AKI, CKD, Tubulointerstitial and Cystic Pathology (incomplete)

Question 1

what causes elevated urea and creatinine (uremia) due to toxic waste accumulating

Answer 1

AKI

Question 2

what is the presentation of AKI

Answer 2

Fatigue
nausea/vomitting
pruritis
anorexia
neurologic dysfunction

Question 3

what is the pathophysiology of pre-renal AKI

Answer 3

hypovolemia - dehydration
hypotension
shock
cardiac failure
massive PE
stenosis of renal artery
increased intraabdominal pressure
medications - NSAIDS

Question 4

what are the pathophysiology of intrarenal AKI

Answer 4

acute tubular necrosis
glomerulopathies
interstitial necrosis
vascular damage or embolism
malignant HTN
Bilateral acute pyelonephritis

Question 5

what are the pathophysiologies of post-renal AKI

Answer 5

obstructive disorders
ureteral destruction
enlarged prostate
neurogenic bladder

Question 6

What are intarenal AKI

Answer 6

acute tubular necrosis
nephrotoxic ATN (contrast, ABX)
glumerulonephritis
Vascular issue (HTN, DIC, vasculitis)

Question 7

what is the process of intra-renal AKI

Answer 7

decreased blood flow - ischemia - necrosis - dead, sad nephrons

Question 8

how do you differentiate between pre-renal and intra-renal

Answer 8

fluid responsiveness

Question 9

what is acute on chronic kidney injury

Answer 9

chronic lower GRF has sudden change in setting of increased physiologic stress
prolonged AKI-> CKD
cellular damage from previous AKI increase risk of developing CKD

Question 10

what is CKD

Answer 10

disruption of GRF - reduced GFR value
lasts > 3 months

Question 11

what will urine contain with CKD

Answer 11

increased protein, RBC, WBC, casts
*brown casts with kidney tubule injuury

Question 12

What are causes of CKD

Answer 12

DM **
HTN**
SLE
chronic glomerulonephritis
obstructive pathology
vascular disorders

Question 13

What is Azotemia

Answer 13

increased urea, creatinine, nitrogenous compounds

Question 14

what is uremia

Answer 14

pro-inflammatory state - uremic syndrome

Question 15

what is the presentation of CKD

Answer 15

results from decreased excretion of waste products that are produced during protein metabolism

Question 16

What are systemic changes of CKD

Answer 16

fractures
pulmonary edema, Kussmaul respiration
LVH, cardiomyopathy, ischemic heart disease, HTN, accelerated atherosclerosis (increase work load)
encephalopathy
anemia
abnormal skin pigmentation, pruritus
decreased immunity

Question 17

What are the elecrolyte changes with CKD

Answer 17

Hyperkalemia
hypocalcemia
hper/onatremia
hypoalbuminemia
K+ super important (determines emergency dialysis needs)

Question 18

What are hyperglycemic osmotic pressures

Answer 18

osmotic diuresis (poyluria) - electrolyte shifts
dehydration will trigger osmoreceptors - increased third (Polydipsia)

Question 19

what does the metabolism of fats release

Answer 19

keto acids

Question 20

what is acute tubular necrosis/injury associated with most commonly

Answer 20

ischemic injury, toxins, sepsis

Question 21

what is the most common cause of intrarenal AKI

Answer 21

acute tubular necrosis/injury

Question 22

what are the factors leading to ischemic induced ATN

Answer 22

hypovolemia
systemic vasodilation
coagulopathy

Question 23

what are factors leading to nephrotoxic induced ATN

Answer 23

abx
contast
others

Question 24

what occurs with ATN

Answer 24

decrease in GFR - activation of RAAS - continued hypoxia- increased inflammatory response - further damage to cells

Question 25

what is a simple cyst

Answer 25

acquired, thin walled cyst within the surface of the kidney
- serous fluid
common often incidental finding

Question 26

What is a autosomal dominant pathology leading to renal cysts (ADPKD)

Answer 26

polycystic kidney disease (thousands of cysts)

Question 27

What does PKD effect

Answer 27

decreases signaling between cells