Final: AKI/CKD Assessment Flashcards
How many mls of urine per day is produced in:
- Anuria:
- Oliguria:
- Polyuria:
- Anuria: <100ml/day
- Oliguria: <400ml/day
- Polyuria: >3000ml/day
What is azotemia?
elevation of BUN w/o symptoms
What is uremia
elevation of BUN w symptoms
- confusion
- N/V
- metallic taste in mouth
- Anorexia
What are most cases of AKI from?
Acute Tubular Necrosis or prerenal azotemia
What all can cause ATN?
Ischemia is most common
Toxins
- antibiotics!!
- -vanco, aminoglycosides
Which cause of AKI (ATN or prerenal azotemia) causes activation of RAAS and ADH?
Prerenal azotemia
-due to decrease in GFR
In prerenal azoemia, is the FeNa? >1 or <1?
<1%
In ATN, is the FeNa? >1 or <1?
> 1%
What sites of the kidney are the most common for ATN?
Proximal tubule and medullary thick ascending limb of the loop of Henla
What causes the decrease in GFR seen in ATN?
- Tubular obstruction -via cast formation
2. Back leakage of urine due to loss of tight junctions
Prolonged prerenal azotemia can progress to what?
ATN (ischemia)
What characterizes interstitial nephritis?
Inflammatory cells within the renal interstitium
What are the three most common causes of interstitial nephritis?
- Drugs (NSAIDs)
- also Abs and PPIs - Infections
- Autoimmune
- SLE, Sjogrens, IgG4-related disease
What disease presents with fever, rash, arthralgias, peripherial eosinophilia, pyuria, WBC casts, minimal proteinuria, and acute renal failure?
Acute Interstitial Nephritis (AIN)
What disease presents with minimal proteinuria, few cells in the urine, and a slow decline in renal function with fibrosis?
Chronic Interstitial Nephritis
Pt comes in with swollen legs and periorbital edema, HTN, dysuria, with +2 albuminuria and RBCs in their urine. They have vomited twice and have asterixis.. what would you diagnose as?
AKI
- Edema
- HTN
- decreased urine
- Protein/hematuria
- SOB
- Uremia (Asterixis, Uremic frost)
What would you order to diagnose AKI (2)?
- Urinalysis w urine microscopy
- Urine albumin/cr or protein/cr ratio
- Renal US
What would small kidneys and cortical thinning on renal US suggest?
CKD
What effect does ADH have on the kidneys? (physiologically)
ADH binds V2 receptors, which in turn puts Aquaporin 2 channels in the Collecting Duct
-reabsorption of more water!
Renal tubular epithelial cells, transitional
epithelial cells, granular casts, or waxy casts suggests what kidney disease pattern?
ATN
WBC, WBC cast, or urine eosinophils suggests what kidney disease pattern?
AIN or pyelonephritis
Dysmorphic RBCs, RBC casts suggests what kidney disease pattern?
Vasculitis or glomerulonephritis
Proteinuria, Hematuria, with dysmorphic RBC and RBC casts suggests what kidney disease pattern?
Nephritis Syndrome
Heavy proteinuria, lipiduria, and minimal hematuria suggests what kidney disease pattern?
Nephrotic syndrome
Hyaline casts suggests what kidney disease pattern?
Prerenal azotemia (non-specific)
WBCs, RBCs, bacteria suggests what kidney disease pattern?
UTI
Indications for dialysis: (AEIOU)
A: Severe Acidosis
E: Electrolyte disturbance (usually hyperkalemia)
I: Ingestion (ex: ethylene glycols, methanol, etc…)
O: Volume overload
U: Uremia
Dr. Selby Standard Questions for History in diagnosis of AKI?
- Fluid intake?
- N/V/D?
- Orthostatics?
- Hx of HTN, DM2, or CKD?
- Recent Antibiotic exposure or any new medication?
- Recent IV iodine contrast exposure?
- Urinary retention symptoms?
- Family history of kidney disease?
If pt doesnt recover from AKI in 3 months, what do they now have?
CDK
-most people recover in 7-21 days
Elevated urine eosinophils should automatically make you think of which AKI?
Acute Interstitial Nephritis
A FeNa <1%=?
A FeNa>2%=?
Prerenal azotemia
ATN
A FeUrea <35%=?
A FeUrea>50%=?
Prerenal azotemia
ATN
If a patient is non-oliguric, can they have prerenal azotemia?
No
-pt must be oliguric to be considered prerenal
