AKI and CKD

Question 1

Define AKI

Answer 1

• Abrupt decrease in kidney function
• Resulting in retention of urea and other nitrogenous waste products
• Retention in urine production and
  in the dysregulation of extracellular volume and electrolytes

Question 2

According to KDIGO 2012 for staging of AKI, what’s the parameter used to stage?

Answer 2

• Increase in SERUM CREATININE by >0.3mg/dL within 48 hours
• Urine output <0.5mL/kg/hr >6 consecutive hours

Question 3

State the pre-renal cause of AKI

Answer 3

IMPAIRED PERFUSION
An adaptive response to severe volume depletion and hypotension, with structurally intact nephrons
- Cardiac failure
- Sepsis
- Blood loss
- Dehydration
- Vascular occlusion

Question 4

State the renal cause of AKI

Answer 4

Question 5

State the post-renal cause of AKI

Answer 5

Luminal
- Stones
- Clots
- Sloughed papillae

Mural
- Renal tract malignancy
- Stricture

Extrinsic compression
- Pelvic malignancy
- BPH
- Retroperitoneal fibrosis

If untreated, obstructive nephropathy leads to IRREVERSIBLE TUBULOINTERSTITIAL FIBROSIS

Question 6

List some cause of high serum creatinine

Answer 6

• Renal dysfunction
• High muscle mass
• Medications that inhibit the kidney tubular secretion

Question 7

List the cause of low serum creatinine

Answer 7

• Improved renal function
• Loss of muscle mass/malnutrition/amputation
• Dilutional effect/fluid overload

Question 8

What are the causes of high blood urea?

Answer 8

• GI or mucosal bleeding
• Steroid use
• Protein loading

Question 9

What’s the value of urea creatinine ratio that suggests pre-renal AKI

Answer 9

> 20(mg/dL)
70(mg/dL)

Question 10

State the normal urine output

Answer 10

0.1 - 1.5 mL/kg/hr
800 - 2000 mL/day

Question 11

State the amount of urine excretion for polyuria

Answer 11

> 3000 mL/day (diuretic phase)

Question 12

State the amount of urine excretion to classify it as oliguria

Answer 12

<0.3 mL/kg/hr
<500 or <400 mL/day

Question 13

State the amount of urine excretion for anuria

Answer 13

<50 or 100mL/day

Question 14

If patient presented with
- Hematuria with dysmorphic red blood cells
- Red blood cell casts
- Varying degree of albuminuria

State the possible diagnosis

Answer 14

Proliferative glomerulonephritis

Question 15

If patient presented with
- Heavy albuminuria with minimal or absent hematuria

State the probable diagnosis

Answer 15

Non-proliferative glomerulonephritis

Question 16

If patient presented with
- Multiple granular and epithelial cell cast with free epithelial cells

State the probable diagnosis

Answer 16

Acute tubular necrosis in a patient with underlying acute kidney injury

Question 17

If patient presented with isolated pyuria

What is the probable diagnosis?

Answer 17

Infection or tubulointerstitial disease

Question 18

If patient presented with normal urinalysis with few cells, no casts, and no or minimal proteinuria

What is the probable diagnosis?

Answer 18

In presence of AKI:
- Pre-renal disease
- Urinary tract obstruction
- Hypercalcemia
- Acute phosphate nephropathy
- Myeloma cast nephropathy

In presence of CKD:
- Ischemic nephropathy
- Hypertensive nephrosclerosis
- Urinary tract obstruction
- Hepato-renal disease
- Cardio-renal disease

Question 19

Interpret the following result for urea:creatinine ratio
1. 40-100:1
2. >100:1
3. <40:1

Answer 19

1. Normal or post-renal cause of AKI
2. Pre-renal cause
3. Intrinsic renal damage

Question 20

State the causes of increased urea:creatinine ratio

Mnemonic: Drivers Can use GPS

Answer 20

• Dehydration/pre-renal failure
• Corticosteroids
• GI hemorrhage
• Protein-rich diet
• Severe catabolic state

Question 21

State the causes of increased urea:creatinine ratio

Mnemonic: I am a SIMPLE SR

Answer 21

• Severe liver dysfunction
• Intrinsic renal damage
• Malnutrition
• Pregnancy
• Low-protein diet
• SIADH
• Rhabdomyolysis

Question 22

If we do MRI with gadolinium for a patient of eGFR <30mL/min, what will it lead to?

Answer 22

Nephrogenic systemic fibrosis

Question 23

State the complications of AKI

Answer 23

• Fluid overload
• Hyperkalemia
• Metabolic acidosis
• Protein catabolism
• Reduced immunity
• GI bleeding

Question 24

State the indication for dialysis

Mnemonic: AEIOU

Answer 24

• Acidosis (Severe metabolic acidosis pH<7.1)
• Excess potassium (Severe hyperkalemia >6.5 mmol/L)
• Intoxication
• Oedema (Refractory fluid overload)
• Uremia

Question 25

Define chronic renal failure

Answer 25

GFR<60mL/min/1.73m2 for >3months with or without kidney damage

Question 26

State the causes of CKD

Answer 26

• DM
• HTN
• Chronic glomerulonephritis
• Chronic pyelonephritis
• Renovascular disease
• Reflux nephropathy; obstructive uropathy
• Urinary stone disease; myeloma
• Analgesic nephropathy; uric acid nephropathy

Question 27

What’s the key to management of CKD?

Answer 27

• General measures (Avoid nephrotoxic drugs and avoid dehydration)
• Slow progression
• Manage complications

Question 28

State (4) common nephrotoxic drugs

Answer 28

• NSAIDS
• Antibiotics (GENTAMICIN)
• Contrast media (Contrast for CT scan etc)
• Traditional or herbal medications