Nephrology Flashcards
One of the most common contributing factors to AKI
Sepsis
Diagnosis:
Recent skin infection or pharyngitis, edema, rashes
variable features of arthralgias, sinusitis (anti-GBM disease), lung hemorrhage (anti-GBM , ANCA- associated, lupus nephritis)
Glomerulonephritis
Diagnosis Recent medication exposure (penicillins, cephalosporins, sulfonamides) or infections (leptospirosis)
Patients present with fever, rash arthralgia
May show eosinophilia, sterile pyuria
Kidney biopsy may be helpful
Interstitial nephritis
Diagnosis
Recent exposure to ischemia or nephrotoxins (aminoglycosides, cisplatin, zoledronate, contrast agents , amphotericin, rhamdomyolysis)
Acute tubular necrosis
Diagnosis
Granular casts, renal tubular epithelial cell casts on urinalysis
FENa >1%
Acute tubular necrosis
Diagnosis
Recent GI infection
Or calcineurin inhibitors
hematologic work up: schistocytes on PBS, elevated LDH, anemia, thrombocytopenia
Thrombotic thrombocytopenic purpura TTP/ Hemolytic uremic syndrome
Diagnosis
Elderly patient with constitutional symptoms and bone p[ain
Work up- monoclonal spike in urine and serum electrophoresis
Bone marrow or renal biopsy can be diagnostic
Myeloma
History of traumatic crush injuries, seizures, immobilization
Elevated myoglobin, and CK and heme-positive with few RBC on urinalysis
FENa may be low
Rhabdomyolysis
History of recent exposure to iodinated contrast
Rise in serum creatinine in 1-2 days; peak within 3-5 days, and recovery within 7 days
Contrast nephropathy
Sudden impairment of kidney function resulting in retention of nitrogenous and other waste products normally cleared by the kidney
AKI
Common Diagnostic features of AKI
Incas in BUN
Increase in the plasma or serum creatinine concentration
Associated with reduction in urine volume
AKI is defined as any of the ff (KDIGO definition)
Increase in SCr by >/= 0.3 mg/dL within 48 hours OR
Increase in SCr to >/= 1.5 x the baseline, which is known or presumed to have occurred within prior 7 days OR
Urine volume <0.5 mL/kg/h
KDIGO STAGE 1
SCr 1.5 - 1.9 x from baseline
Or >/= 0.3 mg/dL increase
UO <0.5 mL/kg/h
KDIGO Stage 2
2-2.9 times from baseline
UO <0.5 mL/kg/h x >/= 12 hours
KDIGO STAGE 3
>3x from baseline Or >/= 4 mg/dL increase Or Initial or renal replacement therapy or In patients <18 y/o decrease in eGFR to <35 mL/min/1.73 m2 UO <0.3 mL/kg/hr x 24 hours (oliguria) Or anuria >/= 12 hours
System for diagnosis and classification of a broad range of acute impairment of kidney function
RIFLE CRITERIA for AKI
RIFLE stands for
Risk Injury Failure Loss ESRD
Complete loss of kidney function >3 months
ESRD
Persistent acute renal failure: complete loss of kidney function > 4 weeks
Loss
RISK RIFLE class GFR
Decreased by >25%
INJURY RIFLE CLASS
GFR
> 50%
FAILURE CLASS
RIFLE
GFR
GFR DECREASED >75%
Common Electrolyte derangements in AKI include
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
