Kidney

Question 1

Acute renal failure definition

Answer 1

The abrupt decrease of renal function sufficient enough to result in retention of nitrogenous waste products as well as loss of regulation of extracellular volume and electrolytes

Question 2

How fast are ARF developed ?

Answer 2

Hours to days

Question 3

ARF classic laboratory definition

Answer 3

• Cr increase of 0.5 mg/ dl
• Cr increase of more than 50%
• Decreased Cr clearance more than 50%
• Any decrease in renal function that requires dialysis

Question 4

What is ADQI?

Answer 4

Acute dialysis quality initiative, RIFLE

Question 5

What is the “R” in RIFLE?

Answer 5

Risk: Increased creatinine x 1,5 or GFR decrease of more than 25% or urine output less than 0,5ml/kg/h x 6h

Question 6

What is the “I” in RIFLE?

Answer 6

Injury: Increased Cr x 2 or GFR decrease of more than 50% or urine output less than 0,5ml/kg/h x 12h

Question 7

What is the “F” in RIFLE?

Answer 7

Failure: Increased Cr x 3 or GFR decrease of more than 75% or urine output less than 0,3 x 24h or anuria for 12h

Question 8

What is the “E” in RIFLE?

Answer 8

ESRD, end-stage renal disease: Loss of renal function for more than 3 months

Question 9

What is the “L” in RIFLE?

Answer 9

Loss: Persistent ARF = complete loss of renal function for more than 4 weeks

Question 10

Which drugs may increase Cr w/out AKI?

Answer 10

Trimethoprim, Cimetidine and Probenecid

Question 11

What may interfere w/ Cr assays in the lab (false elevation) ?

Answer 11

Glucose, acetoacetate, ascorbic acid, cefoxitin, flucytosine

Question 12

What may cause an increase in BUN w/out AKI?

Answer 12

• Gi bleeding
• Catabolic states (prolonged ICU stay)
• Corticosteroids
• Protein loads (TPN-Albumin infusion)

Question 13

What are the alternatives to serum Cr?

Answer 13

• Urinary neutrophil gelatinase-associated lipocalin (NGAL)
• Urinary interleukin 18
• Urinary kidney injury molecule 1 (KIM-1)

Question 14

What accounts for nearly 50% of all causes of AKI?

Answer 14

Sepsis

Question 15

What are the symptoms and signs of renal failure in the means of retention of nitrogenous waste products?

Answer 15

• N/V
• diarrhea
• hiccups
• itching
• dry mouth
• drowsiness
• neuropathy
• pericarditis
• coma

Question 16

What are the symptoms and signs of renal failure in the means of salt and water retention?

Answer 16

• pulmonary edema
• peripheral edema
• ascites
• pleural effusion

Question 17

What are the symptoms and signs of renal failure in the means of potassium retention?

Answer 17

• weakness
• lassitude
• paralysis
• ECG: tenting T-waves, widening QRS, increased PR interval,
• cardiac arrest
• VTach

Question 18

What are the symptoms and signs of renal failure in the means of retention of acid?

Answer 18

• Kussmaul respiration
• Hyperreflexia
• Hypotension

Question 19

What are the major disease categories causing AKI?

Answer 19

• Prerenal 40-80%
• Intrinsic 10-30%
• Postrenal <5%

Question 20

What are the causes of prerenal AKI?

Answer 20

• Volume loss/sequestration
• Impaired cardiac output
• Hypotension (and potentially hypo-oncotic states)
  Net result: hypoperfusion

Question 21

What are the causes of intrinsic AKI?

Answer 21

• Vascular disorders
• Glomerulonephritis
• Interstitial disorders: inflammation and intercalative
• Tubular necrosis: ischemia, toxin, pigmenturia

Question 22

What are the causes of post-renal AKI?

Answer 22

• Intrarenal: crystals and proteins

- Extrarenal: pelvis, ureter, bladder, urethra, prostate

Question 23

Diagnostic tools in AKI

Answer 23

• History and PE
• Urinalysis: SG, pH, blood, crystals, infection
• Urinemicroscopy: casts, cells (eosinophils)
• Imaging: US, Mag-3 scan, retrograde pyelogram
• Markers of CKD: iPTH, size >9cm, anemia, high phosphate, low bicarb
• Biopsy