Acute kidney injury Flashcards Preview

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Flashcards in Acute kidney injury Deck (33):
1

def. acute kidney injury

deterioration of the kidney that has lasted for less than 3 months

2

def. chronic kidney disease

persistent deterioration that has lasted longer than 3 months

3

3 parts to classic approach to AKI

1. pre-renal
2. renal
3. post-renal

4

def. pre-renal AKI

acute injury to kidney secondary to reduced renal blood flow

5

3 major causes of pre-renal

1. decreased ECF
2. "effective" reduced ECF
- heart failure
- reduced oncotic pressure
3. disruption of renal hemodynamics
- drugs

6

3 parts of Hx and Px that suggest pre-renal

1. Hx suggest ECF depletion
2. Phx signs of volume depletion
3. signs of reduced effective volume depletion
- reduced cardiac output
- liver failure

7

2 serum signs of pre-renal

1. hemoconcnetration
- high Hb and albumin
2. low urinary flow
- high Urea/Cr ratio

8

urine signs of pre-renal

bland urine
- low salt

9

def. renal AKI

injury do to damage to the parenchyma

10

clue to renal AKI

1. systemic features
- rash
- joint involment
- pulmonary involvment
2. HT
3. mild-mod ECF overload
4. anemia or thrombopenia
5. abnormal urine sediment

11

what is seen in renal dipstick (4)

1. albumin
2. Hb
3. WBCs
4. other

12

what is seen in renal microscopy

1. cells
2. casts
3. crystals

13

3 classes of of renal AKI

1. tubulo-interstitial
2. glomerular
3. vascular

14

3 types of tubulo-interstitial

1. acute tubular necrosis
2. allergic/acute interstitial nephritis
3. tubular obstruciton

15

what is acute tubular necrosis

injury and death of renal tubular cells
- ischemia and toxins

16

risk factors for tubular ecrosis

1. CKD
2. CV diease
3. ECF volume depletion

17

how to diagnose ATN

labs - blood and protein
hemegranular casts

18

4 ways to diff. ATN from pre-renal

1. dip - Hb and albumin
2. micro - hemegranular casts
3. unine [Na] - >20
4. fractional excretion of Na - >1%

19

what is interstitial nephritis

interstitial inflamation resulting in AKI

20

3 main etiologies of nephritis

1. drug reactions
2. auto-immune
3. infectious

21

what is drug induces AIN

7-10 days after exposure
WBC casts

22

what is tubular obstruction

AKI due to obstruciton

23

2 general etiologies of obstruction

1. endogenous
- tumor lysis
- myleoma
2. exogenous
- drugs

24

2 main types of glomerular disease

1. proliferative
- typically causes AKI
2. non-proliferative
- generally not AKI

25

features of proliferative

- rapid delcine in GFR
- HT
- anemia
- elevated inflammatory markers
****RBC CASTS

26

what are vascular causes of renal AKI

secondary to either small or large vessel disease

27

4 vessels and the problems with them

1. arteries
- atherosclerosis
- fibromuscular dysplasia
2. arterioles
- atheroembolic disease
3. veins
- thrombosis
4. caps
- TTP
- hemolytic uremic syndrome

28

4 vessels and the problems with them

1. arteries
- atherosclerosis
- fibromuscular dysplasia
2. arterioles
- atheroembolic disease
3. veins
- thrombosis
4. caps
- TTP
- hemolytic uremic syndrome

29

what is post-renal disease

inability for urine to leave
- URO

30

4 general goals of Tx of AKI

1. remove offending toxin
2. avoid further toxic therapies/investigations
3. treat ECF depletion
4. avoid AKI complications

31

Tx for pre-renal

improve hemodynamics
- ECF volume replation
- improve cardiac output

32

treatment for AIN

remove offending agent
- consider steroid

33

Tx for ATN

- remove offending agent
- correct ECF depletion
- supportive care

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