Lecture 9 & 10 - Acute Kidney Injury (8 is just cases)

Question 1

how much kidney function must be lost or decreased to qualify as being ARF?

Answer 1

> /= 75%

Question 2

define:
oliguria
acute nephrosis
acute nephritis

Answer 2

oliguria = decreased urine output
acute nephrosis = degeneration of renal tubular epithelium due to hypoxia

acute nephritis = inflammation of kidneys

Question 3

what is the clinical course of AKI

Answer 3

induction phase - time of insult to dysfunction
maintenance phase - tubular lesions established
recovery phase - comepnsatory hypertrophy

Question 4

what are some ischemic or vascular causes of AKI?

Answer 4

1. hypotension
2. anesthesia / surgery
3. NSAIDs - decrease prostaglandins which stops blood flow
4. ACE-I - decreases GFR use for PLN
5. combination of problems like dehydration + NSAIDs + anesthesia

other causes include: dehydration, sepsis, heart failure and hypertension

Question 5

what are some endogenous and exogenous toxic causes of AKI

Answer 5

endogenous = increased Ca

exogenous = ethylene glycol, amingolycosides (like gentamicin), easter lilies, grapes, raisins

Question 6

what are some inflammatory causes of AKI?

Answer 6

1. pyelonephritis - ascending UTI
2. interstitial nephritis
3. glomerulonephritis

Question 7

what is diagnosis of AKI based on?

Answer 7

1. azotemia + inappropriate USG
2. urine volume can be w/e
3. look for complications like increased K, acidosis, dehydration, sepsis, etc

Question 8

what are some clinical signs of AKI?

Answer 8

oliguria/anuria
no weight loss
normal sized kidneys
painful kidneys
increased K
decreased Ca

Question 9

what are some clinical signs of CKD?

Answer 9

weight loss
small kidneys
non-regenerative anemia
severe azotemia 
animal does not feel bad

Question 10

what are some negative prognostic indicators of AKI?

Answer 10

• oliguria that goes unchanged for 4 -6 hours
• pre-existing renal disease
• systemic infection
• older age

Question 11

management of AKI: what is the overall goal and how is it acheived?

Answer 11

buy time!!

• correct dehydration
• correct metabolic disturbances like increased K, acidosis
• convert oliguria to non-oliguria

Question 12

what are some life threatening disturbances to treat and how are they treated?

Answer 12

1. hyperK - start with fluids, and give glucose, insulin or Ca gluconate
2. metabolic acidosis (

Question 13

what is considered oliguria?

Question 14

what is the goal of diuretics and when should they be given/

Answer 14

the only goal is to increase urine volume it does nothing to GFR or azotemia.

increasing urine volume can help correct electrolyte disturbances and relieve tubular obstruction.

should be given if a patient fails to convert to non-oliguria and is re-hydrated.

Question 15

what should you do if a patient fails to convert to non-oliguria after being given fluids and diuretics?

Answer 15

they must undergo renal replacement therapy or dialysis

Question 16

what is the fluid formula for fluid losses?

Answer 16

losses = urine output + expected insensible losses + other

expected insensible = respiration, skin, etc
other = vomiting, diarrhea, etc.

Question 17

what is the difference between AKI and ARF?

Answer 17

AKI = kidney damage that may be impt even in cases without overt azotemia

ARF = syndrome of sudden onset of hemodynamic filtration and excretory failure of kidneys with accumulation of toxins and dysregulation of fluid, electrolyte and acid-base imbalance