Kidney Injury Flashcards by Zahra Kalifa

What is AKI?

1- decrease GFR
2- Elevated Creatinine
3- Decrease urine output

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What are the anatomical types of AKI?

Pre-renal
renal
post-renal

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What are the pre-renal causes of AKI?

decrease perfusion (hypovolumeia)

HF, Sepsis, Cirrhosis

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What are the internsic causes of AKI?

Renal parynchymal injury

Prolonged hypoperfusion, sepsis, nephrotoxins, glomerular disease

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What are the post-renal causes of AKI?

Anatomic obstruction of lower UTI

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What is the RIFLE classification standfor acute kidney injury

R: risk of renal dysfunction
I: injury to the kidney
F: failure of kidney function 
L: loss of kidney function 
E: End stage renal disease

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What is the risk for renal dysfunction?

Creatinine clearance: <25%

Urine output: <0.5\kg for 8hr

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What is the injury to the kidney?

Creatinine clearance: <50%

Urine output: <0.5\kg for 16hr

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What is the failure of kidney to function?

Creatinine clearance: <75%
Urine output: <0.3\kg for 24hr

Creatinine clearance: <35 ml per 1.73
Urine output: anuria for 12 hours

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When to say there’s loss of kidney function?

Presistent failure >4weeks

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When to say there’s end stage renal disease?

Presistant failure >3 months

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What are the clinical symptoms for AKI?

edema
Hypertension
gross hramturia
reduce urine output

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What other lab findings could be found in AKI?

hyperkalemia
hyperphosphatemia
Hypocalcemia
metabolic acidosis
serum sodium abn.

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What suggest prerenal kidney diesase?

vomiting
diarrhea
low oral intake

(Low urine output)

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What suggest hemolytic uremic syndrome?

Bloody diarrhea 3 to 7 days prior to the onset of oligourea

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What suggest post-strep glomerulonephritis?

Pharyngitis - impetigo before hematuria or edema

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What suggest intense nephrotoxicity

Hospitilized patient Recieving nephrotoxic medication

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What suggest HSP or SLE

Fever, joint complaints, rash

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What investigations to order in AKI?

urinalysis
CBC
sodium excretion
complement
Strep infection serology
aminoglycosides

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To differentiate between pre and internsic AKI we can measure

Fractional sodium excretion

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Elevated amingolgucoside indicate

Acute tubular necrosis

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What to look for in physical exam of AKI? (In general)

edema And weight gain
BP
systemic: joint disease\rash

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What suggest prerenal AKI (PA)

volume depletion (dry mucus, tachycardia, decreased BP)

What suggest renal vein thrombosis AKI (PA)

Enlarged palpable kidney

What suggest puretheral obstruction in AKI (PA)

Enlarged bladder.

What is the role of kideny biopsy in AKI?

When diagnosis is not made clear and to guide treatment in acute glomerulonephritis

Differentiate between AKI and ATN: | “Prerenal AKI, and Internsic AKI”

Prerenal: high specific gravity - >40 creatinine - <20 Na - <1% FENa - <35% FEUrea (High SG, Creatinine - Low Na\urea) Internsic: low specific gravity - <20 creatinine - >40 Na - >2% - >50%

What is the general management approach for AKI?

1- specific tx for underlying 2- Fluid, electrolyte, Nutritional 3- drug dosing 4- renal replacement therapy

Summarize fluid management of acute kidney injury

- Hypovoluemic: NS bolus - Euvolemic: “ongoing insensible fluid loss” balanced w\ adminsterd fluids - Hypervolumic: fluid removal by furosamide

What should you stop patient with olgourea\aneuria from taking

Potassium | Phosphorus

What should you advice about sodium ingestion in AKI?

Restrict sodium intake to prevent fluid retention > HTN

Whar is the most common\severe complication of AKI?

Hyperkalemia “cardiac arrythmia”

How to treat metabolic acidosis in AKI?

Sodium bicarb (debatable)

What should be the caloric intake in AKI?

It should increase to counterpart the catabolic needs of a patient “120 kcal\Kg in infant - 150% of the maintance need in older children”

What are the indication for renal replacement therapy?

- uremia - hyperkalemia unresponsive - fluid overload unresponsive

What is the prognosis of AKI

Increased mortality | In mod-severe, follow up to detect signs of CKD

What is the CKD?

Structural\functional kidney damage presist over 3months

What is the functional kidney damage?

- decrease GFR - increased Proteinurea - both

Define chronic kidney injury according to KDIGO

- GFR<60 w\out CKD markers for 3 months | - GFR >60 w\structural - CKD markers (proteinurea, albuminurea, tubular disorders)

What are the stages of chronic kidney disease according to the KDIGO?

- G1: >90 - G2: 60- 89 - G3a: 45 - 59 - G3b: 30 - 44 - G4: 15 - 29 - G5: <15

Name the most common etiologies of CKD

- conginital anomaly of the kidney (hypoplasia or dysplasia) - conginital anomaly of urinary tract (obstructive uropathy)

What is the second largest cause of childhood CKD?

Glomerular disorders “>12 years of age”

How do children with non-glomerular disease usually present?

- asymptoamtic - polyuria - poor growth

What is the best way to diagnose children with non-glomerular CKD?

Imaging | And investigations for creatinine

How does paatient with glomerular disease CKD usually present?

More prominant signs and symptoms

How to detect CKD in early stages?

Usually they are asymptomatic - elevated serum creatinine - prenatal ultrasound for kidney disease.

In which stage of CKD do we commonly see poor growth?

Stage 3 CKD

In which stage do we commonly see uremia, weakness, fatigue, anorexia or vomitting

Stage 4 and 5

What to obtain from the history of CKD

- seizure - anemia - recurrent UTI - high BP - polyruia\polydipsia - poor growth - family hx of HTN\renal - orthopedic\urologic abnormalities - conginital anomaly of kidney

What physical xamination to do in CKD

1- growth parameters (H, W, head circumference) + BP 2- Hyper-volemia (edema - rales - hepatic - cardiac gallop) 3- auscultation: pericardial rub (pericarditis) - diminished heart sound (pericardial effusion) 4- pallor in anemia

What imaging can be used for evaluating CKD?

- US: initial when suspecting CKD - VCUG: for [vesicouretric reflux] hydronephrosis - posterior uretheral valve - renal scan: focal abnormalities - obstruction - other CT & MRI

What are the lab investigations for CKD?

- serum creatinine - Serum bicarbonate - CBC - URinalysis - protein\creatinie ratio in urine Additional - Calcium - phosphorus - 25 hydroxyvitamin D - PTH

In obstructive uropathy and dysplastic kidney, what happens to salt excretion?

Increased leading to hypovoluemia

How to trat ckd when theres anemia

Iron and if severe give erythrropoetin (till gb 11)

How to treat ckd with hypertension?

Arb - ace