Acute Kidney Injury

Question 1

What are the types AKI

Answer 1

Prerenal AKI, intrinsic, Postrenal

Question 2

What are the 3 types of Intrinsic AKI

Answer 2

acute glomerulonephropathy, acute tubular necrosis, acute interstitial nephritis

Question 3

When does AKI become CKD

Answer 3

established renal dysfunction for three or more months

Question 4

What are non preventable risk factors for AKI

Answer 4

Chronic kidney disease, age greater than 75, heart failure, liver disease, diabetes

Question 5

What are preventable risk factors for AKI

Answer 5

Medications, hypotension, sepsis,cirrhosis

Question 6

What can cause pre renal AKI causes

Answer 6

intravascular volume delpletion (dehydration), reduced cardiac output, vascular obstruction

Question 7

What is a marker than is affected by AKI, what happens

Answer 7

increased SCr

Question 8

What are some labs and urine tests that can evaluate for AKI

Answer 8

BUN: Scr greater than 20, urine specific gravity greater than 1.015

Question 9

What are the characteristics of urine for a patient with pre-renal AKI

Answer 9

Highly concentrated urine with low sodium

Question 10

What is the best way to check for post renal AKI

Answer 10

kidney ultrasound

Question 11

What is the best way to check for pre renal AKI, what should the change be , what does it mean if there is not change

Answer 11

Give Normal Saline bolus, if the SCr significantly improves the AKI is prerenal, if there is no change in SCr the AKI is likely intrinsic

Question 12

What does FENA stand for

Answer 12

Fractional Excretion of Sodium

Question 13

What are the circumstances when the FENA can be used

Answer 13

only accurate in oliguric (urine output less than 400ml/day) AKI

Question 14

What are values for FENA and what do they mean

Answer 14

< 1 : suggests pre renal AKI, 1-2: either prerenal or intrinsic, >2: suggests intrinsic AKI

Question 15

When would the FENA be falsely high, why, If it is still low what does this mean

Answer 15

If the patient is on diuretics, diuretics should cause a large excretion of Sodium, if FENA is low despit being on diuretics there is likely pre renal AKI

Question 16

What is usually the cause of glomerulonephropathies

Answer 16

autoimmune disease

Question 17

What is a characteristic finding of GN

Answer 17

Proteinuria

Question 18

What is the best way to check for GN

Answer 18

Protein to creatinine Ratio

Question 19

What is a hallmark feature of nephrotic syndrome

Answer 19

Facial edema and frothy urine

Question 20

What can be given for treatment of proteinuria

Answer 20

ACEIs or ARBs with salt restriction as well

Question 21

T/F: ACEIs and ARBS cause efferent vasodilation that causes less filtration leading to more retention of protiens

Answer 21

True

Question 22

What is the most common of cause of AKI

Answer 22

Acute tubular necrosis

Question 23

What can lead to Acute tubular necrosis

Answer 23

Prolonged or severe pre-renal AKI leading to ischemia

Question 24

What can cause Acute Interstital nephritis

Answer 24

Drug allergy or autoimmune diseases

Question 25

What are the 4 ways to manage AKI

Answer 25

removal of cause if possible, immunosuppresion if autoimmune, prevent hypotension and/or hypovolemia, avoid nephrotoxins

Question 26

What are the indications for dialysis

Answer 26

Metabolic Acidosis (ph less than 7.1), Electrolytes (K greater than 6.5), Intoxication, Refractory fluid Overload, uremia- confusion (A,E,I,O,U)

Question 27

T/F: Starting dialysis is more likely to better patient's renal function in the future

Answer 27

False: Starting dialysis earlier in the coure of renal failure does not improve outcomes

Question 28

What is the most common cause of post renal AKI

Answer 28

Kidney stones or obstruction

Question 29

Whatis hydronephrosis

Answer 29

backup of urine into kidneys

Question 30

What are the most common stones

Answer 30

calcium and oxalate

Question 31

What is the reatement for stones

Answer 31

Usually pass on its own or give fluids

Question 32

What drugs can be used to pass big stones

Answer 32

Tamsulosin

Question 33

What are ways to prevent stones

Answer 33

increase fluid intake (urine output to 2 to 2.5 liters per day), avoid calcium, sodium restriction, avoid dark colas

Question 34

What meds can prevent calcium stones

Answer 34

thiazide diuretics and potassium citrate