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*Pance Re-Up * > Renal #1 (AKI & Rhabdo) > Flashcards

Renal #1 (AKI & Rhabdo) Flashcards

1
Q

What three lab values are indicative of acute renal failure (acute kidney injury)

A

-Increased Creatinine
-Decreased GFR
-Increased BUN (urea nitrogen is a waste product kidneys remove from your blood)

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2
Q

MC type of acute renal failure overall

A

Prerenal Kidney Injury (decreased renal perfusion with nephrons still intact)

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3
Q

Causes of prerenal kidney injury

Think about decreased renal perfusion and what causes this

A

-Reduced renal perfusion (hallmark)
–Hypovolemia: diuretics, shock, GI loss, blood loss
–Affarent arteriole constriction (NSAIDs, IV contrast)
–Efferent (ACE, ARB’s)
–Hypotension

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4
Q

What diagnostics show to indicate prerenal kidney injury

A

-Evidence of water/electrolyte conservation
–Increased BUN: Cr ratio (>20:1)
–Fractional excretion of Na <1%
–Concentrated urine: high urine specific gravity (>1.020)

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5
Q

What is the treatment for prerenal kidney injury?

A

-Volume Repletion to restore volume and renal perfusion

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6
Q

What exactly is acute interstitial nephritis?

What are some causes?

A

-Intrinsic acute kidney injury characterized by inflammatory or allergic response in the interstitium with sparking of glomeruli and blood vessels

-Drug hypersensitivity (MC): NSAIDs, Penicillins, Sulfa Drugs, Ciprofloxacin, Rifampin, Allopurinol
-Infections, Idiopathic, Autoimmune

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7
Q

Symptoms of AIN?

A

Fever, eosinophilia, maculopapular rash, arthalgias

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8
Q

What is seen on urinalysis for AIN (remember it is an inflammatory/allergic cause)

A

-WBC casts and eosinophilia
-Increased serum IgE

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9
Q

Treatment for AIN

A

-Remove offending agent –> spontaneous recovery

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10
Q

MC type of intrinsic kidney injury.

Explain it

A

-Acute Tubular Necrosis (ATN)

Acute destruction and necrosis of renal tubules of nephron

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11
Q

There are two MAIN causes of ATN. What are they?

A

-Ischemic (h/o prerenal injury): prolonged prerenal azotemia associated with hypovolemia or hypotension
-Nephrotoxic: contrast dye, Aminoglycosides (-mycin), Vancomycin. NSAIDs, Rhabdomyolysis, Multiple Myeloma.

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12
Q

What is seen on urinalysis for ATN?

Also explain the urine specific gravity, FENA, and osmolarity

A

-Epithelial cell casts and granular (muddy brown) casts
-Low urine specific gravity (isosthenuria = inability to concentrate urine)
-Low urine osmolarity (dehydration)
-Increased FENA > 2%

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13
Q

Treatment for ATN

A

-Remove offending agents and give IVF (first line)
-Furosemide if not urinating

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14
Q

What is acute glomerulonephritis?

What four things are common in glomerulonephritis?

A

Inflammation of the glomeruli, leading to protein and RBC leakage into the urine.

Hypertension, azotemia, hematuria (RBC casts), and proteinuria (edema)

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15
Q

What is azotemia?

A

Elevation of BUN and Cr levels in the blood

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16
Q

There are MANY types of acute glomerulonephritis. What is the MCC, who does it affect, and when is it MC after?

A

IgA Nephropathy (Berger’s Disease): Often affects young males within days (24-48 hours) after URI or GI infection

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17
Q

Another type of glomerulonephritis, post-infectious, is MC after….

A

Group A Strep infection: 10-14 days after skin (impetigo) or pharyngeal infection

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18
Q

Who should you consider post-infectious glomerulonephritis in (who is the classic presentation in)?

A

-2-14 year old boy with facial edema up to 3 weeks after Strep with scanty, cola-colored dark urine

19
Q

What labs are shown in post-infectious glomerulonephritis?

A

-Increased anti-streptolysin (ASO) titers
-Low serum complement C3

20
Q

Rapidly Progressive Glomerulonephritis (RPGN) is associated with poor prognosis because it has a rapid progression to end stage renal disease within weeks to months. What is seen on biopsy that makes this diagnosis?

A

Crescent formation on biopsy

21
Q

Explain Goodpasture’s Disease along with two symptoms you should remember with this

A

-Positive anti-GBM antibodies against type IV collagen of the glomerular basement membrane in kidneys and lung alveoli

Acute glomerulonephritis and hemoptysis

REMEMBER, KIDNEYS AND LUNGS

22
Q

Finally, the last form of glomerulonephritis, vasculitis, has two types. Microscopic Polyangiitis, which is ________, has what positive lab?

A

Vasculitis of small renal vessels

+ P-ANCA

23
Q

On the other hand, granulomatosis with polyangiitis (Wegener’s), is _______, has what positive lab?

A

Necrotizing vasculitis

+ C-ANCA

24
Q

What are some symptoms of acute glomerulonephritis, in general?

A

-Hematuria (cola or tea-colored urine)
-Edema (peripheral and periorbital)
-Fever, abdominal or flank pain
-Oliguria (small amount of urine)
-Hypertension

25
Q

What is seen on labs, in general, for acute glomerulonephritis?

A

-Hematuria, RBC casts, proteinuria (<3g), high specific gravity
-Increased BUN and Cr

26
Q

What is the gold standard diagnostic for acute glomerulonephritis, even though not needed in most cases?

What is seen on the following conditions with this diagnostic?
-IgA nephropathy
-Poststreptococcal
-Goodpasture Syndrome

A

-Renal biopsy

-IgA: IgA mesangial deposits
-PostStrep: immune humps of IgG, IgM, and C3
-Goodpasture: linear IgG deposits in the GBM

27
Q

Treatment for acute glomerulonephritis

A

-Usually self-limited with good prognosis

–IgA nephropathy: ACEi
–Edema: Loop Diuretics (edema)
–Hypertension: BB, CCB
–RPGN: Corticosteroids + Cyclophosphamide

28
Q

Finally, postrenal kidney injury otherwise known as obstructive uropathy, is characterized by _________. This is rare because both kidneys need to be obstructed.

A

Obstruction of the passage of urine

29
Q

What are some etiologies of postrenal kidney injury?

A

-Kidney stones, tumors, BPH, prostate cancer

30
Q

What is the initial imaging study used in postrenal kidney injury to look for obstruction and hydronephrosis?

A

US

31
Q

Treatment for postrenal kidney injury (it’s easy)

A

removal of obstruction

32
Q

Rhabdomyolysis, which can be caused from things such as ________, has symptoms such as (there are three)

A

-Trauma, heat stroke, seizures, cocaine, statin therapy, snake bites, prolonged immobility, crush injuries

Muscle pain + weakness/swelling + dark/tea colored urine

33
Q

What is the pathophysiology of rhabdomyolysis?

A

-Muscle breakdown –> myoglobin released (toxic to kidneys/plugs it up) –> AKI/ATN

34
Q

What is the most specific diagnostic that can be done for rhabdomyolysis and what does it show?

A

Urine Analysis/Dipstick: positive for heme but negative for RBC’s

35
Q

On an ECG for rhabdomyolysis, you should look for _________, which is displayed by _________

A

Hyperkalemia

Increased/High T Wave

36
Q

Furthermore, in rhabdomyolysis, Creatinine Kinase (muscle enzymes) will be

A

Very high (5x normal)

37
Q

What is the treatment for rhabdomyolysis?

A

IVF +/- Mannitol (Diuretic) or Sodium Bicarb (alkalize urine)

38
Q

Mannitol, a diuretic, works mainly where?

It increases urine volume by drawing fluid from intracellular compartment and increasing tubular osmolarity.

A

Proximal tubule

39
Q

What is one adverse effect of Mannitol that you should remember?

A

Pulmonary edema (due to increased fluid shifts)

40
Q

What are 4 main indications to use Mannitol as treatment?

A

-Increased ICP
-Increased IOP
-Promotes diuresis in AKI
-Increases excretion of toxic metabolites (rhabdomyolysis)

41
Q

Loop Diuretics, such as ______, ______, or _______, are the strongest class of diuretics. What do they do?

A

Furosemide, Bumetanide, Torsemide

Inhibits water, Na+, K+, Cl- transport as well as Ca+ and Mg+ absorption across the thick ascending limb of the Loop of Henle, leading to dilute urine.

42
Q

What is Ethacrynic Acid?

A

Medication similar to Furosemide that can be used if Sulfa Allergy and safe in patients with gout. However, associated with higher risk of ototoxicity.

43
Q

What is one adverse effect of Loop Diuretics that should be remembered (remember what it does).

A

-Decreased electrolytes: hypokalemia, hypocalcemia, hypomagnesemia
-Ototoxicity
-Hyperglycemia
-Hyperuricemia

*Pance Re-Up * (76 decks)

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