Renal AKI - Selby

Question 1

if pt has urine output of 600ml /day will the FeNa /FeUrea be valid?

Answer 1

NO

only valid for OLIGURIC pt of <400-500

Question 2

Two most common causes of AKI ?

Answer 2

#1  ATN
#2 pre-renal azotemia

Question 3

Pt with history of iodine contrast dye or antibiotics should raise suspicion for ___________ (ATN )

Answer 3

Nephrotoxic ATN

Question 4

What part of the nephron is susceptible to ischemia?

Answer 4

renal medulla

Question 5

What two segments of the nephron are most susceptiblet to ischemia due to high metabolic demand?

Answer 5

PCT and TAL

Question 6

What test/lab can you run to distinguish between prerenal azotemia vs ischemic ATN?

Answer 6

UA. : findings are different between both

slide 17

Question 7

Pt consuming Painkillers, antibiotics, PPIs should raise suspicion for ?

Answer 7

acute interstitial neprhitis

Question 8

What presents with BLAND urinary sediment and renal fibrosis?

Answer 8

CHRONIC interstitial nephritis

Question 9

A 60-year-old man presents to the emergency room with a 1-day history of fever and a new skin rash. He is taking methicillin for a soft tissue infection. On physical exam, he has a diffuse maculopapular rash over his trunk. His serum creatinine is elevated at 3 mg/dL. Urinalysis reveals white blood cells. Further testing with Wright stain is positive for eosinophils in the urine. Dx?

Answer 9

ACUTE interstitial neprhitis

Question 10

If patient is on diuretics it is best to use (FeUrea/FeNa)?

Answer 10

FeUrea-> because sodium changes drastically with diuretic used

Question 11

A person with prerenal azotemia will have _______(increase/decreased) urea?

Answer 11

INCREASED (because in prerenal azotemia ADH/ RAAS is increased to increase volume, ADH increases AQP2 receptors and urea transporters. This is why BUN is >20:1)

Question 12

How do you treat a prerenal azotemia?

Answer 12

restore ECV

Question 13

What are the indications for dialysis?

Answer 13

Acidosis
Electrolyte disturbance
Ingestion (ethylene glycol, methanol)
O: volume overload
Uremia

Question 14

What are some factors that determine if pt recovers from AKI?

Answer 14

1. severity
2. underlying CKD
3. age (older less likely)
4. need for hemodialysis