AKI, HRS

Question 1

Pathophysiology AKI

Answer 1

reduced perfusion in nephrons –> hypoxia and oxidative stress

Renal hypo-perfusion - ATN

Sepsis - perfusion redistribution, inflammation (IL-6, TNF)

Question 2

Contrast induced AKI

RF
Prevention

Answer 2

RF - CKD, Hypotension, Vol depletion, contrast type, nephrotoxics

Prevention - pre hydration

Question 3

Hepatorenal syndrome

CF
Prevention

Answer 3

• pts with severe liver disease, usually with portal hypertension but can occur in acute liver disease
• rise in Cr, bland urine, oliguria, low urine Na

-Prevention - albumin
?terlipressin

Question 4

Rhabdomyolysis

Cause
CF
Mx

Answer 4

Leakage of muscle cells
-trauma, hyperthermia, toxins, genetic defects

-pigmented reddish brown urine, oliguria, hyperK, hypoCa

Mx - IVT, RRT if required

*different from muddy brown casts which is ATN

Question 5

Arthero-embolism/ cholesterol embolism

RF
CF

Answer 5

RF - HTN, age, smoking, AAA

CF - “Blue toe syndrome”, livedo reticularis, renal failure, intestinal ischemia
-acalculous nec cholecystitis, nec pancreas, retinal art occlusion etc