Renal Approach To AKI and Renal Failure - Dr. Grin

Question 1

AKI is seen from what

Answer 1

elevated Cr

= which can cause high urea, electrolyte imbalance and volume overload

Question 2

AKI Dx how

Answer 2

1. increase in serum Cr by > 0.3mg/dL in 48hrs
2. increase serum Cr > 1.5 times higher then BASELINE
3. Decrease urine volume

Question 3

reason AKI you need to compare Cr to baseline

Answer 3

more muscular pts have higher Cr levels

Question 4

Cr and eGFR relationship in AKI

Answer 4

inverse

as Cr goes us, eGFR goes down (esp early increase)

Question 5

Anuria 
Oliguria 
Azotemia
Pre-renal Azotemia 
Uremia

Answer 5

Anuria = less then 100ml/day
Oliguria = under 400-500ml
Azotemia = high BUN
Pre-renal Azotemia = high BUN not proportional to Cr
Uremia = high BUN + sx like confusion, n, v, metallic taste

Question 6

AKI sx you usually see

Answer 6

aymptomatic 
= htn
= edema
= dyspnea
= uremia

Question 7

uremia sx you can see in physical exam

Answer 7

1. Asterixis (also seen in cirrhosis)

2. uremic frost (white crystal on feet)

Question 8

AKI prerenal

Answer 8

1. hypovolemia (bleeding, V,D)
2. Hypervolemia (CHF)
3. drugs impairing renal regulations (NSAIDs, ACEI)
4. sepsis, SIRS, cirrhosis = vasodilation

Question 9

AKI intrinsic renal

Answer 9

1. acute tubular necrosis (can happen from prerenal, uric acid, myeloma LCs, IV contrast, mygobulin)
2. Acute interstitial nephritis (PPIs, NSAIDs, ABs some)
3. Glomerular disease (post strep GN)
4. vascular (vasculitis, malignant htn, TTP/HUS)

Question 10

AKI postrenal

Answer 10

1. Bladder outlet obstruction (BPH, Blood clot)

2. Ureteral obstruction : stone, compressed from malignancy

Question 11

AKI prerenal tx

Answer 11

reverse BF (most common cause is dehydration

Question 12

labs that show AKI from prerenal cause**

Answer 12

1. urine NA < 20mEg/L
2. BUN/Cr > 20:1
3. Urine osmolality > 500mosm/kg

Question 13

prerenal meds

Answer 13

NSAIDS : X vasodilation afferent (coming)

ACEI : X constrict efferent arteriole (leaving)

Question 14

Acute Tubular necrosis

Answer 14

renal tubular cells die and slough off and clog tubules = decrease GFR

1. sepsis
2. myoglomin =rhbdo
3. LCs
4. IV contrast

Question 15

prerenal vs ATN

Answer 15

prerenal is reversible before interstitial AKI ATN

Question 16

acute intersitial nephritis

Answer 16

= immune cells into interstitium
(PPIs, NSAIDS,)
= fever, rash, eosinophils

Question 17

labs in Intrinsic AKI

Answer 17

1. Urine NA > 40mEg/L
2. BUN / Cr < 15:1 (cant absorb urea)
3. Urine osm < 350mosm/kg

Question 18

Postrenal AKI BPH

Answer 18

obstruction of bladder outlet from prostatic enlargement

Question 19

Postrenal AKI ureteral obstruction is usually

Answer 19

bilateral obstruction

Question 20

Postrenal AKI labs you see

Answer 20

1. Urine NA : <
2. BUN:Cr >
3. Urine osmo >

== HIGH pressure in tubules**