Kidney Disease

Question 1

KDIGO criteria for RISK of AKI

Answer 1

Increased SCr 1.5-1.9 x baseline OR >/= 0.3 mg/dl increase in 48 hrs

Question 2

KDIGO criteria for INJURY of AKI

Answer 2

2.0-2.9x baseline or GFR decrease > 50%

Question 3

KDIGO criteria for Failure of AKI

Answer 3

3.0x baseline SCr OR Increase in SCr >/= 4 mg/dl OR Initiation of renal replacement therapy

Question 4

Normal GFR is ~ what per min?

Answer 4

120-125 mL

Question 5

GFR is regulated intrinsically:
Afferent arteriole constriction occurs in response to what?
Afferent arteriole dilation occurs in response to what?
+/- vasoconstriction in response to what?

Answer 5

vasc smooth muscle stretch in HTN
Vasc smooth muscle relaxation in hypotension
NaCl concentrations

Question 6

Passive process for urine production involves what?

Answer 6

hydrostatic pressure pushes fluid & solute thru membranes

Question 7

Proximal Convoluted tubule is responsible for?

Answer 7

most absorptive capability
reabsorbs all glucose, AA, 65% of Na & H20

Question 8

Nephron loop is responsible for what:
Descending loop?
Ascending loop?

Answer 8

reabsorbs water
Na, K, Cl, Ca, Mg reabsorption

Question 9

Distal Convoluted tubule is responsible for what?

Answer 9

Na transport; aldosterone regulation
Tubular secretion disposes substances

Question 10

In acidotic states what does the Distal convoluted tubule dispose of?

Answer 10

drugs
metabolites
urea
uric acid
excess K
Creatinine
NH4
H+

Question 11

In alkalotic states what does the distal convoluted tubule do?

Answer 11

Cl reabsorption occurs as bicarb acid is excreted

Question 12

Selected causes of AKI requiring Immediate diagnosis and specific therapies
Decreased Kidney Perfusion

Answer 12

Volume status and urinary diagnostic indices

Question 13

Selected causes of AKI requiring Immediate diagnosis and specific therapies
Acute glomerulonephritis, vasculitis, interstitial nephritis, thrombotic microangiopathy

Answer 13

Urine sediment examination
serologic testing
hematologic testing

Question 14

Selected causes of AKI requiring Immediate diagnosis and specific therapies
UTI

Answer 14

Kidney US

Question 15

Causes of AKI
Exposures

Answer 15

Sepsis
Critical Illness
Circulatory Shock
Burns
Trauma
Cardiac Surgery
Major noncardiac surgery
nephrotoxic drugs
radiocontrast agents
poisonous plants and animals

Question 16

Causes of AKI
Susceptibilities

Answer 16

Dehydration or volume depletion
advanced age
female gender
black race
CKD
Chronic diseases (heart, liver, lung)
DM
CA
Anemia

Question 17

Prerenal causes of AKI

Answer 17

Hypovolemia
Impaired Cardiac Function
Systemic Vasodilation
Increased Vascular resistance

Question 18

Intrinsic Causes of AKI

Answer 18

Tubular
Glomerular
Interstitium
Vascular

Question 19

Postrenal Causes of AKI

Answer 19

Extrarenal Obstruction
Intrarenal Obstruction

Question 20

Prevention and Management of AKI
What type of fluids to use?
Use what during shock?
Use of what to maintain a blood glucose between what?
If AKI is present achieve a total energy intake of how much?
How much protein in non-catabolic AKI w/o RRT?
How much protein if on RRT? up to how much on CRRT or hyper-catabolic state?

Answer 20

Isotonic crystalloids > colloids for volume expansion (unless bleeding)
Vasopressors + fluids
Insulin for BG 110-149 mg/dL
20-30kcal/kg/d
0.8-1g/kg/d
1-1.5g/kg/d; 1.7g/kg/d

Question 21

Prevention and Management of AKI
Type of nutrition?
Avoid what to prevent AKI?
When to use diuretics with AKI?
Avoid low dose what to prevent or tx AKI?
Avoid what abx if possible?

Answer 21

enteral > parenteral
diuretics
AKI with volume overload only
dopamine
aminoglycosides

Question 22

Risk Factors for Contrast-Induced AKI include

Answer 22

pre-existing renal dysfunction
DM
HTN
CHF
advanced age
Volume depletion
HD instability
Large volume/high osmolality of contrast
nephrotoxic med agents

Question 23

Risk of Contrast-Induced AKI can be as high as 25% if what is present?

Answer 23

pre-existing renal dysfunction
OR
CKD + DM, CHF, advanced age, or nephrotoxic meds

Question 24

Prophylaxis prior to contrast administration is recommended for patients who have AKI or an eGFR < 30 mL/min who are not undergoing maintenance dialysis. What is the recommended prophylaxis?

Prophylaxis should be considered for patients with an eGFR of what?

Answer 24

IV NS

30-44 mL/min

Question 25

Clinical Evaluation
History

Answer 25

Meds - prescribed, OTC, Herbals, recreational
Social - exposure to tropical diseases (malaria), water, sewage, rodents (leptospirosis, hantavirus)

Question 26

Clinical Evaluation
PE

Answer 26

Fluid status
Acute/chronic heart failure
Infection/sepsis
+/- CO, preload responsiveness
Intra-abdominal pressure

Question 27

Clinical Evaluation
Labs

Answer 27

Creatinine
BUN
Electrolytes
CBC
UA with micro (cells, casts, crystals, bacteria)
urine chemistries (Na, creatinine, urea)

Question 28

Clinical Evaluation
Imaging

Answer 28

US

Question 29

Furosemide Stress Test
when to do it?
how much to give?
Monitor UO for how long?
Predicted progressive AKI for UO of how much?

Answer 29

Stage 1 or Stage 2 AKI
1mg/kg IV furosemide
2 hrs
< 200cc

Question 30

AKI Definition

Answer 30

Increase in SCr by 50% w/n 7 days OR increase in SCr by 0.3mg/dl w/n 2 days OR oliguria

Question 31

CKD definition

Answer 31

GFR < 60 ml/min for > 3 mo

Question 32

AKD definition

Answer 32

Alterations in kidney function & structure that do not meet criteria for either AKI or CKD, yet may need medical attention to restore kidney function & reverse damage

Question 33

NKD definition

Answer 33

GFR >/= 60 ml/min and Stable SCr

Question 34

Life-threatening Indications for RRT

Answer 34

Hyperkalemia
Acidemia
Pulmonary Edema
Uremic Complications

Question 35

Nonemergent indications for RRT

Answer 35

Solute Control
Fluid removal
Correction of acid-base abnormalities