ECC

Question 1

What’s the marker for AKI?

Answer 1

Creatinine

Question 2

At what creatinine value do we worry about kidney injury?

Answer 2

Trick question!
There is no absolute value. We worry about kidney injury every time creatinine increases more than 1.5x its initial baseline value

Question 3

What is the most common sign of kidney injury?

Answer 3

oliguria, anuria, uremia when damage is already done

loss in the ability to concentrate urine at the early stages

Question 4

What are the main risk factors for kidney injury?

Answer 4

Infection (lepto)
hypovolemia
nephrotoxic drugs (NSAIDs)
toxins (ethylene glycol)
coagulation disorders

Question 5

What are some findings on clinical exam that can make you suspect AKI?

Answer 5

• big kidney small kidney
• uremia (mouth ulcers, breath..)
• neuro signs (seizure, head pressing..)
• big distended bladder

Question 6

What can be some pre-renal causes/risk factors of AKI?

Answer 6

• hypoperfusion (hypovolemic/cardiogenic shock)
• hypotension
• dehydration

with these expect increased USG (unless there is also renal damage), reduction in urinary output, increased creatinine

Question 7

Causes of AKI

Infections, Vascular, Neoplasia, Perfusion, Toxins..

Answer 7

Infections: pyelonephritis, lepto, lyme, leishmania, sepsis
NEoplasia: lymphoma and other RCT
Immune mediated: SLE
Perfusion: NSAIDs, hyperviscosity, shock, ACEin, hypo/hypertension
Toxins: raisins, ethylene glycol

Question 8

Signs of AKI on urinalysis

Answer 8

• Casts (indicate tubular damage v early on)
• isosthenuria (between 008 and 015)
• Glucosuria
• proteinuria

Question 9

U/S signs of AKI

Answer 9

• increased echogenicity of cortex
• masses
• loss of corticomedullary definition
• dilated pelvis