney disease?

A

Pain (abdomen, flank, back) and HTN

40
Q

What are 4 main tx of polycystic kidney disease?

A

(1) BP management-ACE/ARB
(2) pain control-avoid NSAIDS, cyst decompression, nephrectomy
(3) tx recurrent infections (may develop UTI, infected cysts)
(4) tx for hematuria-hydrate (transfuse if needed)

41
Q

What are 4 findings that indicate need to dialyze pts?

A

(1) acidosis electrolytes
(2) ingestions
(3) overload
(4) uremia

Clin Med 3- Exam 2 (15 decks)

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