Renal Assessment

Question 1

What is anuria

What is oliguria

What is polyuria

Answer 1

UOP <50-100 ml/day

UOP < 400-500 ml/day

UOP > 3000 ml/day

Question 2

What is Azotemia

What is uremia

Answer 2

elevated BUN without sx

Elevated BUN with sx (usually nonspecific)

Question 3

Most cases of AKI are from either

Answer 3

ATN

Prerenal azotemia

Question 4

what are some causes of prereanl azotemia?

Answer 4

antibiotics

iv contrast

heme pigments

light chains

Question 5

pre renal azotemia results in what?

Answer 5

activation of RAAS and ADH release

both lead to decreased UOP as a mechanism to resotre ECV

Question 6

A FeNa <1% is considered what

a FeNa >2% is considered what?

Answer 6

Prerenal azotemia

ATN

Question 7

Why is the vasa recta susceptible to ischemia?

Answer 7

the renal medulla is a watershed area receiving its blood supply from the vasa recta making it relatively starved of O2

Question 8

Why do the proximal tubule and mTAL have high metabolic activity?

Answer 8

because of Na reabsorption driven by basolateral membrane Na/K ATPase

Question 9

In ATN, the GFR decreases due to what two things?

Answer 9

1. tubular obstruction from cast formation
2. back leak of urine filtrate due to loss of tight junctions

Question 10

when someone is in pre-renal azotemia for a long enought time, what may develop?

Answer 10

ATN

Question 11

What drugs cause interstitial nephritis?

Answer 11

Nsaids, abx, PPIs

Question 12

What is Acute interstitial nephritis?

Answer 12

classic presentation includes fever, rash, arthralgias, peripheral eosinophilia, WBC casts

Question 13

What is chronic interstitial nephritis

Answer 13

class presentation includes minimal proteinuria, bland urinary sediment, slow renal decline and fibrosis

Question 14

What are the s/s of AKI?

Answer 14

edema

HTN

decreased urine output

proteinuria

hematuria

SOB

uremia

pericardial friction rub

asterixis

uremic frost

Question 15

What labs should be ordered for AKI diagnosis?

Answer 15

urinalysis with micro

urine albumin/crt ratio or urine protein/crt ratio

Question 16

a BUN/crt ratio of 20:1 or more indicates what?

Answer 16

prerenal azotemia or ATN

Question 17

Renal US showing small kidneys is suggestive of what?

Renal US showing cortical thinning if suggestive of what?

Answer 17

CKD (for both)

Question 18

What is the purpose of ordering a FeNa or FeUrea?

Answer 18

to differentiate prerenal azotemia from intrinsic renal injury (ATN usually)

Question 19

If a pt is non-oliguric, then by definition they cannot be

Answer 19

prerenal

Question 20

In dehydration, why do urea levels go up?

Answer 20

ADH binds to V2 receptors and increases cAMP levels which leads to insertion of AQP and urea transporters

Question 21

What are some pertinent questions to ask for AKI?

Answer 21

fluid intake

n/v/d

orthostatics

HTN, DM2, CKD

recent abx or new meds

recent IV contrast

urinary retention sx

family hx of kidney disease

Question 22

What are some s/s of dehydration?

Answer 22

dry mucosa

skin turgor

JVD

Question 23

What are the indications for dialysis?

(AEIOU)

Answer 23

A-severe Acidosis

E-Electrolyte disturbance

I-Ingestion

O-volume overload

U-Uremia

Question 24

What is the prognosis of AKI?

Answer 24

depends on severity and duration, underlying conditions, age, and need for hemodialysis

no guaruntee that function will recover

most people recover within 7-21 days

if no recovery after 3 months, pt now has CKD