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Section 10: Renal and Genitourinary Disorders > Chapter 88: Acute Kidney Injury > Flashcards

Chapter 88: Acute Kidney Injury Flashcards

1
Q

Reversible mechanisms of community acquired AKI

A

volume depletion
medications
infection
urinary obstruction

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2
Q

Wha are the functions of the kidney?

A

glomerular filtration
tubular reabsorption
secretion

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3
Q

normal GFR of early adulthood?

A

120ml/min/1.73m2

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4
Q

every decade, how many decrease in GFR is noted?

A

8ml/min/1.73m2

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5
Q

what is the driving force of glomerular filtrations?

A

glomerular capillary pressure

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6
Q

glomerular capillary pressure depends on 2 things

A

renal blood flow and autoregulation

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7
Q

recovery from AKI depends on what factor?

A

renal blood flow

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8
Q

classification of AKI that increases tubular pressure that decreases the driving force for filtration

A

postrenal AKI

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9
Q

most common cause of intrinsic AKI?

A

ischemic injury or ischemic tubular necrosis

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10
Q

Once the cause of acute kidney injury is resolved, the remaining functional nephrons increase filtration and eventually ___

A

hyperthrophied

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11
Q

If the number of remaining nephrons is below some critical number, continued hyperfiltration results in progressive ___ , eventually leading to ___

A

glomerular sclerosis

nephron loss

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12
Q

causes of endothelial leak that will result in third spacing

A

sepsis
pancreatitis
burns
hepatic failure

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13
Q

AKI that may present as flank pain and hematuria

A

crystal-induced nephropathy
nephrolithiasis
papillary necrosis

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14
Q

what would you suspect in patient with rhabdomyolysis or hemolysis after blood transfusion?

A

pigment-induced AKI

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15
Q

patient presented with darkening of urine and edema

A

acute glumerulonephritis

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16
Q

Fever, arthralgia, and rash are common with ___

A

acute interstitial nephritis

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17
Q

patient presented with severe flank pain

A

acute renal arterial occlusion

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18
Q

Cough, dyspnea, and hemoptysis raise the possibility of ___

A

Goodpasture’s syndrome or Wegener’s granulomatosis

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19
Q

this symptom strongly suggest obstruction

A

anuria (alternating oliguria and polyuria)

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20
Q

Serum Cr increased 2.0–3.0 times or GFR decrease 50%–75% and urine output of 0.5 mL/kg/h for 12 h

A

AKIN stage 2

RIFLE: Injury

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21
Q

Serum Cr increased 1.5 times or (AKIN only) Cr increase >0.3 milligram/dL (≥26.5 μmol/L) over <48 hour or GFR decrease 25%–50% and urine output of 0.5 mL/kg/h for 6 h

A

AKIN stage 1

RIFLE: Risk

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22
Q

Serum Cr increased >3.0 times or Cr >4 milligrams/dL (≥354 μmol/L) and acute increase >0.5 milligram/dL (44 μmol/L) or GFR decrease >75% and urine output of 0.3 mL/kg/h for 24 h or Anuria for 12 h

A

AKIN stage 3

RIFLE: Failure

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23
Q

Need for renal replacement therapy for >3 months

A

RIFLE: End-stage renal disease

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24
Q

Complete loss of kidney function for >4 weeks

A

RIFLE: Loss

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25
Q

T or F: Determine if kidney injury is prerenal, postrenal, or intrin- sic through history, physical, and diagnostic testing

A

True

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26
Q

ECG is the fastest screening test for hyperkalemia, but sensitivity for a level over ___ ranges from 14% to 60%

A

6.5 mmol/L

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27
Q

how many postpaid bladder residual volume suggests bladder outlet obstruction?

A

> 125mL

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28
Q

anuria

A

<100ml/24 hours

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29
Q

prerenal AKI can be divided into?

A

volume loss
hypotension
diseases of the large and small renal arteries

30
Q

In the elderly population, the rate of postrenal AKI is as high as ___

A

22%

31
Q

it is a type of AKI that is most common in hospital acquired AKI than community acquired AKI.

A

intrinsic acute kidney injury

32
Q

definition of contrast-induced nephropathy

A

change in serum creatinine (25% increase from baseline or an absolute increase of 0.5 milligram/dL [44 μmol/L] 48 to 72 hours after infusion)

33
Q

causes of crystal-induced nephropathy (renal tubule)

A

elevated uric acid in tumor lysis syndrome, acyclovir, sulfonamides, indinavir and triamterene

34
Q

mechanism of ACE inhibitor in increasing serum creatinine

A

decrease the GFR and increase renal blood flow

35
Q

arteriolar changes (efferent arteriolar vasodilation) may precipitate significant AKI in a patient with undiagnosed ___

A

bilateral renal artery stenosis

36
Q

other than increase serum creatinine what is the usually side effect?

A

mild hyperkalemia

37
Q

mechanism of NSAIDS in increasing serum creatinine?

A

decrease GFR and renal blood flow (vasoconstriction of afferent arteriolar)

38
Q

type of AKI in NSAIDS use

A

prerenal initially then post renal in long term use

39
Q

the most common antiviral that causes AKI

A

antiretroviral such as acyclovir and valacyclovir

40
Q

In patients with no renal function (GFR = 0), serum creatinine level increases ___

A

1 to 3 milligrams/dL (88 to 265 μmol) a day

41
Q

T or F: Elevation of serum creatinine may take 24 hours after onset of decreased function

A

False. 48 hours

42
Q

Example of intrinsic AKI that causes rhabdomyolysis

A

cocaine
ethanol
lovastatin

43
Q

stages of CKD

A 
Stage 1: GFR ≥90 mL/min/1.73 m2
Stage 2: GFR 60–89 mL/min/1.73 m2
Stage 3: GFR 30–59 mL/min/1.73 m2
Stage 4: GFR 15–29 mL/min/1.73 m2
Stage 5: GFR <15 mL/min/1.73 m2
44
Q

A protein produced by all nucleated cells has been proposed as a replacement for creatinine in estimating GFR

A

cystitis C

45
Q

Exact measurements of urine output require a urinary catheter to be in place for greater than ___ hours to meet the criteria of AKI

A

6 hours

46
Q

Urea is reabsorbed in tubule with sodium. so in patient with hypernatremia how many percent of urea clearance is low?

A

30%

47
Q

In the setting of prerenal AKI, the serum ratio of BUN to creatinine is typically ___

A

> 10

48
Q

Pigmented granular casts are common with ___

A

ischemic or toxic tubular injury

49
Q

This findings in urinalysis is normal in pre renal AKI

A

hyaline casts

50
Q

Brown granular casts are common in ___

A

hemoglobinuria or myoglobinuria

51
Q

The finding of hemoglobin on urine dipstick analysis with no red cells on microscopy suggests ___

A

myoglobinuria

52
Q

kidney dimension of ___ suggests chronic kidney disease

A

<9 cm

53
Q

Hyperechogenicity in the ultrasound indicates ___

A

Hyperechogenicity indicates diffuse parenchymal disease

54
Q

This test will allow assessment of renal perfusion and can allow diagnosis of large-vessel causes of AKI.

A

Color flow Doppler US

55
Q

___ is the ratio of the differ- ence between systolic and diastolic flow to systolic flow [(Vmax – Vmin)/ Vmax]

A

Resistive index (NV <0.7)

56
Q

In the vasoconstrictive phase of ischemic AKI, in which there may be no diastolic flow, the ratio may be as high as ___

A

1.0

57
Q

In critically ill patient with AKI. What is the priority of treatment?

A

resuscitation

58
Q

IF GFR is less than 30 avoid IV contrast except what cases?

A

major trauma
aortic dissection
STEMI

59
Q

In general, for IV contrast studies in patients with GFR of
___, weigh benefits of the study against the risk
of renal function decline.

A

30 to 59 mL/min/1.73 m2

60
Q

For patient with abnormal kidney for contrast-enhanced imaging. What fluid we should give?

A

500 to 1000ml LR prior to procedure and equal amount after procedure

61
Q

Permanent loss of renal function develops over the course of ____ in the setting of complete obstruction

A

10 to 14 days

62
Q

The risk of chronic kidney disease increases significantly if obstruction is complicated by ___

A

UTI

63
Q

T or F: n the absence of fluid overload, diuretics are recommended for patients with AKI

A

False. In the absence of fluid overload, diuretics are not recommended for patients with AKI

64
Q

Furosemide stress test can be done in patient with

A

mild to moderate fluid overload and AKIN stage 2 and below

65
Q

How to do Furosemide stress test?

A

Administer 1 milligrams/kg of furosemide in naive patients or 1.5 milligrams/kg in those with prior exposure; a urine output of <200 mL over 2 hours has a sensitivity of 87.1% and a specificity of 84.1% to predict progression to AKIN stage 3 AKI

66
Q

safe effective use of sodium bicarbonate requires ___

A

urine flow and ability to tolerate a fluid load

67
Q

Treatment for glomerulonephritis

A

renal biopsy
corticosteroid
cyclophosphamide
plasmapheresis

68
Q

types of cardiorenal syndrome

A

type 1 - acute deterioration in cardiac function that causes AKI
type 2 - chronic
type 3 - AKI that causes acute cardiac injury and/or dysfunction
type 4 - chronic
type 5 - secondary to a separate systemic condition such as sepsis

69
Q

This is a form of renal replacement therapy primarily used to remove excess fluid

A

Ultrafiltration

70
Q

T or F: U.S. Food and Drug Administration states that metformin should be withheld temporarily in patients receiving iodin- ated contrast media if their GFR is between 30 and 60 mL/min/1.73 m2 and restarted after creatinine has been checked 48 hours after contrast administration, and patients with lower GFRs should have metformin held and not restarted

A

True.
U.S. Food and Drug Administration states that metformin should be withheld temporarily in patients receiving iodin- ated contrast media if their GFR is between 30 and 60 mL/min/1.73 m2 and restarted after creatinine has been checked 48 hours after contrast administration, and patients with lower GFRs should have metformin held and not restarted

71
Q

T or F: The American College of Radiology has made the following recommenda- tions. For patients with estimated GFR ≥30 mL/min/1.73 m2, there is no need to discontinue metformin prior to the procedure or following the procedure

A

True.
The American College of Radiology has made the following recommenda- tions. For patients with estimated GFR ≥30 mL/min/1.73 m2, there is no need to discontinue metformin prior to the procedure or following the procedure

72
Q

T or F: For patients with eGFR ≤30 mL/min/1.73 m2, metformin should be withheld at the time of the contrast infusion and for 48 hours after the procedure

A

True.
For patients with eGFR ≤30 mL/min/1.73 m2, metformin should be withheld at the time of the contrast infusion and for 48 hours after the procedure

Section 10: Renal and Genitourinary Disorders (8 decks)

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