Renal acute renal diseases

Question 1

What is the definition of AKI?

Answer 1

Clinically manifesting as a reversible acute increase in nitrogen waste
products—measured by blood urea nitrogen (BUN) and serum
creatinine levels—over the course of hours to weeks

Question 2

What is eGFR calculation derived from?

Answer 2

Mathematically derived entity based on a patient’s serum creatinine
level, age, sex and race.

Question 3

What is normal GFR?

Answer 3

“Normal” GFR is usually >90 ml/min/1.73m^2

Question 4

Who are creatinine based estimating equations not recommended for use with?

Answer 4

Individuals with unstable creatinine concentrations:
-Includes pregnant women
-patients with co-morbid conditions
-Patients with extremes in muscle mass and diet

Question 5

What is pre-renal acute kidney injury?

Answer 5

Hypovolaemia
– Haemorrhage
– Diarrhoea/vomiting
↓Perfusion
– Septic shock
– Cardiac failure
Drugs
– Angiotensin converting
inhibitors
– Non steroidal anti-inflammatory
drugs

Question 6

What is intrinsic renal disease?

Answer 6

-Glomerular
-Vascular
-Tubular
-Interstitial

Question 7

What is the post renal acute kidney failure?

Answer 7

Sudden obstruction of urine flow causing
Hydronephrosis, Hydroureter due to:
- Kidney Stones
- Bladder tumour
-Enlarged prostate (men)

Question 8

What is prerenal AKI due to?

Answer 8

Prerenal AKI is due to inadequate renal perfusion

Question 9

What may cause inadequate renal perfusion?

Answer 9

-Extracellular fluid volume depletion
-Cardiovascular disease
-Decompensated liver disease

Question 10

When can prerenal conditions cause disease?

Answer 10

Prerenal conditions typically do not cause permanent kidney damage
(and hence are potentially reversible) unless hypoperfusion is severe
and/or prolonged.

Question 11

What are the most common causes of renal AKI?

Answer 11

• Acute tubular necrosis
• Acute glomerulonephritis
• Nephrotoxins (including prescription and over-the-counter drugs—see Analgesic Nephropathy)

Question 12

What happens in glomerular disease?

Answer 12

Glomerular disease increases glomerular capillary permeability to proteins and red blood cells; it may be inflammatory (glomerulonephritis) or the result of vascular damage due to ischemia or vasculitis.

Question 13

What does nephritis usually involve?

Answer 13

Interstitial inflammation (nephritis) usually involves an immunologic or allergic phenomenon.

Question 14

What may tubules get damaged by and why?

Answer 14

Tubules also may be damaged by ischemia and may become obstructed by cellular debris, protein or crystal deposition, and cellular or interstitial edema.

Question 15

What are the 4 principles of glomerular disease?

Answer 15

• Nephrotic syndrome
• Nephritic syndrome
• Isolated proteinuria/haematuria
• Rapidly progressive GN

Question 16

What are the 3 key factors of nephrotic syndrome?

Answer 16

1. Oedema
2. Heavy proteinuria(>3.5g/day)
3. Hypoalbuminemia(<30/L)
   HOP

Question 17

What are the abrupt signs of nephritic syndrome?

Answer 17

Abrupt onset (1-3 days) of:
-Haematuria
-Proteinuria
-Decreased GFR (raised creatinine, oedema, hypertension)

Question 18

What is a classical cause of nephritic syndrome?

Answer 18

post-streptococcal GN

Question 19

What are the 3 main groups of rapidly progressive GN?

Answer 19

• Anti-glomerular basement membrane (Goodpasture) disease
• Small vessel anti-neutrophil cytoplasm antibody (ANCA) +ive vasculitis
• Miscellaneous conditions >tuft damage >fibrin in Bowman’s space