AKI, CKD, Dialysis

Question 1

what is AKI

Answer 1

An acute reduction in function (GFR) and accumulation of nitrogenous waste (BUN, creatinine)

Question 2

What is the progression of kidney injury

Answer 2

Risk- injury - failure - loss - ESRD

Question 3

What is stage 1 AKI

Answer 3

increase in SCr by .3+ in 48 hours
increase SCR 1.5-1.9x baseline
urine volume less than .5 for 6-12 hours

Question 4

Etiology of pre-renal AKI

Answer 4

Intrarenal vasoconstriction
volume depletion
Systemic vasodilation

Question 5

What is stage 2 AKI

Answer 5

increase SCr 2 - 2.9x baseline
urine volume less than .5mL/Kg/h for 12+HRS

Question 6

What is stage 3 AKI

Answer 6

increase SCr 3x baseline
SCr 4.0+
Initiation of RRT
GFR decreases to <35 (<18y/o)
Anuria for 12+ hours

Question 7

What are the 3 distinct types of AKI

Answer 7

Pre-renal (m/c) - hypoperfusion
intra-renal (due to ATN)
post-renal (obstruction)

Question 8

What is the etiology of renal AKI

Answer 8

Glomerulonephritis
interstitial nephritis
tubular nephritis
vascular

Question 9

What is the number 1 cause of intra-renal AKI

Which patients are at higher risk

Answer 9

acute tubular necrosis (ATN)

hospitalized patients

Question 10

Which AKI improves with fluids

Which does not respond to fluid

Which has a hx of stones, BPH, and cancer

Answer 10

pre-renal

renal and post renal

post-renal

Question 12

What will be seen on microscopic exam with AKI

Answer 12

Casts
*few hyaline casts are normal

Question 13

What does renal tubular epithelial casts indicate

RBC casts?

muddy brown casts?

WBC casts?

Answer 13

ATN/AIN

glomerulonephritis, AIN

ATN

AIN

Question 14

What is the treatment for AKI

Answer 14

Supportive

Question 15

What does FeNa help distinguish between

What is normal

Answer 15

It helps differentiate between pre-renal and intra-renal AKI

between 1-2%

less than 1% = pre-renal and >2% is renal AKI

Question 16

What are the risk factors for CKD

Answer 16

Hypertension
DM
*others but these are the biggest contributers

Question 17

What is CKD

How many stages

Answer 17

A gradual decline in Kidney function (weeks-years)

5

Question 18

How is Kidney decline measured

Answer 18

GFR

Question 19

How does stage 1 & 2 CKD present

stage 3 & 4?

Answer 19

generally asymptomatic

vague symptoms if they are present

Question 20

How does stage 5 CKD present?

Answer 20

worsening nutrition
electrolyte / mineral disturbances

Question 21

What is a hallmark lab finding for CKD

Answer 21

persisten reduced GFR (>3months)

Question 22

What electrolyte imbalance occurs with fluid retention in CKD

Fluid loss?

Answer 22

Hypernatremia

Hyponatremia

Question 23

What will cause an elevated PTH in CKD

What does reduced ammonia production cause

Answer 23

Hypocalcemia and low vitamin D

metabolic acidosis

Question 24

what is the imaging study of choice with CKD

Answer 24

Renal US

Question 25

What is the average wait time for a kidney

Answer 25

3-5 years

Question 26

What diet modifications need to be made with CKD management | What foods are high is phosphorus

Answer 26

salt restriction potassium / phosphorus restriction focus on a plant based diet | meat, cheese, seeds, milk, cola, canned fish, fast food

Question 27

What is the mainstay treatment for ESRD | What is the definitive treatment for CKD

Answer 27

renal replacement therapy | renal transplant

Question 28

What is the #1 cause of mortality with CKD

Answer 28

coronary vascular disease

Question 29

What is the #1 complication of CKD | What are some other complications

Answer 29

hypertension | Anemia, coagulopathy, hypoglycemia, metabolic bone disease

Question 30

What is renal replacement therapy | What are the different procedures ## Footnote What is most common

Answer 30

technique that replaces the filtration of the dysfunctional kidneys | Dialysis, hemofiltration, peritoneal dialysis ## Footnote intermittent HD

Question 31

Which patients will receive RRT

Answer 31

Fluid overload (unresponsive to diuretics) hyperkalemia hypercalcemia uremia metabolic acidosis GFR <10 GFR<15 w/ DM Certain toxins **all unresponsive to other treatment

Question 32

What are the 2 processes that drive RRT

Answer 32

* Diffusion: movement of partivles down a concentration gradient * Convection: movement of particles & water down a pressure gradient

Question 33

What is hemofiltration

Answer 33

Convection RRT - takes off larger molecules (myoglobin/cytokines) - removes water & solutes (replace fluid)

Question 34

What type of RRT is Dialysis

Answer 34

Diffusion RRT - removes the smaller molecules (filtration solutes)

Question 35

What are the most common causes of nephrotexic acute tubular necrosis

Answer 35

Hemoglobin/myoglobin (red/brown casts in Collecting Tubule) Vancomycin (inflammatory response