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STEP 2 Cardio + Renal > Renal. AKI+Nsaids+contrasAIN+IN+papil (07-23) (1) > Flashcards

Renal. AKI+Nsaids+contrasAIN+IN+papil (07-23) (1) Flashcards

1
Q

UW. Prerenal AKI.
etiology? main mechanism

A

Decreased renal perfusion

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2
Q

UW. Prerenal AKI.
etiology 5 that were in table

A
  1. True volume depletion
  2. Decreased EABV (eg. Hf, cirrhosis)
  3. Displacement of intravascular fluid (increased vascular permeability in sepsis, pancreatitis)
  4. Renal artery stenosis
  5. Afferent arteriole vasoconstriction (eg NSAIDs).
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3
Q

UW. Prerenal AKI.
What mechanism of nsaids etiology?

A

afferent arteriole vasoconstriction

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4
Q

UW. Prerenal AKI.
clinical? 5

A

incr. creatinine
Decr. urine output
BUN/Cr ratio > 20:1
Fract. Na < 1 proc.
Unremarkable urine sidement

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5
Q

UW. Prerenal AKI.
main treatment?

A

restoration of renal perfusion

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6
Q

UW. Prerenal AKI.
Presentation - oliguria. how much ml?

A

<500 ml day

OR < 0,5 ml/kg/h

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7
Q

UW. Prerenal AKI.
BUN/Cr ratio?
what if high urea?

A

> 20:1

anion gap metabolic acidosis

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8
Q

UW. Prerenal AKI.
FeNa?

A

< 1 proc.

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9
Q

UW. Prerenal AKI.
Urine sodium (uNa)?

A

<10 (kai kur raso <20)

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10
Q

UW. Prerenal AKI.
FeUrea?

A

< 35 proc.

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11
Q

UW. Prerenal AKI. treatment? 4

A

place catheter
if volume down -> iv fluids
if volume up (cardiorenal syndrome) –> diuresis
Avoid nephrotoxic drugs - metformin, ACEI, ARB.

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12
Q

UW. Prerenal AKI. Cardiorenal syndrome mechanism. Left heart failure?

A

LHF –> decr. Sv, CO –> decr. renal perfusion –> dec. GRF (renal injury) –> RAAS activation –> SNS tone and incr. Na and H2O absorption –> back to the first point ie LFH

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13
Q

UW. Prerenal AKI. Cardiorenal syndrome mechanism. Right heart failure?

A

RHF –> incr. CVP, RVP –> decr. glomerular capillary pressure gradient –> dec. GRF (renal injury) –> RAAS activation –> SNS tone and incr. Na and H2O absorption –> back to the first point ie RHF

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14
Q

UW. Postrenal AKI.
Causes?ureter

A

cancer and stones

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15
Q

UW. Postrenal AKI.
Causes?bladder

A

cancer, stones, neurogenic bladder (spinal cord injury, stroke)

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16
Q

UW. Postrenal AKI.
Causes?urethra

A

cancer, stones, BPH, Foley’s cath.

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17
Q

UW. Postrenal AKI.
Causes?
one very common case
what drug group?

A

postoperative urinary retention
First generation antihistamines (or drugs, containing anticholinergic activity) -> detrusor hypoactivity

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18
Q

UW. Postrenal AKI.
workup? 2

A

US or CT scan

look for hydroureter or hydronephrosis

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19
Q

UW. Postrenal AKI.
workup. what first thing to do in post-op?

A

check catheter

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20
Q

UW. Postrenal AKI.
treatment?

A

relieve obstruction - either Foley, surgery or nehrostomy

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21
Q

UW. Intrarenal AKI.

A
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22
Q

UW. Intrarenal AKI.
3 groups?

A

GN
Acute interstitial nephritis
Acute tubular necrosis

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23
Q

UW. Intrarenal AKI.
GN - UA finding.
What to rule out?

A

finding - RBC casts

rule out - nephrotic syndrom (> 3,5 g/dl, edema, inc. cholesterol)

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24
Q

UW. Intrarenal AKI.
acute interstitial nephritis. UA findings?

A

WBC casts, WBC, eosinophils.

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25
Q

UW. Intrarenal AKI.
acute interstitial nephritis - causes?

A

Drugs - sulfadrugs (TMP-SMX(, penicillin, cephalosporins, NSAIDS, allopurinol, PPIs)

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26
Q

UW. Intrarenal AKI.
acute interstitial nephritis presentation? 4

A

eosinophilia, eosinophiluria, fever, wbc casts, skin rash, hematuria

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27
Q

UW. Intrarenal AKI.
acute interstitial nephritis onset?

A

onset variable.
5 day to several weeks/month following exposure

28
Q

UW. Intrarenal AKI.
ATN. 2 groups?

A

ischemia and exposure to toxins

29
Q

UW. Intrarenal AKI.
ATN. what are toxins?

A

IV contrast,
AMG,
myoglobin (rhabdomyolysis)
GN

30
Q

UW. Intrarenal AKI.
ATN. what to do prior radiologic procedures?

A

evaluate kidney function before administergin IV CONTRAST

31
Q

UW. Intrarenal AKI.
ATN. what lab incr. in case of rabdomyolysis?

A

potassium and creatin kinase.

32
Q

UW. Intrarenal AKI.
ATN. Multiple myeloma also cause (??)

A

.

33
Q

UW. Acute interstitial neph. symptoms?

A

fever,
rash (DONT FORGET IT),
arthralgias,

eosinophilia,
hematuria, sterile pyuria, WBC casts,
eosinophiluria

renal: AKI, on byopsy inflammatory infiltrates in kidney interstitium

34
Q

UW. Intrarenal AKI.
ATN. DIsease course? phases 4

A

prodrome - cr rises
oliguric phase
polyuric phase: urine output increases
recovery phase

35
Q

UW. Intrarenal AKI.
ATN. treatment?

A

discontinue affending drug/toxin
vigorous IV fluids

36
Q

UW. Intrarenal AKI.
ATN. BUN/cr?

A

typically normal
<15:1

37
Q

UW. Intrarenal AKI.
ATN. UNa?

A

> 40

38
Q

UW. Intrarenal AKI.
ATN. Na exc? proc.

A

> 2 proc.

39
Q

UW. Intrarenal AKI.
ATN. urine osmolality?

A

~ 300

40
Q

UW. prerenal AKI.
urine osmolality?

A

> 500

41
Q

UW. Intrarenal AKI.
ATN. urine specific gravity?

A

<1.020

42
Q

UW. prerenal AKI.
urine specific gravity?

A

> 1.020

43
Q

UW. Intrarenal AKI.
ATN. Microscopy?

A

muddy brown casts

44
Q

UW. prerenal AKI. Microscopy?

A

bland

45
Q

UW. Contrast induced nephropathy.

4 risk factors?

A

Age > 75
CKD (esp. diabetic nephropathy)
Reduced renal perfusion (eg hypotension)
High contrast load

46
Q

UW. Contrast induced nephropathy.

prevention? 3

A

periprocedural saline hydration

Lowest possible volume of agent

Hold NSAIDs

47
Q

UW. Contrast induced nephropathy.

workup?

A

History and physical exam

Urinalysis

BUN/Cr ratio < 20:1 (jeigu pagal ATN lentele < 15)

sometimes need biopsy

48
Q

UW. Contrast induced nephropathy.
treatment?

A

Disease specific.

Discontinue of nephrotoxic agent.

Supportive care.

Dialysis

49
Q

UW. intrarenal. GN. what urinalysis?

A

RBC casts/RBC

50
Q

UW. Analgesic nephropathy. it the most common cause of drug-inducec CKD.

A

.

51
Q

UW. Analgesic nephropathy. 2 most common pathologies?

A

Chronic tubulointerstitial nephritis
Papillary necrosis

52
Q

UW. Analgesic nephropathy. what 3 risk in general due to chronic analgetics use?

A

premature aging

atherosclerotic vascular disease

Urinary tract cancer

53
Q

UW. Analgesic nephropathy.
what common scenario?

A

long term use of 1 or multiple anagetics for chronic headaches or other somatic complaints

54
Q

UW. Analgesic nephropathy.
what usually symptoms?

A

usually asymptomatic

but can have chronic tubulointerstitial nephritis or hematuria due to papillary necrosis

55
Q

UW. Analgesic nephropathy.

A
56
Q

UW. Analgesic nephropathy. diagnosis. blood labs?

A

incr. creatinine

57
Q

UW. Analgesic nephropathy. diagnosis. urinalysis?

A

hematuria
sterile pyuria
mild proteinuria (<1,5 g/d)

58
Q

UW. Analgesic nephropathy. diagnosis. what shows CT?

A

small kidneys with bilateral renal papillary calcifications

59
Q

UW. papillary necrosis.
rare cause of non-glomerular hematuria

A

.

60
Q

UW. papillary necrosis. mechanism?

A

occurs due to sloughing of the renal papilla

61
Q

UW. papillary necrosis. risk factors - mneumonic NSAID.

A

N - Nsaids (cause constriction of medullary blood vessels - vasa recta)
Sickle cell disease
Analgesic abuse
Infection (pyelonephritis)
DM

62
Q

UW. Contrast induced nephropathy. when onset?

A

Acute rise in Cr within 24-48h post contrast administration, following gradual return to baseline

63
Q

FA. prerenal mechanism?

A

decr. renal perfusion

64
Q

FA. intrarenal mechanism?

A

injury within nephron

65
Q

FA. posternal mechanism?

A

urinary outflow obstruction

66
Q

FA. prerenal. what urine finding may be, but considered as normal (in volume depletion)?

A

hyaline casts

STEP 2 Cardio + Renal (26 decks)

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