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Clinical Medicine II > Renal: AKI > Flashcards

Renal: AKI Flashcards

1
Q

This process is defined by:

  • urea/nitrogen retention
  • dysreg of volume status and lytes
  • based on GFR or urine output
A

AKI

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2
Q

KDIGO defines AKI as…

A

increased Cr of 0.3 + within 48 hrs

OR

Increased Cr by 50% in 7 days

OR

urine output < 0.5 ml/kg/hr for > 6 hours

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3
Q

Which KDIGO stage?

increased Cr of 0.3 + within 48 hrs

OR

Increased Cr by 50-99% in 7 days

OR

urine output < 0.5 ml/kg/hr for > 6-12 hours

A

stage 1

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4
Q

Which KDIGO Stage?

Increased Cr by 100-199% in

OR

urine output < 0.5 ml/kg/hr for > 12-24 hours

A

Stage 2

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5
Q

Which KDIGO stage?

increased Cr of 0.3 to 0.4+

OR

Increased Cr by 200+%

OR

urine output < 0.3 ml/kg/hr for 24+ hours

OR

anuria for 12+ hours

OR

Renal replacement therapy

A

stage 3

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6
Q

AKI develops in what percent of ICU patients?

A

60%

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7
Q

What is the MC type of AKI in hospitalized patients?

A

pre-renal

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8
Q

Which type of AKI?

decreased renal perfusion

A

pre-renal

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9
Q

Which type of AKI?

pathology of vessels, glomeruli or tubules

can be caused by acute tubular necrosis

A

intrinsic renal

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10
Q

Which type of AKI?

obstruction

A

post-renal

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11
Q

Can etiologies of AKI overlap?

A

yes! decreased perfusion can lead to acute tubular necrosis (pre-renal + intrinsic)

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12
Q

Rank the incidence of AKI types

A

ATN (45%) > Prerenal (20% > obstruction (10%)

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13
Q

5 things that can cause pre-renal AKI…

A 
true volume depletion
hypotension
edema
renal artery ischemia
GFR drugs
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14
Q

Which two drugs can affect GFR and cause pre-renal AKI?

A

NSAIDs and ACE-Is

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15
Q

What are three causes of intrinsic renal AKI?

A

renal ischemia
sepsis
nephrotixins

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16
Q

What are nephrotoxins that may cause intrinsic renal AKI?

A

Abx (vanco/aminoglycosides)

IV contrast

Cisplatin

HIV meds

IVIG

Mannitol

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17
Q

Three major risk factors for ATN caused by IV contrast

A

renal dz
volume depletion
repeat dosing

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18
Q

What are the two mechanisms by which contrast can cause AKI?

A

tubular epithelial toxicity

medullary ischemia from vasoconstriction

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19
Q

What are 4 prevention factors for IV induced AKI?

A

hydration

low osmolal agents at low doses

avoid repeat dose

avoid nephrotoxics for 48 hours after

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20
Q

A decreased GFR without intrinsic renal disease requires what kind of obstruction?

A

bilateral

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21
Q

Post-renal AKI is often caused by what three things?

A

Prostate disease

Mets

neurogenic bladder

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22
Q

urine output of > 400mL/24 hours…

A

nonoliguric

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23
Q

urine output of < 400 mL/24 hours

A

oliguric

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24
Q

Urine output < 50 to 100mL/24 hours

A

anuric

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25
Q

Labs for AKI…

A

UA, CMP + CR/BUN, GFR, FENa

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26
Q

Imaging for AKI…

A

Renal US

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27
Q

Is biopsy used for AKI?

A

yes

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28
Q

UA should be examined at ______ temperature within _____ hours

A

room temp w/in 2 hours

29
Q

Muddy brown casts indicate…

A

ATN

30
Q

Normal serum Cr for men…

A

0.6-1.2

31
Q

Normal serum Cr for female…

A

0.5-1.1

32
Q

Calculating GFR given creatinine…

A

1/factor of normal cr

ex. 2x Cr = GFR 1/2 of normal, 3x Cr = GFR 1/3 of normal, etc.

33
Q

FENa is a measure of sodium in urine. It helps distinguish what?

A

prerenal AKI or ATN

34
Q

FENa < 1% indicates…

FENa > 2% indicates…

A

< 1% = prerenal

> 2% = intrarenal/ATN

35
Q

What are two pitfalls of FENa?

A

unreliable if on duretics, Cr not stable in AKI

36
Q

Major reason for imaging with AKI…

A

obstruction/hydronephrosis

37
Q

MC type of imaging for AKI…

A

US

38
Q

renal fxn after relief of obstruction is dependent on…

A

severity and duration of obstruction

39
Q

If no clear AKI etiology, severe disease or increased rate of decline (markedly elevated Cr or worsening), what should be performed?

A

kidney bx

40
Q

This is a definitive diagnostic that may allow therapeutic intervention to prevent ESRD…

A

kidney bx

41
Q

How often is Bx used to dx AKI?

A

rarely

42
Q

The following are C/I for…

bleeding diathesis
severe HTN
pylo
tumor
solitary kidney
A

Biopsy

43
Q

The following are life threatening complications of…

volume imbalance
acidosis
hyperkalemia
hyperphosphatemia
hypocalcemia
uremia
A

AKI

44
Q

Severe AKI can have what severe sign?

A

AMS

45
Q

Life threatening complications of AKI require…

A

hemodialysis

46
Q

What should be assessed in all patients with AKI?

A

volume status

47
Q

A patient presents with the following. How should they be treated?

  • hx of fluid loss
  • hypovolemia on PE
  • oliguria
A

fluid challenge via 0.9 NS to confirm pre-renal cause

48
Q

How much fluid should you begin with for a fluid challenge to assess pre-renal AKI?

A

1-3 L with repeated clinical assessment

49
Q

If a patient doesn’t respond to fluid challenge, what etiology is likely?

A

intrinstic AKI/ATN

50
Q

In patients that are NOT anuric, what can be given to temporarily relieve hypervolemia?

A

diuretics

51
Q

What offers the most efficient method of fluid volume removal?

A

dialysis

52
Q

Two considerations of diuretic use for volume overload…

A
  1. not prolonged/temporizing measure

2. monitor urine output

53
Q

what condition can cause a loss of bicarb and worsen metabolic acidosis?

A

diarrhea

54
Q

Tx of metabolic acidosis has two options…

A

dialysis

bicarb

55
Q

Dialysis or Bicarb?

not volume overloaded

acidosis due to diarrhea

pH < 7.1 and waiting on dialysis

no other acute dialysis indications

A

Bicarb

56
Q

Dialysis or Bicarb?

volume overload

severe metabolic acidosis (< 7.1)

A

dialysis

57
Q

Bicarb admin in hypervolemic patients should be avoided for what reason?

A

it is administered with fluids

58
Q

hyperkalemia is generally axs, but can occur with…

A

impaired neuromuscular transmission

arrhythmia

59
Q

what are two treatments for hyperkalemia?

A

medical therapy, dialysis

60
Q

increased serum phosphorus due to reduced GFR is a common cause of…

A

hypocalcemia

61
Q

the below are sxs of…

Paresthesia, tetany, confusion, seizures.

Trousseau’s and Chvostek’s sign.

prolonged QT

A

hypocalcemia

62
Q

how do you tx hypocalcemia?

A

IV calcium if symptomatic

63
Q

If hypocalcemia is asymptomatic in presence of hyperphosphatemia, what is the initial therapy?

A

correction of hyperphosphatemia?

64
Q

How do you treat hyperphosphatemia? What about low calcium? High calcium?

A

dietary phosphate binders

low: calcium acetate or carbonate

high (non-calcium sources): aluminum hydroxide or lanthhum carbonate

65
Q

Is uremia more common in chronic or acute kidney disease?

A

chronic

66
Q

the following signs of uremia indicate tx with…

pericarditis (friction rub)

neuropathy (asaterixis)

unexplained AMS

A

dialysis

67
Q

Do most patients with AKI recover renal function?

A

yes: UOP and Cr normalize

68
Q

AKI makes you more susceptible for…

A

CKD, ESRD

69
Q

mortality rate for ICU patients with AKI is…

A

> 50%

Clinical Medicine II (31 decks)

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