OnlineMedEd: Nephrology - "Acute Kidney Injury" Flashcards
List the four categories of prerenal AKI.
- Heart failure (MI, CHF)
- Hypovolemia (diuresis, diarrhea, dehydration, hemorrhage)
- Interstitial edema (nephrotic syndrome, cirrhosis, gastrosis)
- Renal artery obstruction (renal artery stenosis, fibromuscular dysplasia)
Post-renal AKI can be caused by _______________.
any type of obstruction: urethral (prostate, stricture, stone), bladder (neurogenic, cancer) or ureteral (UVJO, URPJO, cancer, stone)
Review the three types of renal AKI.
- Glomerulonephritis
- Acute interstitial nephritis
- Acute tubular necrosis
Review the classic triad of nephrotic syndrome.
- Edema
- Proteinuria (greater than 3 g/dL/day)
- Hyperlipidemia
Which three medicines are common causes of acute interstitial nephritis?
- Penicillins
- Bactrim
- Cephalosporins
Look for what three lab findings in acute interstitial nephritis?
- WBC casts in urine
- WBCs in urine
- Eosinophils in urine
Acute tubular necrosis is caused by what three things?
- Ischemia
* Toxins (contrast, myoglobin)
FENa is low (less than 1%) in which kind of AKI?
Prerenal
The kidneys absorb sodium when fluids are low.
Labs that suggest prerenal AKI include _________________.
BUN:Cr greater than 20, FENa less than 1%, FEUrea less than 35%, and urinary sodium less than 10
Discuss how post-renal AKI is diagnosed.
If the history and labs don’t point to pre-renal AKI, then you do an US or CT to look for urinary obstruction.
Intrarenal AKI can only be definitively diagnosed with ________________.
biopsy
However, if the history, physical, and UA are consistent with one diagnosis, it’s reasonable to avoid the biopsy (to spare the risk).
How is post-renal AKI treated?
Catheterization, nephrostomy, or surgery to relieve the obstruction
Review the indications for acute hemodialysis.
AEIOU
•Acidosis
•Electrolyte disturbances (particularly K and Ca)
•Intoxication (with a substance that can be dialyzed, like lithium)
•Overload
•Uremia
