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D&T test 5 - Renal, Urogential > Caster- Approach to AKI > Flashcards

Caster- Approach to AKI Flashcards

1
Q

Does Cr clearance over- or under-estimate GFR? by how much? and why?

A

it over estimates it by 10-15% because that much is secreted by the PCT

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2
Q

Cr is derived from what?

A

mtb of creatine in skeletal muscle

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3
Q

What is required for accurate Cr level measurement

A

steady state

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4
Q

Cr level depends on what 3 things?

A

Age,
Muscle Mass/weight,
Gender

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5
Q

Cr levels are higher in what race

A

AA

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6
Q

The most dangerous/extreme changes in kidney function occur when Cr increases from what to what?

A

1-2

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7
Q

What is normal serum level for Cr?

A

0.6 - 1.2

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8
Q

define AKI

A

decline in renal function that occurs over hours-days

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9
Q

serum Cr increase 1–> 2 represents what % decrease in GFR?

A

50%

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10
Q

serum Cr increase 2 –> 3 represents what % decrease in GFR?

A

17%

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11
Q

What 4 tyhings are you unable to do in AKI

A
  1. excrete waste
  2. regulate volume
  3. Manage electrolytes
  4. make bicarb
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12
Q

What is stage one of AKIN criteria designed to catch and how

A

it catches early changes in kidney function by being the stage that occurs if sCr increases >0.3mg/dl

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13
Q

both RIFLE and AKIN criteria for AKI measure what two criteria (either of which can be used)

A

Serum Cr or Urine Output can be used

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14
Q

4 risk factors for AKI

A

CKD
DM
Heart or Liver dysfunction
Age >50

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15
Q

define azotemia

A

increased BUN and Cr

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16
Q

3 presenting things with AKI

A

Azotemia
Oliguria
Electrolyte Imbalance

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17
Q

define Oliguria

A

< 400 ml/day

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18
Q

define Anuria

A

< 50 ml/day

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19
Q

3 major causes of AKI

A

pre-renal
intra-renal
post-renal

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20
Q

What are the four intra-renal locations of AKI

A

tubular
Interstitial
GLomerular
Vascular

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21
Q

What are 2 indications for doing a renal biopsy on AKI pt?

A

1) Acute glomerulonephritis suspected (proteinuria, hematuria, RBC casts)
2) If etiology of AKI unclear or recovery is not as expected

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22
Q

Urinalysis shows muddy brown casts = what dx?

A

ATN

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23
Q

pre-renal AKI is caused by hypoperfusion cuased by what two things?

A

hypovolemia- (improves with fluids)

Decreased effective BV

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24
Q

What 3 conditions cuase decreased effective BV?

A

CHF
Cirrhosis
Sepsis

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25
Q

Inresponse to decreased BF kidneys do what 2 things to increase GFR?

A

release PGs to dilate AA

ATII vasoconstricts the EA (more than AA)

26
Q

what 2 drug classes block ATII activity?

A

ACEIs, ARBs

27
Q

What drug class blocks PG production–> AA vasoconstriction

A

NSAIDs

28
Q

Pre-renal AKI BUN:cr ratio value and MOA

A

> 15

MOA: decreased GFR –> RAAS –> Na/H20 reabsorption and BUN follows

29
Q

Urine Na in pre-renal AKI

A

low (<20)

30
Q

Fractional excretion of Na (FeNa) in pre-renal AKI

A

<1%

31
Q

Urine osm in pre-renal AKI and MOA

A

high (>500)

low GFR–> upregulated ADH –> concentrated urine

32
Q

FeNa <1% = what dx

FeNa >2% = what dx

A 
<1% = pre-renal AKI
>2% = Intra-renal AKI (usually ATN or obstruction)
33
Q

When do you use FeUrea instead of FeNa and why

A

if pt is on diuretics (since they impair Na reabsorption)

34
Q

FeUrea <35% –> what dx

A

Pre-renal AKI

35
Q 
FeNa= equation
FeUrea = equation
A

[(uNa)x(sCr)/(sNa)x(uCr)] x 100

[(sCr)x(uUrea)/(sUrea)x(uCr)] x 100

36
Q

What is MC AKI in hospital

A

ATN

37
Q

3 stages of ATN

A

Initisaition
Maintenance
Recovery

38
Q

What causes muddy brown casts in ATN

A

necrotic tubule cells slough off into tubule

39
Q

2 etiologies of ATN

A

ischemic

nephrotoxic

40
Q

prolonged hypoperfusion destroys which 2 parts of tubule and why those?

A

PCT, TAL bc they are the most metabolically active

41
Q

Nephrotoxic destroys which part of tubule

A

PCT

42
Q

which mtbolite of ethylene glycol forms a stone and which type of stone in nephrotixic ATN

A

oxalate is a mtbolite

forms calcium oxalate stones

43
Q

Pigment Nephropathy is due to what two proteins? what type of proteins are these?

A

Heme proitiens:
Myoglobin (muscle injury),
Hemoglobin (Hemolysis)

44
Q

Two etiologies of Interstitial AKI

A

Pyelonephritis

AIN

45
Q

What causes AIN

A

Drug -induced HSR in the interstitium and tubules

46
Q

what are 4-drug causes of AIN

A

NSAIDs, Penicillin, diuretics, PPIs

47
Q

Presentation of AIN ( 3 things- plus 1 finding which is the hallmark!!!???)

A

Fever, rash, pyuria/hematuira

Eosinophils in interstitium/urine = Hallmark!!!!

48
Q

What 3 vascular TMAs cause interstitial AKI

A

Hemolytic Uremic Syndrome (HUS)
Thrombotic Thrombocytopenic Purpura (TTP)
Malignant HTN

49
Q

common cause of AKI in children

A

Hemolytic Uremic Syndrome (HUS)

50
Q

Cancer can cause what type of AKI

A

obstructive/post-renal

51
Q

What is MC stone in adults

A

Calcium oxalate

52
Q

What are urine findings (pH, smell) in Magnesium Ammonium phosphate (MAP) stones?

A

smells like Ammonia

Alkaline urine

53
Q

Proteus causes what type os stone and what specific named calculus type

A

causes Magnesium Ammonium phosphate (MAP) stone with a “staghorn calculus”

54
Q

AKI, AGMA, calcium oxalate stones = what dx

A

ethylene glycol ingestion

55
Q

staghorn calculus, signs of infx (urine WBCs), alkaline urine–> what dx

A

proteus infx

56
Q

Radiopaque (visible on XR) = what type of stones

A

calcium stones

57
Q

Post-obstructive diuresis: MOA, complication of what?

A

accumulation of solutes –> osmotic diuresis

complicationo of bladder decompression after Stone removal

58
Q

Indictaions for hemodialysis (5)= mnemonic and the thing itself

A

AEIOU
Acidosis (metabolic) - refractory
Electrolyte imbalance: hyperK, hyperCa, HypoNa
Ingestion: ehtylene glycol, methanol, lithium
Overload: refractory to diurectics
Uremia: BUN >100, sx (AMS, tremors)

59
Q

if RBC cast is seen = dx

A

Glomerulonephritis

60
Q

eosinophils in urine = dx

A

AIN

61
Q

WBC cast = 2 dx

A

AIN, pyelonephritis

62
Q

fatty cast or proteinuria = dx

A

nephrotic synd

D&T test 5 - Renal, Urogential (27 decks)

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