April 25, 2016 - Acute Kidney Injury II

Question 1

Causes of Intra-Renal Kidney Injury

Answer 1

Acute tubular injury (75%)

Glomerulonephritis (10%)

Acute interstitial nephritis (5%)

Vascular (10%)

Question 2

Acute Tubular Necrosis (ATN)

Answer 2

The death of tubular epithelial cells that form the renal tubules of the kidneys.

Ischemia or pre-renal causes

Exogenous toxins (aminoglycosides etc.)

Pigments (hemoglobin, myoglobin, etc.)

Can be caused by sepsis (35%), post-surgical (25%), or contrast-associated kidney failure.

Question 3

Course of ATN

Answer 3

1. Initiation phase (injury phase)
2. Maintenance phase (parenchymal injury) - this consists of low urine output and lasts for 1-2 weeks and may have complications
3. Recovery phase - in this phase the patient will diurese themselves and you need to watch to ensure they maintain enough fluid

Question 4

Crush Syndrome

Answer 4

When individuals are crushed, all the free myosin from their damaged muscles gets released into the circulation. This can plug up the kidneys, develop into AKI, and they can die.

It is important to give fluids to dilate the patient ASAP.

Question 5

Diagnosing Glomerulonephritis

Answer 5

Measure three things in the urine…

1. ANCA

2. Anti-GBM autoantibodies

3. Immune complexes (low C3)

If none of these three things are positive, it means the patient has IgA nephropathy.

Question 6

Indications for Dialysis

Answer 6

AEIOU

A - acidosis

E - electrolyte abnormalities

I - ingestions

O - fluid overload

U - symptoms of uremia