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SALMAN HARRISON'S > 304 - Acute Kidney Injury > Flashcards

304 - Acute Kidney Injury Flashcards

1
Q

AKI can be defined by one of the following 3 criteria:

  1. Nitrogen retention (___ and ___ increase in the blood
  2. Oliguria (
A 
BUN
Cr
400
Electrolytes
Acid base
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2
Q

AKI is responsible for ___ of the acute hospitalizations and up to 30% of admissions to the ___

A

5-7%

ICU

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3
Q

Main causes for AKI in developing countries include: (3)

A

Diarrhea
Infectious disease
Rhabdomyolysis

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4
Q

Most of the community acquired AKI are due to: (3)

A

Hypovolemia
Iatrogenic (drugs)
Urinary track blockage

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5
Q

Most nosocomial AKI are due to: (4)

A

Post surgery
Sepsis
Contrast fluids
Nephrotoxic drugs

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6
Q

Most cases of AKI are defined as pre-renal (__%), intrinsic ARF is responsible to ___% of the cases, and post renal to ___%

A

55%
40%
5%

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7
Q

Pre renal azotemia is usually due to ____

A

Kidney hypoplasia

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8
Q

Intrinsic ARF is caused by ____ disease

A

Kidney parenchyma

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9
Q

Post renal ARF is usually caused by ____

A

Urinary tract obstruction

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10
Q

Pre renal azotemia is defined by ___ or ___ levels increase due to ____ - disturbance of glomeruli filtration. It is by definition ___ once hemodynamic status return to normal. No ____ damage occur.

A 
BUN
Cr
Tissue hypoplasia
Reversible 
Parenchymal
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11
Q

The common causes to prerenal azotemia are: (5)

A

Hypovolemia
Cardiac output decrease
Iatrogenic agents leading to auto regulation disturbance (ACEi/ARB/NSAIDs)

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12
Q

The main causes for intrinsic AKI include ___, ___, and ___.

A

Ischemia
Sepsis
Nephrotoxins

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13
Q

In ___ of sepsis cases we might end up with ____. It increases the rate of ___

A

50%
Intrinsic AKI
Mortality

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14
Q

In Intrinsic AKI due to ___ we might find ___ and ___ in the urine

A

Sepsis
Tubular debris
Casts

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15
Q

Normal kidneys receive ___ of the CO and consume ___ of the oxygen while at rest.

A

20%

10%

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16
Q

Vascular disease may lead to renal ischemia. We can divide them into small vessels (5) and large vessels.

A 
APLA
TTP/HUS
Radiation nephritis
Scleroderma
Cholesterol emboly
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17
Q

Vascular disease may lead to renal ischemia. We can divide them into small vessels, and large vessels (4)

A

Renal artery dissection
Emboly
Thrombi
Renal vein pressure

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18
Q

___ and acute ____ may also lead to intrinsic AKI

A

Burns (in 25% of patients with > 10% body surface burn)

Pancreatitis

19
Q

Contrast nephropathy will first show ___ and ___ increase ___ hours after contrast fluids were given. Pick levels are reached after ___ days, and return to normal after ___ days

A 
Cr
BUN
24-48
3-5
7
20
Q

Contrast nephropathy is defined by a sharp decrease in ___, unspecified urine sediments and low ___

A

GFR

FENa

21
Q

Contrast nephropathy is unlikely, beside in the following patients: (5). Remember also-: age>80, single kidney

A
  1. Diabetic
  2. CRF
  3. CHF
  4. Hypovolemia/ dehydration
  5. MM
22
Q

Which Abx may lead to intrinsic AKI? (4)

A
  1. Vancomycin
  2. Aminoglycosides
  3. Amphotericin
  4. Acyclovir
23
Q

Which chemotherapeutic agents may lead to intrinsic AKI? (4)

A

Cisplatin
Carboplatin
Ifosfamide
Bevacizumab

24
Q

____ released after rhabdomyolysis due to: trauma/muscles ischemia/vascular surgery/etc… may lead to ___ AKI

A

Myoglobin

Intrinsic

25
Q

Beside myoglobin, other endogenic toxins that nay lead to intrinsic AKI include: (4)

A

Hemolysis
MM
TLS
Hypercalcemia

26
Q

Post renal AKI etiologies include: (3)

A

Urethral neck obstruction
Urethral obstruction
Urethra obstruction

27
Q

Oliguria is defined by

A

400
Rhabdomyolysis
Hemolysis

28
Q

In pre renal urine analysis we will ___ see cells, but ___ casts (hyaline and transparent) are possible

A

Not

Tamm Horsfall

29
Q

In intrinsic urine analysis we will ___ see WBC/RBC cells. ___ ___ and are possible

A

Might
Hematuria
Pyuria

30
Q

In intrinsic urine analysis we will see ____ casts. Light ___ is possible. Only ___% of cases do not have ___

A

Muddy brown
Proteinuria
20-30%
Casts

31
Q

To summarize:

  1. Hyaline casts->___
  2. Muddy brown casts ->___
  3. RBC casts ->___
  4. WBC casts ->___
  5. Broad granular casts ->___
A
  1. Pre renal
  2. Intrinsic
  3. Glomerular damage (IS nephritis is possible)
  4. IS nephritis
  5. CKD
32
Q

Uric acid crystals are found in ___ AKI for different reasons including ____

A

Pre renal

TLS

33
Q

Oxalate a crystals are found after exposure to ____

A

Ethylene glycol

34
Q

Which CBC results may suggest HUS/TTP? (5)

A 
Anemia
Thrombocytopenia
Schistocytes 
LDH increase
Haptoglobin decrease
35
Q

When suspecting HUS/TTP we must include tests for: (2)

A
  1. ADAMTS13

2. Shiga toxin (E.coli producing)

36
Q

In AKI usually hyper___, hyper___, and hypo___ are seen.

A

Kalemia
Phosphotemia
Calcemia

37
Q

High AG will suggest ___ intoxication

A

Ethylene glycol

38
Q

Low AG will suggest ___.

A

MM

39
Q

GN and vasculitis are to be suspected when the seeing low complement factors and high titer of ___, ___, ___, ___.

A

ANA
ANCA
AGBM
Cryoglobulins

40
Q

FENa (fractional Excretion of Sodium) < 1% than ___, beside when: (4)

A 
Pre renal
Diuretic
CKD
Salt wasting syndrome
Adrenal insufficiency
41
Q

FENa > 1% than ____

A

ATN (acute tubular necrosis)

42
Q

Pre renal azotemia:

  1. FENa ___
  2. UCr/PCr > ___
  3. BUN/Cr > ___
  4. Urine Na < ___
A
  1. 1%
  2. 500
  3. 40
  4. 20
  5. 20
43
Q

Uremia is when ___ levels are increased due to accumulation of ___. when > ___ ml/dL- mental status changes and hemostasis disturbance

A

BUN
Nitrogen waste products
100

44
Q

How FENa is calculated?

A

FENA= ((UNA X PCr) / (UCr X PNa)) X 100

SALMAN HARRISON'S (163 decks)

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