Renal II Final Flashcards
What is Acute Kidney Injury “AKI”? What is it also know as?
Measurable increase in serum creatinine by 50% if patient’s previous values known, or absolute increase by 0.5 – 1.0 mg/dL.
Also known as Acute Renal Failure “ARF
What is Chronic Kidney Disease “CKD” ? What is it also know as?
Irreversible impairment of kidney function.
Also known as “CRF”
What are the five stages of CKD, and what are they based upon?
Based on estimated GFR “eGFR”:
1: eGFR 90 or greater with evidence of kidney damage o 2:60–90“mild”
3: 30 – 59 “moderate”
4: 15 – 29 “severe”
5: Less than 15 mL/min per 1.73 m2
What are the common symptoms of Uremia?
Nausea Vomiting Anorexia Bleeding Headache Dizziness Pruritus (“Uremic frost” – deposit of urea crystals on skin) Mental status changes
What are the (potentially) reversible causes of prerenal kidney injury?
True volume depletion
o Blood loss, GI loss, over- diuresis
Effective volume depletion (volume overload with reduced renal perfusion) ie “3rd spacing”
o Congestive Heart Failure “CHF”, Cirrhosis, Pancreatitis, Systemic
Inflammatory Response
Renovascular disease
Drugs
What are the (potentially) reversible causes of intrinsic kidney injury?
Tubulointerstitial Disease o ATN (Acute Tubular Necrosis) o Allergic Interstitial Nephritis o Pyelonephritis o Heavy metal poisoning
Glomerulonephritis
IgA Nephropathy
Glomerular endotheliopathies
What are the (potentially) reversible causes of postrenal kidney injury?
Bladder neck – stones
Prostatic hypertrophy
Ureter – stones or external compression from abdominal or pelvic mass, or
retroperitoneal fibrosis
Nephrolithiasis “stones” in kidney
Papillary necrosis
How do you calculate the fractional excretion of sodium “FeNa” (%) and what does it determine?
(Urine sodium x Plasma Creatinine / Plasma sodium x Urine Creatinine) X 100
Pre-renal if less than 1.
Intrinsic if greater than 1.
What is the typical clinical presentation for Nephritic Syndrome i.e. Acute Glomerulonephritis?
Edema
Hypertension
Proteinuria – NON-nephrotic range i.e. less than 3.5 gm/24hr (24 hr urine collection)
Hematuria
How does Nephrotic Syndrome present?
In addition to the edema and hypertension seen with Nephritic, the protein exceeds 3.5 gm/24 hrs and patients may present w/ protein-calorie malnutrition
Hyperlipidemia is also seen
What does “active” urine sediment on microscopy indicate?
Underlying renal process
o Red cell casts – glomerular disease
o White cell casts – tubulointerstitial disease
What are the primary causes of kidney disease?
Primary processes originating in the kidney itself “intrinsic” such as glomerular and tubular disorders.
What are the secondary causes of kidney disease?
o TOXINS
ENDOGENOUS – potential causes: Trauma, Marathons (unusually strenuous exercise, particularly with dehydration, Seizures, Prolonged immobility eg after a fall or injury, Viral Syndrome)
Rhabdomyolysis – breakdown of muscle produces myoblobin
Lactic acidosis – due to tissue hypoxia and anaerobic metabolism
EXOGENOUS
Non-steroidal anti-inflammatory pain relievers – multiple are Over- The-Counter (OTC)
o Ibuprofen (IBF) – several generic versions in addition to brand names such as Motrin, Advil, Aleve)
o Aspirin (ASA)
Iodinated contrast dye used in medical imaging such as CT scan or intravenous pyelogram
Other medications
o HYPERTENSION (Hypertension “HTN” also has primary and secondary causes o Diabetes Mellitus Types 1 and 2
o AUTOIMMUNE DISORDERS
o INFECTION
o MALE GENITOURINARY DISORDERS
Prostatic hypertrophy
Prostatitis
What values do you use to determine treatment for hyperkalemia?
EKG changes, comorbidities, volume status and response to previous treatment measures.
What is Polystyrene resin (Kayexalate) and what is it used for?
Removes potassium via GI tract, Furosemide but depends on renal function, and possibly Albuterol to redistribute potassium into cells, but weakest effect.
It is initial (conservative) approach to treatment for hyperkalemia.
What do you do if treatment with Polystyrene resin (Kayexalate) does not work?
- Calcium IV – stabilizes cardiac membrane
- Insulin IV – redistributes potassium back into cells
- Consider glucose – to counteract insulin if necessary
- Hemodialysis if poor response to above
- Consider bicarbonate – in severe metabolic acidosis without response to above
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Calculate the anion gap.
Na – (Cl + HCO3)
Mnemonic for differential diagnosis in “gap” (high anion gap) metabolic acidosis.
MUDPILES :
Methanol
Uremia (Chronic Kidney Disease)
Diabetic Ketoacidosis (DKA)
Paracetamol, Propylene glycol (Inactive stabilizer in many medications)
Infection, Isoniazid, Iron, Inborn errors of metabolism (peds)
Lactic acidosis
Ethylene glycol (antifreeze)
Salicylates (aspirin)
Mnemonic for differential diagnosis in “non-gap” (normal anion gap) metabolic acidosis.
HARDUPS:
Hyperalimentation
Acetazolamide and other carbonic anhydrase inhibitors
Renal Tubular Acidosis – second most likely cause
Diarrhea – MOST common cause – lose bicarbonate which leads to increased concentration of Chloride
Ureteroenteric fistula
Pacreaticoduodenal fistula
Spironolactone
What is the goal BP when treating the general >60y/o population?
SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation – Grade A).
What is the corollary recommendation for HTN
In the general population aged over 60 years, if pharmacologic treatment for high BP results in lower achieved SBP (eg, <140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted. (Expert Opinion – Grade E).
What is the goal BP when treating the general <60y/o population?
SBP <140mmHg. DBP <90mmHg. (For ages 30-59 years, Strong Recommendation – Grade A; For ages 18-29 years, Expert Opinion – Grade E).
What is the goal BP when treating the general >18y/o population with CKD?
SBP <140mmHg and goal DBP <90mmHg. (Expert Opinion – Grade E).
What is the initial HTN treatment for non-blacks with diabetes?
Thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation – Grade B).
What is the initial HTN treatment for the black population with diabetes?
Thiazide-type diuretic or CCB. (For general black population: Moderate Recommendation–Grade B; for black patients with diabetes: Weak Recommendation – Grade C).
What is the HTN treatment for the general >18y/o population with CKD?
ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B).
What are the complications of HTN?
Brain: TIA, stroke Eye: retinopathy Blood Vessels: Peripheral vascular disease Kidney: Renal failure Heart: LVH, CHD, HF
