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Harrison's Nephro > AKI > Flashcards

AKI Flashcards

1
Q

Vasodilator prostaglandins

A

Prostacyclin, Prostaglandin E2, kallikrein, kinins and NO

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2
Q

Tubuloglomerular feedback

A

Decreases in solute delivery to the macula densa elicit dilatation of the of the juxtaposed afferent arteriole to maintain glomerular perfusion

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3
Q

NSAIDs mechanism in AKI

A

Limit renal afferent vasodilation

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4
Q

ACEi/ARBS mechanism AKI

A

Limit renal efferent vasoconstriction

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5
Q

Small vessels

A 
Glomerulonephritis
Vasculitis
TTP/HUS
DIC
Atheroemboli
Malignant HTN
Calcineurin inhibitors
Sepsis
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6
Q

Tubules

A

Toxic ATN (Endogenous-Rhabdomyolysis, Hemolysis
Exogenous (contrast, cisplatin gentamicin)
Ischemic ATN
Sepsis

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7
Q

Intratubular

A

Endogenous (Myeloma proteins,uric acid, cellular debris)

Exogenous( Acyclovir, Methotrexate)

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8
Q

Large Vessel

A

Renal Artery embolus, dissection, vasculitis
Renal vein thrombosis
Abdominal compartment syndrome

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9
Q

Interstitium

A

Allergic (PCN, Rifampin)
Infection ( Severe, pyelonephritis, Legionella, sepsis)
Infiltration (lymphoma, leukemia)
Inflammatory ( Sjogrens, Tubulointerstitial nephritis, uveitis, sepsis)

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10
Q

Risk factors for Nephrotoxin Associated AKI

A

Older age
Chronic Kidney Disease
Prerenal Azotemia

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11
Q

Clinical Course of Contrast Induced AKI

A

Rise in SCr beginning 24-48 h following exposure
Peaking within 3-5 days
Resolving within 1 week

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12
Q

Amphotericin B

A

Dose and Duration dependent

Clinical Features: Polyuria, Hypogmagnesia, Hypocalcemia, Nongap Metabolic acidosis

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13
Q

Acyclovir

A

Cause AKI by tubular obstruction especially in high doses (500 mg/m2) or in setting of hypovolemia

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14
Q

Manifestations of Ifosfamide AKI

A

Hemorrhagic cystitis, tubular toxicity

Type II RTA, Polyuria, Hypokalemia, modest decline in GFR

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15
Q

Components of TUMOR LYSIS Syndrome

A

Hyperuricemia
Hyperkalemia
HYperphosphatemia
Hypocalcemia

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16
Q

Definition of AKI

A

Rise in SCr at least 0.3 mg/dL withinn 48 hours or at least 50% higher than baseline within 1 week or a reduction in urine output to less than 0.5 ml/kg for longer than 6 hours

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17
Q

Proteinuria in AKI

A 
Mild Proteinuria (<1g/day) from AKI from Ischemia or Nephrotoxins
Heavy proteinuria (nephrotic range >3.5 g/day) glomerulonephritis, vasculitis, interstitial nephritis
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18
Q

Urine casts of AKI fr ATN due to ischemic injury/Sepsis

A

Pigmented “muddy brown” casts and tubular epithelial cell casts

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19
Q

Urine casts in Glomerulonephritis

A

Dysmorphic red blood cells or RBC casts

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20
Q

Casts in Interstitial Nephritis

A

WBC cass

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21
Q

RBCs/RBC casts

A

Vasculitis
Malignant Hypertension
Thrombotic microangiopathy

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22
Q

WBC casts

A 
Interstitial Nephritis
GN 
Pyelonephritis
Allograft rrejection
Malignant infiltration of the kidney
23
Q

Renal Tubular Epithelial Casts

A 
ATN
Tubulointerstitial nephritis
Acute cellular allograft rejection
Myoglobinuria
Hemoglobinuia
24
Q

Granular casts

A

ATN , GN
Vasculitis
Tubulointerstitial Nephritis

25
Q

Eosinophiluria

A 
Allergic Interstitial nephritis
Atheroembolic disease
Pyelonephritis
Cystitis
Glomerulonephritis
26
Q

Crystalluria

A

Acute uric nephropathy
Calcium oxalate (ethylene glycol intoxication)
Drugs or toxins(acyclovir, indinavir, sulfadiazine, amoxicillin)

27
Q

Causes of inc BUN

A

UGIB
Hyperalimentation
Increased tissue catabolism
Glucocorticoid use

28
Q

Fractional excretion of Sodium

A

Fraction of filtered sodium load that is reabsorbed by the tubules
Depends on the sodium intake, effective intravascular volume, GFR, diuretic intake, intact tubular reabsorptive mechanisms

29
Q

Obstruction can be present without radiologic abnormalities in the following conditions

A
  1. Volume depletion
  2. Retroperitoneal fibrosis
  3. Encasement with tumor
  4. In early course of the obstruction
30
Q

Novel biomarkers of AKI

A

Kidney Injury Molecule 1
Neutrophil Gelatinase asociated lipocalin
Interleukin 18
L type fatty-acid binding protein

31
Q

Definitive treatment of Hepatorenal Syndromme

A

Orthotropic Liver transplantation

32
Q

Major complications of AKI

A
  1. Arrythmias
  2. Pericarditis
  3. Pericardial effusion
33
Q

Example of potassum binding resins

A

Calcium resonium

Sodium polystyrene

34
Q

Classic lesion of secondary hyperparathyroidism

A

Osteitis fibrosa cystica

High bone turnover with increased PTH levels

35
Q

Low bone turnover with low or normal PTH levels

A

Adynamic bone disease & osteomalacia

36
Q

FGF 23 defends normal serum phosphorus

A
  1. Inc renal phosphate excretion
  2. Stimulation of PTH
  3. Suppression of formation of 1,25 (OH) 2D3
37
Q

Clinical manifestation of hyperparathyroidism

A

Bone pain and fragility
Brown tumors
Compression syndromes
Erythropoietin resistance

38
Q

Complications of adynamic bone disease

A

Increased incidence of fracture
Bone pain
Inc vascular and cardiac calcification
Tumoral calcinosis

39
Q

This complication starts as livedo reticularis and advances to patches of ischemic necrosis on the legs, thighs, abdomenn and breasts

A

Calciphylaxis(Calcific Uremic arteriopathy)

40
Q

Non calcium containing phosphate binders

A

Sevelamer

Lanthanum

41
Q

Calcium containing phosphate binders

A

Calcium acetate

Calcium carbonate

42
Q

Target PTH level

A

150–300 pg/mL

43
Q

Traditional risk factors for ischemic vascular disease

A 
Hypertensionn
Hypervolemia
Dyslipidemia
Sympathetic overactivity
Hyperhomocysteinemia
44
Q

CKD related risk factors for Ischemic Vascular Disease

A 
Anemia
Hyperphosphatemia
Hyperparathyroidism
Inc FGF 23 
Sleep apnea
Generalized Infammation
45
Q

Target BP of CKD patients with DM or proteinuria >1 g/24 hrs

A

BP:130/80

46
Q

Classic ECG finding in Pericarditis

A

PR-interval depression

Diffuse ST segment elevation

47
Q

Causes of Anemia in CKD

A 
Relative deficiency of EPO
Diminished RBC survival
Bleeding diathesis
Iron deficiency
Hyperparathyroidism/Bone marrow fibrosis
Chronic inflammation
Folate or Vit B12 deficiency
Hemogobinopathy
Comorbid conditions: Hypo/Hyperthyroidism, pregnancy, HIV associated , autoimmune disease, immunosuppresive drugs
48
Q

Target hemoglobin concentration

A

Hgb: 110-115 mg/dL

49
Q

Abnormal bleeding time and coagulopathy may be reversed with

A
  1. Desmopressin (DDAV
  2. Cryoprecipitate
  3. IV conjugated estrogens
  4. Blood transfusions
  5. ESA therapy
50
Q

Skin condition unique to CKD which consists of progressive subcutaneous induration especially on the arms and legs

A

Nephrogenic Fibrosing Dermopathy

51
Q

CKD would usually have bilaterally small kidneys except in these diseases

A
  1. DM Nephropathy
  2. Amyloidosis
  3. HIV nephropathy
52
Q

Contraindications to Kidney Biopsy

A
  1. Bilaterally small kidneys
  2. Uncontrolled hypertension
  3. Active UTI
  4. Bleeding diathesis
  5. Severe obesity
53
Q

Indications fo RRT

A

Uremic pericarditis
Encephalopathy
Intractable muscle cramping, anorexia and nausea
Intractable Hyperkalemia/ECFV overload

Harrison's Nephro (4 decks)

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