Nephrology- Acute Kidney

Question 1

Management of acute elevation of creatinine in the Hx of BPH

Answer 1

Renal ultrasound and urinary catheter.

Severe bladder outlet obstruction due to BPH can cause AKI

Question 2

Evaluation of lower urinary tract symptoms

Answer 2

UA
PSA

CR (not required/ recommended)

Question 3

Does stoping metphorim reduce risk for contrast AKI?

Answer 3

Holding metformin prevents metformin accumulation (aka lactic acidosis) it does not affect contrast AKI risk

Question 4

Prevention of contrast AKI

Answer 4

IV 0.9& saline
Hold NSAIDs.
Smallest contrast volume possible

Question 5

Labs pre renal azotemia

Answer 5

↑Creatinine
BUN: creatine ration >20
Anion Gap Metabolic acidosis from uremia

Question 6

Management of renal vein thrombosis

Answer 6

if AKI: urgent clot removal (thrombolysis

No AKI: anticoagulation alone is appropriate

Question 7

S&S AIN

Answer 7

WBC cast
Pyuria 
Urine Eosinophs
Rash
Fever
Hematuria 
Arthralgias

Question 8

Drugs that can cause AIN

Answer 8

Pee (diuretics)
Pain (NSAIDs)
Penicillin (cephalosporin, TMP-SMX)
rifamPin

Question 9

hepatorenal syndrome

Answer 9

Cirrhosis–> splanchnic arterial dilation & ↓ SVR –>

RAAS –> renal vasoconstriction –> ↓ perfusion & ↓ GFR

Question 10

S&S hepatorenal syndrome

Answer 10

↓GFR no clear cause and no improvement with fluids.
FeNa <1%
No RBC, Casts, proteinuria

Question 11

Management hepatorenal syndrome

Answer 11

Return liver function
Splanchic vasaconstrictors (midodrine, octreotise, norepi)
Albumin
address precipitating factors

Question 12

Precipitating factors for hepatorenal syndrome

Answer 12

GI bleed
SBP
Sepsis 
Xs diuretic use 
NSAID use