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Y4R3 - Medicine II 🩺 > L1: AKI > Flashcards

L1: AKI Flashcards

1
Q

Def of AKI

A
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2
Q

Epidemeology of AKI

A
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3
Q

Dx Criteria of AKI

A
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4
Q

S. Cr in AKI

A
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5
Q

Urine Output in AKI

A
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6
Q

Staging Cr in AKI

A
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7
Q

Stage I AKI

A
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8
Q

Stage II AKI

A
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9
Q

Stage III AKI

A
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10
Q

Urinary obstruction must be excluded as a cause of low urine output.

A

..

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11
Q

The most abnormal parameter is used for classifications.

A

..

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12
Q

Etiology of AKI

A
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13
Q

Pre-Renal Causes of AKI

A
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14
Q

Pre-Renal Causes of AKI

  • Hypovolemia
A
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15
Q

Pre-Renal Causes of AKI

  • ## Shock
A

Septic, Cardiogenic or Anaphylactic

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16
Q

Pre-Renal Causes of AKI

  • Drugs
A
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17
Q

Renal Causes of AKI

A
  • Glomerular
  • Tubulo-interstitial
  • Vascular
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18
Q

Renal Causes of AKI

  • Glomerular
A

Glomerulonephritis (Especially rapidly progressive glomerulonephritis) → Discussed separately.

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19
Q

Renal Causes of AKI

  • Interstitial
A

AIN = Acute Interstitial Nephritis

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20
Q

Renal Causes of AKI

  • Tubular
A
  • Ischemic ATN
  • Toxic ATN
  • Sepsis
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21
Q

Causes of ATN

A
  • Ischemic ATN
  • Toxic ATN
  • Sepsis
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22
Q

Ischemic ATN

A
  • ALL CAUSES OF PRERENAL DISEASE particularly if SEVERE, PROLONGED & accompanied by hypotension, surgery, and/or sepsis can cause ATN.
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23
Q

Types of Toxic ATN

A
  • Endogenous & Exogenous
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24
Q

Types of Endogenous Nephrotoxins

A
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25
Q

Protein Endogenous Nephrotoxins

A
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26
Q

Crystals as endogenous nephrotoxins

A

Uric acid → in Tumor lysis syndrome.

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26
Q

Types of Exogenous Nephrotoxins

A
  • Drugs
  • Toxic Manifestations
  • Heavy Metals
  • Contrast Agents
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27
Q

Exogenous Nephrotoxins

  • Drugs
A

â–ª Antibiotics: Aminoglycosides.
â–ª Antifungal: Amphotericin B.
▪ Antiviral: Acyclovir – Cidofovir.
â–ª Chemotherapeutic agents: Cisplatin, Methotrexate.

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28
Q

Exogenous Nephrotoxins

  • Toxic Ingestions
A

Ethylene glycol

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29
Q

Exogenous Nephrotoxins

  • Heavy Metals
A

Mercury – Lead – Arsenic

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30
Q

Renal Causes of AKI

  • Vascular
A

Intrinsic renal vascular diseases directly affect both SMALL & LARGE sized blood vessels
within the kidneys.

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31
Q

Vascular Causes of AKI

  • Small Blood Vessels
A
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32
Q

Vascular Causes of AKI

  • Large Blood Vessels
A

â‘  Renal infarction from aortic dissection or renal artery abnormality (such as aneurysm).

â‘¡ Acute renal vein thrombosis.

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33
Q

Post-Renal Causes of AKI

A
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34
Q

Pathophysiology Stages of AKI

A
  • Initiating Event (Kidney Injury)
  • Oliguric / Anuric (Maintenance)
  • Polyuric (Diuretic)
  • Recovery
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35
Q

Pathophysiology Stages of AKI

  • Initiating Injury
A
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36
Q

Pathophysiology Stages of AKI

  • Oliguric / anuric (Maintainence) Phase
A
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37
Q

Decreased GFR Mehcanisms in Oliguric / anuric (Maintainence) Phase

A

◈ Toxins + Ischemia → Necrosis & Sloughing of tubular epithelial cells into tubular lumen → obstruction of tubules → Increased intraluminal pressure.

â—ˆ Back-leak of tubular fluid to renal interstitium.

◈ Excess renin activation → Afferent vasoconstriction.

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38
Q

Complications of Oliguric / anuric (Maintainence) Phase

A

① Fluid retention → Dilutional hyponatremia.

② Electrolyte retention → Hyperkalemia & Hyperphosphatemia.

â‘¢ Ca++: Decreased (May still normal).

â‘£ Increases S. Creatinine, Urea & H+ (Metabolic acidosis).

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39
Q

Duration of Oliguric / anuric (Maintainence) Phase

A

1–3 weeks

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40
Q

Pathophysiology Stages of AKI

  • Polyuric (Diuretic) Phase
A
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41
Q

Mechanism of Polyuric (Diuretic) Phase

A
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42
Q

Complications of Polyuric (Diuretic) Phase

A

â‘  Loss of water (dehydration).
② Loss of electrolytes (hyponatremia, hypokalemia etc…).

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43
Q

Duration of Polyuric (Diuretic) Phase

A

∼ 2 weeks

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44
Q

Polyuric (Diuretic) Phase is characteristic for which type of AKI?

A

Ischemic (renal)

45
Q

Pathophysiology Stages of AKI

  • Recovery
A

Kidney function & urine production normalize

46
Q

CP of AKI

A

Symptoms of the cause + ………

47
Q

CP of AKI

  • Volume Status
A
48
Q

CP of AKI

  • Sodium
A
49
Q

CP of AKI

  • Potassium
A
50
Q

CP of AKI

  • Other electrolyres
A

Increased P & Decreased Ca

51
Q

CP of AKI

  • Metabolic Acidosis
A
52
Q

CP of AKI

  • Urine Output
A
53
Q

Non-oliguric AKI (absence of oliguria) argues against ……

A

a pre-renal etiology.

54
Q

….. AKI reveals nothing about the etiology

A

Oliguric

55
Q

Anuric AKI Most often seen in …..

A

shock & complete bilateral urinary tract obstruction.

56
Q

CP of AKI

  • Uremic Manifesfations
A

Refer to Chronic kidney Disease (CKD)

57
Q

CP of AKI

  • Cardiac Complications
A
58
Q

CP of AKI

  • Nutritional Symptoms
A
59
Q

Steps in Dx of AKI

A
  • Is it AKI or Not?
  • What Type?
  • Role of Bx?
60
Q

Dx of AKI

Diffrence Between AKI & CKD

A
61
Q

Compare between AKI & CKD in Terms of

  • Hx
A
62
Q

Compare between AKI & CKD in Terms of

  • Renal Size
A
63
Q

Compare between AKI & CKD in Terms of

  • Hb
A
64
Q

Urine Sediment in Pre-Renal AKI

A
  • Normal or near normal.
  • Hyaline casts &/or fine granular casts may be seen
65
Q

Compare between AKI & CKD in Terms of

  • Renal Osteodystrophy
A
66
Q

Compare between AKI & CKD in Terms of

  • Serum Creatinine
A
67
Q

Lab Results in Pre-Renal AKI

A
68
Q

US in Pre-Renal AKI

A

Normal

69
Q

Response to Acute TTT in Pre-Renal AKI

A

Rapid improvement in renal function
following acute intervention

70
Q

Urine Sediments in Renal AKI

A
71
Q

Labs in Renal AKI

A
72
Q

US in Renal AKI

A

May be enlarged
(Due to inflammation or edema)

73
Q

Response to Acute TTT in Renal AKI

A

lack of response to acute intervention

74
Q

Urine Sediment in Post-renal AKI

A

May be hematuria & pyuria

75
Q

Labs in Post-renal AKI

A
76
Q

US in Post-renal AKI

A

Bilateral hydronephrosis

77
Q

Response to acute TTT in Post-renal AKI

A

Rapid improvement in renal function following resolution of the obstruction

78
Q

….. is the preferred test for distinguishing between prerenal disease & intrinsic renal.

A

FENa+

79
Q

FENa+ is not utilized during diuretic therapy (as in prerenal conditions can be > 1)

A

…

80
Q

Indications of Biopsy in AKI

A
81
Q

CI of Bx in AKI

A
82
Q

CI of Bx in AKI

  • kidney Status
A
83
Q

CI of Bx in AKI

  • Patient Status
A
84
Q
  • Most contraindications are relative rather than absolute.
  • Clinical circumstances that necessitate urgent renal biopsy may be overridden, EXCEPT FOR uncontrolled bleeding diathesis.
A

..

85
Q
  • In advanced chronic kidney disease and ultrasound imaging of reduced kidney volume, the renal biopsy is generally contraindicated.
A

…

86
Q

Approach to Specifc underling Causes of AKI

  • Hemolysis
A
87
Q

Approach to Specifc underling Causes of AKI

  • Rhabdomyolysis
A
88
Q

Approach to Specifc underling Causes of AKI

  • Tumor Lysis Syndrome
A
89
Q

Managment aspects of AKI

A
  • TTT of Cause
  • Supportive
  • KRT
90
Q

Managment aspects of AKI

  • TTT of underlying Causes
A
91
Q

Managment aspects of AKI

  • Supportive Care
A
92
Q

Goals of Supportive Care

A

â‘  Avoid further renal insult & potentially aggravating factors.

â‘¡ Support adequate kidney perfusion.

â‘¢ Ensure early identification & treatment of complications.

92
Q

Aspects of Supportive Care of AKI

A

â‘  Medications
â‘¡ Volume status
â‘¢ Electrolytes
â‘£ Acid-base disturbances
⑤ Others (Nutritional support, Contrast agents & Hyperuricemia)

93
Q

Supportive Care of AKI

  • Volume Status
A
94
Q

Supportive Care of AKI

  • medications
A
95
Q

Supportive Care of AKI

  • Electrolytes
A
96
Q

Supportive Care of AKI

  • Electrolytes (Hyperkalemia)
A
97
Q

Supportive Care of AKI

  • Electrolytes (Hyponatremia)
A
98
Q

Supportive Care of AKI

  • Electrolytes (hyperphosphatemia)
A
99
Q

Supportive Care of AKI

  • Electrolytes (Hypocalcemia)
A
100
Q

Supportive Care of AKI

  • Metabolic Acidosis
A
101
Q

When should Treating Metabolic Acidosis by Bicorbonate Avoided? and What is the alternative?

A
102
Q

Nutitional Support in AKI

  • Protein
A
103
Q

Nutitional Support in AKI

  • Calories
A

20 to 30

104
Q

Nutitional Support in AKI

  • Salt & Fluid
A

Restricted → To correct hypervolemia

105
Q

Nutitional Support in AKI

  • K
A

Restricted → To correct hyperkalemia

106
Q

Nutitional Support in AKI

  • P
A

Restricted → To correct hyperphosphatemia

107
Q

Nutitional Support in AKI

  • Ca
A

Allowed

108
Q

contrast agents in AKI?

A
109
Q

TTT of Hyperuricemia in AKI

A

Acute treatment is usually not required except in the setting of tumor lysis syndrome.

110
Q

Indications of KRT in AKI

A

Y4R3 - Medicine II 🩺 (16 decks)

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