Lecture 17 - Acute Kidney Injury

Question 1

Acute Kidney Injury is defined as rise in creatinine of ____mg/dL.

Answer 1

0.3

Question 2

The most sensitive scan for a Post-Renal obstruction is a _____ scan.

Answer 2

Nuclear scan –> detects passage of radioisotope

Question 3

Patients with Post-renal obstructions will present with _______ (enlargement of the calyces), while patients with Intra-renal obstructions will present more with direct kidney damage.

Answer 3

Hydronephros

Question 4

Pre-renal Acute Renal Failure occurs when something causes decreased renal _____ –> this leads to decreased Glomerular filtration pressure –> decreased GFR.

Answer 4

Decreased renal Perfusion

Question 5

What’s the gold standard for diagnosis of Pre-renal Acute renal failure?

Answer 5

Physical exam

Question 6

For patients NOT on diuretics, a FENa of < ___% is supportive of Pre-renal Acute Renal Failure diagnosis. For patients on diuretics, FEUrea < ____% is a better measure.

Answer 6

< 1%

< 30%

Question 7

Patients presenting with hematuria, renal failure, and decreased ______ –> think vascular AKI.

Patients with Renal infarcts may also present with AKI, though rarely, but would have flank pain with gross hematuria.

Patients that present with Pyuria, decreased compliment, and blue ____ –> think clotting/Atheroembolic disease.

Answer 7

Platelets

Blue toes

Question 8

AKI onset 5-7 days after new exposure (e.g. to drugs/medications) –> think ______ interstitial nephritis.

Answer 8

Allergic Interstitial nephritis

Question 9

To distinguish between Allergic Interstitial Nephritis and Acute Interstitial Nephritis, look to timing of onset AND interstitial infiltrate. What’s the most common cause of Acute Interstitial Nephritis?

Acute –> _______ infiltrate

Allergic –> _____ infiltrate

Answer 9

NSAIDs

Acute –> Neutrophil

Allergic –> Eosinophilic

Question 10

The most common cause of Intrinsic AKI is _____ _____ ______ (ATN).

______ contrast is one of the common causes, along with nephrotoxic antibiotics, myoglobin and hemoglobin.

Answer 10

Acute Tubular Necrosis (ATN)

Iodinated

Question 11

BUN : Creatinine ratio in Pre-renal Azotemia is > ____ : 1. How does this compare to ATN?

Answer 11

> 20 : 1

ATN BUN : Creatinine = 10-15 : 1

Question 12

Indications for Dialysis of AKI patients include:

1. ______ Syndrome
2. Metabolic ______
3. _____ and fluid overload
4. Refractory ________.

Answer 12

1. Uremic Syndrome
2. Metabolic Acidosis
3. CHF and Fluid overload
4. Refractory Hyperkalemia