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Renal Final > Approach to Diagnosis of Acute Kidney Disease > Flashcards

Approach to Diagnosis of Acute Kidney Disease Flashcards

1
Q

definition of kidney disease

A
  • alteration in kidney structure or function

- GFR < 60

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2
Q

if kidney disease has been going on for more than 3 months it is considered

A
  • chronic kidneys disease
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3
Q

if kidney disease has been going on for less than 3 months it is considered

A
  • acute kidney disease
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4
Q

if the kidney disease has been going on for hours to days (2-7 days), it is considered

A
  • acute kidney injury
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5
Q

AKI and AKD can occur in

A
  • CKD
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6
Q

AKI and AKD can lead to

A
  • CKD
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7
Q

decreased urine output is a sign of

A
  • AKD/AKI
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8
Q

small, echogenic kidneys on ultrasound is a sign of

A
  • CKD
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9
Q

causes of AKD can be classified into

A
  • pre-renal
  • intra-renal
  • post-renal
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10
Q

cause of pre-renal kidney disease

A
  • reduced renal perfusion
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11
Q

cause of intra-renal kidney disease

A
  • vascular
  • glomerular
  • tubular
  • interstitial injury
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12
Q

cause of post-renal kidney disease

A
  • obstructed kidney

- interference with normal urine flow

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13
Q

causes of decreased renal perfusion

A
  • low ECF volume

- altered renal blood flow or hemodynamics

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14
Q

causes of low ECF volume

A
  • GI losses
  • hemorrhage
  • diuretics
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15
Q

causes of altered renal blood flow or hemodynamics

A
  • sepsis
  • heart failure
  • cirrhosis/hepatorenal syndrome
  • hypercalcemia
  • medications
  • vascular disease
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16
Q

causes of intra-renal kidney disease

A
  • glomerular disorders
  • acute interstitial nephritis
  • tubular obstruction
  • acute tubular necrosis
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17
Q

causes of acute interstitial nephritis

A
  • medication induced
  • autoimmune
  • infection related
18
Q

causes of tubular obstruction

A
  • crystals
  • tumor lysis
  • myeloma casts
19
Q

causes of acute tubular necrosis

A
  • ischemic

- nephrotoxic

20
Q

ischemic causes of acute tubular necrosis

A
  • decreased effective renal perfusion

- prolonged renal state

21
Q

nephrotoxic causes of acute tubular necrosis

A
  • nephrotoxic medications
  • heme pigments
  • iodinated radiocontrast
22
Q

initiating phase of acute tubular necrosis lasts how long

A
  • hours to days
23
Q

definition of initiating phase of acute tubular necrosis

A
  • time from onset of precipitating event until tubular injury occurs
24
Q

maintenance phase of acute tubular necrosis lasts how long

A
  • 1-3 weeks
25
Q

maintenance phase of acute tubular necrosis characterized by

A
  • marked decrease in GFR

- risk of electrolyte abnormalities

26
Q

recovery phase of acute tubular necrosis is the period during which what takes place?

A
  • repair of renal tissue
27
Q

abnormal urine with RBCs, RBC casts, and proteinuria will lead us to what condition

A

PRE-RENAL

  • glomerulonephritis
  • vasculitis
  • thrombotic microangiopathy
  • Atheroemboli
28
Q

abnormal urine with WBCs, WBC casts, and eosinophils will lead us to what condition

A
  • pyelonephritis
  • interstitial nephritis
  • atheroemboli
  • glomerulonephritis
29
Q

abnormal urine with RTE cells and pigmented cells will lead us to which conditions

A
  • tubular injury (acute tubular necrosis)
30
Q

acute tubular necrosis will have what in the urine

A
  • granular “muddy brown” casts
31
Q

if fractional excretion of Na is <1% the condition is mostly due to

exceptions

A
  • pre-renal
  • glomerulonephritis/vasculitis
  • radiocontast and heme pigement ATN
  • ATN + chronic pre-renal condition
  • nonoliguric ATN
32
Q

if fractional excretion of Na is > 1% the condition is mostly due to

exceptions

A
  • acute tubular necrosis
  • chronic kidney disease
  • diuretic use in past 24-48 hours
33
Q

how to calculate fractional excretion

A

Urine_Cr * BUN

34
Q

fractional excretion of urea < 35% suggests what cause

A
  • pre-renal
35
Q

fractional excretion > 50% suggests what cause

A
  • acute tubular necrosis
36
Q

urine hyaline casts suggest what causes

A
  • pre-renal
37
Q

urine granular casts suggest what causes

A
  • acute tubular necrosis
38
Q

how do kidneys try to compensate for diminished perfusion

how do NSAIDs stop this

A
  • increasing afferent arteriolar dilation

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

39
Q

definition of renal papillary necrosis

A
  • necrosis and sloughing of the papillae from impairment of blood flow
40
Q

renal papillary necrosis associated with

A
  • NSAIDS
  • Diabetes Mellitus
  • Sickle Cell Disease/Trait
41
Q

treatment of renal papillary necrosis

A
  • supportive

Renal Final (13 decks)

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