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URN Biweekly 2 > AKI- Bessette > Flashcards

AKI- Bessette Flashcards

1
Q

a rapid decline in the GFR resulting in retention of nitrogenous wastes, primarily creatinine and blood urea nitrogen

A

Acute Kidney Injury (AKI)

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2
Q

associated w/ increased mortality and increased length of hospital stay

A

AKI

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3
Q

______ nephrology consultation leads to increased mortality and increased length of ICU stays

A

delayed

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4
Q

an increase in serum creatinine of _____ within 48 hours (AKI criteria)

A

0.3 mg/dl

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5
Q

______ baseline increase in serum creatinine w/in 7 days (AKI criteria)

A

> /= 1.5x baseline

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6
Q

a reduction in urine output(<______ for >6 hours) (AKI criteria)

A

<0.5 ml/kg/hr for > 6 hrs

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7
Q

ultimately a decrease in GFR and urine output and an increase in creatinine

A

AKI

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8
Q

<500 ml urine output/24 hours

A

oliguric

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9
Q

> 500 ml urine output/24 hours

A

nonoliguric

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10
Q

<100 ml/24 hrs

A

anuric

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11
Q

age >75
chronic kidney disease
cardiac failure
liver disease
diabetes
nephrotoxic medications
hypovolemia

A

risk factors for developing AKI

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12
Q

mismatch b/t oxygen or nutrient delivery and energy demand

A

pathogenesis of AKI

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13
Q

direct toxicity to tubular cell or vascular endothelium

A

pathogenesis of AKI

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14
Q

an AKI biomarker that you need to look back a day or two b/c its not sensitive

A

creatinine

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15
Q

small changes in _______ may reflect large changes in GFR

A

creatinine

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16
Q

1-1.5 is a ______ decrease in renal function

A

huge

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17
Q

another AKI biomarker that can be used; send off test

A

Cystatin C

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18
Q

AKI may lead to_____

A

CKD

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19
Q

CKD predisposes ____

A

AKI

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20
Q

the more you have an AKI +/or the worse it is= higher risk for _____

A

CKD

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21
Q

this type of AKI deals with hypovolemia (decreased CO and decreased perfusion of kidneys)

A

prerenal AKI

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22
Q

type of AKI that deals with glomerular, tubules and interstitium, and vascular

A

intrinsic AKI

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23
Q

type of AKI that deals with bladder outlet obstruction

A

postrenal AKI

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24
Q

physiologic response to renal hypoperfusion w/out tubular injury

A

prerenal AKI

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25
Q

kidney is normal and there is reduced renal perfusion

A

prerenal AKI

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26
Q

urine Na+ decreased
urine osmolality increased

A

prerenal AKI

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27
Q

fractional excretion of urea <35%
BUN to creatinine ratio > 20:1

A

prerenal AKI

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28
Q

% of sodium filtered by kidney is excreted in the urine

A

fractional excretion of Na+

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29
Q

helps distinguish prerenal AKI from ATN

A

fractional excretion of Na+

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30
Q

<1% fractional excretion of Na+

A

prerenal AKI

31
Q

> 2% fractional excretion of Na+

A

ATN

32
Q

(Urine Na+/Plasma Na+)/
(urine creatinine/plasma creatinine) x100

A

fractional excretion of Na+

33
Q

fractional excretion of Na+ formula

A

(urine Na+/plasma Na+)/(urine creatinine/plasma creatinine) x 100

34
Q

% of urea filtered by the kidney that is excreted in the urine

A

fractional excretion of urea

35
Q

fractional excretion of urea formula

A

(urine urea/plasma urea)/(urine creatinine/plasma creatinine) x 100

36
Q

low FE of urea (<35%)

A

prerenal AKI

37
Q

high FE of urea (>50%)

A

intrinsic AKI (tubular damage)

38
Q

what is less affected by diuretics than fractional excretion of Na+

A

fractional excretion fo urea

39
Q

conditions that affect glomeruli, tubules, interstitium, or vasculature

A

intrarenal AKI (intrinsic)

40
Q

__85__% of intrarenal AKI is due to what

A

tubular damage

41
Q

can be due to ischemic or nephrotoxic causes

A

intrinsic AKI (tubular damage)

42
Q

does not improve with volume repletion

A

intrinsic AKI

43
Q

Involves inflammation and damage to the glomerular basement membrane, mesangium and capillary endothelium

A

acute glomerulonephritis

44
Q

has high FENa+ (>2%)
and high FEurea (>50%)

A

intrinsic AKI

45
Q

usually immune mediated, RBC casts

A

nephritic

46
Q

proteinuria, HTN, edema

A

nephrotic

47
Q

kidney biopsy needed for diagnosis of what (that is causing AKI)

A

acute glomerulonephritis

48
Q
A

RBC casts

49
Q

urine findings include: dysmorphic RBCs
RBC casts
proteinuria (mild)

A

nephritic

50
Q
A

RBC casts

51
Q
A

maltese crosses
nephrotic

52
Q

this intrinsic AKI is mainly due to medications (antibiotics)

A

acute interstitial nephritis

53
Q

key to diagnosis is hx of exposure and may have rash, fever, eosinophils

A

Acute interstitial nephritis

54
Q

WBC and WBC casts
hematuria
mild proteinuria
(rxn to medicine)

A

acute interstitial nephritis

55
Q
A

eosinophils
(acute interstitial nephritis)

56
Q

most common type of AKI in hospitalized patients

A

Acute Tubular Injury

57
Q

2 main causes of acute tubular injury

A

ischemic
nephrotoxic

58
Q

muddy brown casts seen with this (due to sloughed cells)

A

acute tubular necrosis

59
Q

Mechanism of tubular injury:

A
  1. ischemia/toxins
  2. loss of cell polarity
  3. cell necrosis/apoptosis
  4. sloughing of cells
  5. viable cell migration and proliferation
  6. viable cell differentiation into normal epithelium
60
Q
A

muddy brown casts
(ATN)—-intrinsic AKI

61
Q
A

muddy brown casts
(ATN)

62
Q

this type of AKI is due to obstruction of urinary outflow

A

postrenal AKI

63
Q

obstruction of parenchyma; bilateral or unilateral kidney obstruction; reduced UOP/anuria; bladder outlet obstruction

A

postrenal AKI

64
Q

on US, could see hydroureter or hydronephrosis

A

postrenal AKI

65
Q

can see distended bladder on physical exam

A

postrenal AKI

66
Q

steps to diagnose AKI:

A

hx
physical
labs
renal US
biopsy

67
Q

GFR/Cr clearance not useful unless what

A

serum [Cr] is in steady state

68
Q

pre or post renal easiest to correct and how

A

foley catheter
saline

69
Q

management of AKI

A

supportive care

70
Q

what to avoid if you have AKI

A

nephrotoxic agents (ex. NSAIDs)

71
Q

first sign of recovery from AKI in oliguric and anuric patients

A

increased urine output (UOP)

72
Q

recovery from AKI is seen when serum_______ stabilizes and decreases

A

creatinine

73
Q

early recognition and treatment is essential for what

A

AKI

74
Q

intact renal functional reserve (RFR) to deficient RFR leads to what

A

CKD

URN Biweekly 2 (15 decks)

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