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(oms2) pcm iii final > Final: AKI/CKD Assessment > Flashcards

Final: AKI/CKD Assessment Flashcards

1
Q

How many mls of urine per day is produced in:

  1. Anuria:
  2. Oliguria:
  3. Polyuria:
A
  1. Anuria: <100ml/day
  2. Oliguria: <400ml/day
  3. Polyuria: >3000ml/day
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2
Q

What is azotemia?

A

elevation of BUN w/o symptoms

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3
Q

What is uremia

A

elevation of BUN w symptoms

  • confusion
  • N/V
  • metallic taste in mouth
  • Anorexia
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4
Q

What are most cases of AKI from?

A

Acute Tubular Necrosis or prerenal azotemia

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5
Q

What all can cause ATN?

A

Ischemia is most common

Toxins

  • antibiotics!!
  • -vanco, aminoglycosides
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6
Q

Which cause of AKI (ATN or prerenal azotemia) causes activation of RAAS and ADH?

A

Prerenal azotemia

-due to decrease in GFR

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7
Q

In prerenal azoemia, is the FeNa? >1 or <1?

A

<1%

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8
Q

In ATN, is the FeNa? >1 or <1?

A

> 1%

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9
Q

What sites of the kidney are the most common for ATN?

A

Proximal tubule and medullary thick ascending limb of the loop of Henla

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10
Q

What causes the decrease in GFR seen in ATN?

A
  1. Tubular obstruction -via cast formation

2. Back leakage of urine due to loss of tight junctions

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11
Q

Prolonged prerenal azotemia can progress to what?

A

ATN (ischemia)

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12
Q

What characterizes interstitial nephritis?

A

Inflammatory cells within the renal interstitium

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13
Q

What are the three most common causes of interstitial nephritis?

A
  1. Drugs (NSAIDs)
    - also Abs and PPIs
  2. Infections
  3. Autoimmune
    - SLE, Sjogrens, IgG4-related disease
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14
Q

What disease presents with fever, rash, arthralgias, peripherial eosinophilia, pyuria, WBC casts, minimal proteinuria, and acute renal failure?

A

Acute Interstitial Nephritis (AIN)

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15
Q

What disease presents with minimal proteinuria, few cells in the urine, and a slow decline in renal function with fibrosis?

A

Chronic Interstitial Nephritis

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16
Q

Pt comes in with swollen legs and periorbital edema, HTN, dysuria, with +2 albuminuria and RBCs in their urine. They have vomited twice and have asterixis.. what would you diagnose as?

A

AKI

  • Edema
  • HTN
  • decreased urine
  • Protein/hematuria
  • SOB
  • Uremia (Asterixis, Uremic frost)
17
Q

What would you order to diagnose AKI (2)?

A
  1. Urinalysis w urine microscopy
  2. Urine albumin/cr or protein/cr ratio
  3. Renal US
18
Q

What would small kidneys and cortical thinning on renal US suggest?

A

CKD

19
Q

What effect does ADH have on the kidneys? (physiologically)

A

ADH binds V2 receptors, which in turn puts Aquaporin 2 channels in the Collecting Duct
-reabsorption of more water!

20
Q

Renal tubular epithelial cells, transitional

epithelial cells, granular casts, or waxy casts suggests what kidney disease pattern?

A

ATN

21
Q

WBC, WBC cast, or urine eosinophils suggests what kidney disease pattern?

A

AIN or pyelonephritis

22
Q

Dysmorphic RBCs, RBC casts suggests what kidney disease pattern?

A

Vasculitis or glomerulonephritis

23
Q

Proteinuria, Hematuria, with dysmorphic RBC and RBC casts suggests what kidney disease pattern?

A

Nephritis Syndrome

24
Q

Heavy proteinuria, lipiduria, and minimal hematuria suggests what kidney disease pattern?

A

Nephrotic syndrome

25
Q

Hyaline casts suggests what kidney disease pattern?

A

Prerenal azotemia (non-specific)

26
Q

WBCs, RBCs, bacteria suggests what kidney disease pattern?

A

UTI

27
Q

Indications for dialysis: (AEIOU)

A

A: Severe Acidosis

E: Electrolyte disturbance (usually hyperkalemia)

I: Ingestion (ex: ethylene glycols, methanol, etc…)

O: Volume overload

U: Uremia

28
Q

Dr. Selby Standard Questions for History in diagnosis of AKI?

A
  1. Fluid intake?
  2. N/V/D?
  3. Orthostatics?
  4. Hx of HTN, DM2, or CKD?
  5. Recent Antibiotic exposure or any new medication?
  6. Recent IV iodine contrast exposure?
  7. Urinary retention symptoms?
  8. Family history of kidney disease?
29
Q

If pt doesnt recover from AKI in 3 months, what do they now have?

A

CDK

-most people recover in 7-21 days

30
Q

Elevated urine eosinophils should automatically make you think of which AKI?

A

Acute Interstitial Nephritis

31
Q

A FeNa <1%=?

A FeNa>2%=?

A

Prerenal azotemia

ATN

32
Q

A FeUrea <35%=?

A FeUrea>50%=?

A

Prerenal azotemia

ATN

33
Q

If a patient is non-oliguric, can they have prerenal azotemia?

A

No

-pt must be oliguric to be considered prerenal

(oms2) pcm iii final (4 decks)

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