Week 11 AKI & UTD patho Flashcards
If we see Casts in someone’s urine, it indicates that they have what
Damage to their tubules (Intra-tubual damage). The epithelial cells have sloughed off and are collecting in the filtrate.
How do you aleviate pre-renal injury?
Fix blood pressure
How do you aleviate post renal injury?
remove/fix the obstruction
What types of AKI can be reversed easily?
- pre-renal injury
- Post -renal injury
What do delays in intervention lead to with pre-renal injury and post-renal injury?
Intra-renal injury (bad)
What are the 3 stages of Intra-renal Injury?
- initiation
- Maintenance
- recovery
What are the 5 urinary tract disorders?
- Immunological kidney disorders
- Urinary tract infections
- Kidney stones (Calculi)
- Polycystic kidney disease
- Cancer
Is mortality high or low with AKI?
Low
Do people with AKI sometimes need dialysis?
Yes
What disease can AKI lead to?
CKD
What are the 3 risk factors for developing AKI?
- Infection - sepsis is most common cause
- low BP
- Nephrotoxins
What is the most common cause of infection that leads to AKI?
Sepsis
What are 3 reasons people have low BP that can lead to AKI?
shock, surgery, heart failure
What are 3 examples of nephrotoxins that can lead to AKI?
medication
radiocontrast
chemical exposure
What are 3 pre-renal factors that lead to AKI?
- hypovolemia
- altered peripheral vascular resistance
- cardiac disorders
What are 5 intra-renal factors that lead to AKI?
- renal ischemia that lasts a while
- nephrotoxic drugs
- organic solvents - ethylene glycol
- acute hemolysis and rabdo
- acute glomerulonephritis
What are examples of nephrotoxic drugs that lead to AKI?
antibiotics - *aminoglycosides the “-cins”
NSAIDS
CT dye/contrasts
What are 3 post-renal factors that lead to AKI?
- stones/tumours
- enlarged prostrate
- urethral scarring/infection (STIs)
What does azotemia mean?
Lots of waste product in the urine
What happens in the nephron during pre-renal AKI?
- decreased renal blood flow
- Hypoperfusion
- decreased GFR
- In the proximal tubule more Na and H2O are absorbed to help compensate
- Aldosterone and ADH increase to help compensate for low BP
- in the distal tubule more Na and H2O to help compensate
- 3 compensations = Oliguria & Azotemia
What happens in the nephron during intrarenal injury?
- There is injury to the tubule (necrosis)
- Casts form from cells sloughing off
- Causes intratubular obstruction
- So then increase in intratubular pressure
- causes backflow and leaking of proteins
- This reduces GFR
- Oliguria
What is happening in the nephron during post-renal AKI?
blockage causes back up in the glomerulus so GFR goes down because of changes to the delicate pressure balance
What are the 2 reasons that AKI happen?
- renal system circulatory issue - so a drop in GFR
- Damage to the actual glomerulus or tubule
What issue in the heart contributes to low perfusion to the kidneys?
CO
How do the glomerular pressures change in pre and post renal injuries?
-the hydrostatic pressure lowers in pre-renal injury
-the hydrostaic pressure rises due to back flow in post renal injury ?
During the initiation stage of Intrarenal AKI what are the 2 major things we will see?
- increase serum creatinine & BUN- waste due to GFR issues
- decreased urine output (due to compensatory mechanisms)