AKI-Clinic VIR Flashcards

1
Q

definition of kidney injury/disease

A

alteration in kidney structure or function such than GFR is less than 60

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2
Q

chronic kidney disease must last greater than or equal to?

A

3 months

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3
Q

limitations to serum creatinine as measure of kidney function

A

does not truly reflect decrease in GFR until 3 days after insult begins; affected by body mass, hydration, etc.

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4
Q

signs of acute vs. chronic kidney disease

A

acute: decreased urine output; chronic: small, echogenic kidneys on US

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5
Q

most common cause of AKI in community is ____, in hospital is _____

A

pre-renal (ischemia or nephrogenic); intra-renal (especially tubular injury)

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6
Q

causes of decreased renal perfusion (pre-renal ischemia)

A

low ECF volume (GI loss, hemorrhage, diuretics); altered blood flow (sepsis, heart failure, cirrhosis, hypercalcemia, medications, vascular dz)

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7
Q

causes of acute tubular necrosis (intra-renal)

A

ischemic tubular injury (from pre-renal cause oftentimes) or nephrotoxins (cisplatin, aminoglycosides, heme, iodinated radiocontrast)

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8
Q

causes of post-renal injury

A

prostate hypertrophy, kidney stones

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9
Q

diagnostic approach to evaluating AKI

A
  1. history, 2. physical exam, 3. exclude urinary tract obstruction, 4. examine urine
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10
Q

what component of the physical exam is particularly important when dx AKI

A

volume status: are there signs of volume depletion (skin turgor, orthostatic hypoTN)? If so, then likely PRE-RENAL

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11
Q

how do you exclude post-renal causes of AKI?

A

insert foley catheter and observe no change in urine output; renal US demonstrates cortex of normal thickness, no dilation in collecting system

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12
Q

urine sediment will look ____ if pre-renal injury

A

normal

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13
Q

causes of RBC casts and proteinuria in the urine

A

glomerulonephritis, vasculitis, TMA, atheroemboli

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14
Q

causes of WBC casts and eosinophils in urine

A

pyelonephritis, interstitial nephritis, atheroemboli, glomerulonephritis

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15
Q

cause of renal tubular endothelial cells and dark muddy casts in urine

A

ATN

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16
Q

the most important distinction to make when analyzing urine indices is between ____ and ____

A

pre-renal and ATN

17
Q

describe the SG, osmolality, sodium, FENa, and FEUrea for pre-renal tubular injury

A

SG >1.020, osmol >500, Na <35% (so basically higher SG and osmolality, lower excretion of sodium and urea)

18
Q

describe the SG, osmolality, sodium, FENa, and FEUrea for ATN

A

SG ~1.010, osmol 30, FENa >2%, FEUrea >50% (so basically lower SG and osmolality, higher excretion of sodium and urea)

19
Q

why is FE (fractional excretion) used to measure sodium and urea excretion?

A

unaffected by water reabsorption

20
Q

how to calculate FENa

A

Na excreted/Na filtered X 100 = (UNa X SCr)/(UCr X SNa) X 100

21
Q

when should FE Urea be used instead of FE Na?

A

when diuretics have been given in past 24-48 hours (b/c urea is reabsorbed before you get to action of diuretics)

22
Q

when might FE Na be greater than 2% in a setting other than ATN?

A

CKD, recent diuretic use

23
Q

when might ATN present with an FE Na of <1%?

A

if it is from radiocontrast, is early (nonoliguric), or is co-occuring with chronic pre-renal condition

24
Q

what is an example of an intra-renal process that causes an FE Na of <1%?

A

glomerulonephritis/vasculitis

25
Q

tx of pre-renal kidney injury

A

normal saline + stop diuretics

26
Q

how do NSAIDs decrease blood flow to the kidneys?

A

block intra-renal prostaglandins, attenuating afferent dilation and causing a reduction in GFR

27
Q

iodinated contrast from a CT can result in rapid onset?

A

ATN (nephrogenic)

28
Q

these drugs can cause interstitial nephritis

A

antibiotics, NSAIDs, diuretics

29
Q

tx of interstitial nephritis

A

steroids

30
Q

nephrostomy tube

A

percutaneous drain placed in renal collecting system; used to decompress obstruction, divert fistula, access for other procedure

31
Q

enter back at 30-40 degree angle from spine to avoid?

A

colon, liver, spleen

32
Q

go into the ____ calyx

A

lower (it has smaller vessels)

33
Q

nephroureteral stent

A

allows for drainage from renal pelvis to bladder & maintains access for future intervention

34
Q

ureteral “JJ” stent

A

allows for drainage from renal pelvis to bladder & completely internalized

35
Q

complications of ureteral stents

A

hemorrhage, PTX, puncture, urinoma, AV fistula, cath malfunction (clogged), urosepsis (so pre-tx with ABX)