Lecture 5 A cute kid knee injury (AKI)

Question 1

AKI is characterized as an increase in ____ and ____ serum concentration. This occurs due to a decreased ___

Answer 1

creatinine, BUN;

GFR

Question 2

Creatinine is a breakdown product of ____ in ____ and is usually produced at a constant rate in body, depending on ____

Answer 2

creatine phosphate, muscle;

muscle mass

Question 3

3 characteristics of creatinine clearance that make it used to calculate GFR:
freely ____;
neither ____ nor ____

Answer 3

filtered;

reasbosrbed nor secreted

Question 4

3 general categories of renal failure

Answer 4

pre-renal, intrinsic, postrenal

Question 5

2 most common causes of renal failure (in notes)

Answer 5

pre-renal or acute tubular necrosis;

post renal is least common

Question 6

death is most commonly caused in acute renal failure because of ____ or ____ complications

Answer 6

infection, cardiorespiratory

Question 7

normal serum creatinine is less than _____. normal BUN is between ___ and ____

*according to FA

Answer 7

1.2, 7-18 mg/dL

Question 8

decreased GFR = ____ urine production

Answer 8

decreased (ie oliguria)

Question 9

Pre-renal:

due to decreased ____. this causes activation of the ____ in an attempt to conserve volume

Answer 9

renal blood flow;

RAAS (renin ang aldost system)

Question 10

creatinine vs BUN:

which is usually reabsorbed somewhat?

Answer 10

BUN is;

creatine is not

Question 11

what is the normal Cr : BUN ratio?

Answer 11

15-20:1

Question 12

Pre-renal azotemia can be caused by ____ ____ depletion or decreased ____ circulating volume to the kidneys ie CHF, cirrhosis, hypotension

Answer 12

intravascular volume;

effective

Question 13

Angiotensin II normally ____ the ____ arteriole. Prostaglandin E2 normally ____ the ____ arteriole. Both of these cause a ____ in GFR

Answer 13

vasoconstricts, efferent;
vasodilates afferent;
increase

Question 14

which 2 general drug classes impair renal blood flow?

Answer 14

ACE inhibitors (inhibit efferent vasoconstriction);
NSAIDS (inhibit afferent vasodilation)

Question 15

pre-renal azotemia:
Na/H2O and BUN are ____ by the kidney in an attempt to conserve volume. Creatinine is ____. What happens to the BUN/Cr ratio?

Answer 15

conserved (ie absorbed);
not (ie excreted);
increases ie greater than 20

Question 16

Pre-renal azotemia:
is urine osmolality high or low?
Is urine Na+ high or low?
Is FENa (Fracitonal excretion of Na) high or low?

Answer 16

high (ie greater than 500)
low (less than 20) due to reabsorption
low (less than 1%)

Question 17

equation for FENa

Answer 17

(urine Na/serum Na) divided by (urine Cr/Serum Cr)

Question 18

4 categories of intrinsic renal failure

Answer 18

tubular, glomerular, interstitial, vascular

Question 19

acute tubular necrosis (ATN) is caused by ___ or ____

Answer 19

ischemia, toxins

Question 20

3 phases of ATN:
which phase has concern of hypovolemia from polydipsia?
Which phase has the lowest urine output?

Answer 20

inciting event, maintenance, recovery

highest urine = recovery phase
lowest urine = maintenance phase

Question 21

key finding in urine of ATN?

Answer 21

granular muddy brown casts (dead tubular cells)

Question 22

which endoegnous toxin causes ATN typically?

2 exogenous toxins mentioned in notes (and FA)

Answer 22

myoglobinuria (From crush injury);

radiocontrast dye, aminoglycosides

Question 23

which 2 nephritic syndromes can cause AKI?

Answer 23

acute post strep glomerulonephritis;

rapidly progressive glomerulonephritis (RPGN)

Question 24

RPGN can be a primary disorder or can be secondary to systemic disease such as ____ vessel vasculitis or _____ (An auto-immune disease)

Answer 24

small (eg wegeners);

SLE

Question 25

Under LM, RPGN is described as ____ shaped.

Acute post-strep GN is described as ____ and ___cellular

Answer 25

crescent moon;

enlarged, hyper

Question 26

intrinsic renal disease:
is reabsorption of BUN impaired or relatively normal?
what does the BUN/Cr look like?

Answer 26

impaired;

decreased ie less than 15 (aren’t reabsorbing BUN or Cr)

Question 27

intrinsic renal disease:
urine osmolality is low or high?
what about urine Na?
FENa?

Answer 27

low ie less than 350
high ie more than 40
high ie more than 2%

Question 28

post-renal azotemia is due to outflow obstruction, such as ____, _____, neoplasia, congenital probs

Answer 28

stones, BPH

Question 29

post renal AKI occurs only with _____ ____

Answer 29

bilateral obstruction

Question 30

____ detected on renal ultrasound is the major signal that obstruction is present

Answer 30

hydronephrosis

Question 31

volume-overloaded patient is treated with ____

volume-depleted patient is resuscitated with ____

Answer 31

lasix;

saline

Question 32

post-renal azotemia:

early, increased tubular ____ causes resoprtion of BUN. late, increased tubular ____ causes excretion (ie no absorb)

Answer 32

pressure;

damage