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Flashcards in acute kidney injury 2 Deck (28):
1

what type of test is often done to see if there is kidney blockage, or a structural issue with the kidney?

renal imaging (ultrasonogram)

2

what are two types of prerenal hypoperfusion?

1. systemic hypoperfusion
2. isolated renal hypoperfusion

3

what indicates isolated renal hypoperfusion

bilateral renal artery stenosis embuli
(cholesterol or thrombotic)

4

what indicates systemic hypoperfusionq

1. intravascular volume depletion
2. relative decrease in volume

5

what are 3 things that indicate intravascular volume depletion by systemic hypoperfusion

1. dehydration
2. hemorrhage
3. overdiuresis

6

what are 3 things that indicate relative decrease in volume due to systemic hypoperfusion

1. heart failure
2. liver disease
3. nephrotic syndrome

7

what is nonoliguric disease typically classified as prerenal decreases GFR and usually stops when agent causing it is removed?

functional acute renal failure

8

what do ACE inhibitors inhibit?
what does this cause?
where?

angiotensin II

9

what general change causes functional acute renal failure?

hemodynamic changes ( no direct kidney pressure)

10

what two endogenous compounds are the main factors for vasodilation and vasoconstriction

1. prostaglandins
2. angiotensin II

11

what compound effects the afferent arteriole's constriction and dilation?

prostaglandins

12

what compound effects the efferent arteriole's constriction and dilation?

angiotensin II

13

what are the 3 main causes of functional acute renal failure

1. NSAIDs
2. ACEI's and ARB's
3. Calcineurin inhibitors (immunosuppresents, ie cyclosporine)

14

what is the MOA of ACEI/ARB induced AKI?

vasodilation of efferent arteriole (leaving kidney)

15

angiotensin II causes what?

vasoconstriction

16

what can commonly be seen lab values that appears significant at the start of an ACEI?

rise in SCr of less than 30%

17

why should ACE inhibitors be started at low doses and slowly increased

due to vasodilation increasing SCr

18

what are 4 conditions that can exacerbate change in renal function with ARBs and ACEI's?

1. dehydration
2. renal artery stenosis
3. CHF
4. Cirrhosis
(still can use with these pt's just monitor closely)

19

what accounts for around 37% of drug induced AKI

NSAID's

20

what enzyme is essential for maintaining renal hemodyanamics, effected by NSAIDs

COX-2

21

NSAID's cause what problem, where leading to AKI?

constriction of afferent arteriole, leading to hypoperfusion

22

what are two common calcineurin inhibitors

tacrlimus
cyclosporine

23

what are calcineurin inhibitors often used for?
how long are pt's at risk of CKD after this

post transplant immunosuppressant's
5 years after transplant of nonrenal organ

24

what is the dose limiting adverse effect of tacrolimus and cyclosporine (calcineurin inhibitors)?

nephrotoxicity

25

when does nephrotoxicity normally present with cyclosporine therapy

within 6 months of cyclosporine therapy

26

what MOA do calcineurin inhibitors have to cause ARF

reversible, but extreme vasoconstritction and injury to afferent arteriole

27

what are 2 causes of functional ARF other than drug induced

1. hypercalcemia - direct vasoconstriction
2. hepatorenal syndrome - ARF in pt's with severe liver disease (probably mediated by prostaglandins)

28

when prerenal or functional ARF are seen what should be thought of immediately as cause?
what should be the next step in diagnosis

hypoperfusion

is it systemic hypoperfusion or renal hypoperfusion