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Block 34 metabolic -Ellen > Acute Kidney injury PT1 > Flashcards

Acute Kidney injury PT1 Flashcards

(57 cards)

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1
Q

2 measures of a rapid decline in renal function

A
  • rise in serum creatinine

- decrease in urine output

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2
Q

laboratory findings for increase in creatinine

A

> 26.5 micromol/L witin 48 hours

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3
Q

increase in creatinine above baseline for AKI

A

> 1.5x within 7 days

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4
Q

decrease in urine for AKI

A

<0.5 ml/kg/h for 6 hours

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5
Q

3 types of AKI

A

pre-renal
renal
post-renal

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6
Q

Urea: creatinine ratio for normal and post renal AKI

A

40-100 : 1

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7
Q

Urea: creatinine ratio for pre-renal AKI

A

> 100: 1

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8
Q

Urea: creatinine ratio for intrinsic renal damage

A

<40: 1

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9
Q

what do pre-renal AKIs cause in the body

A

Azotemia

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10
Q

3 characteristics in prerenal failure

A

low urine Na
high urine osmolarity
high BUN:cr ratio

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11
Q

causes of prerenal failure (5)

A
  • renal artery stenosis
  • NSAID
  • systemic hypotension
  • hepatorenal syndrome
  • hypercalcaemia
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12
Q

genetic condition that can cause renal artery stenosis

A

fibromusclular dysplasia

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13
Q

diagnostic key for renal artery stenosis

A

uncontrolled hypertension refractory to treatment

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14
Q

treatment of renal artery stenosis

A

angioplasty and treat LDL with statins

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15
Q

danger of ACEi with bilateral RAS

A

can lead to a very low GFR

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16
Q

when can NSAIDs cause prerenal failure

A

in patients with pre-existing renal disease

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17
Q

what do NSAIDs block

A

prostaglandins

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18
Q

what do prostaglandins do and therefore NSAIDs stop

A

dilation of the afferent arteriole

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19
Q

what absorption co-exists with Na reabsorption

A

urea reabsorption -therefore RAAS activation causes high BUN levels

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20
Q

more commonly what type of AKI do NSAIDs cause

A

intrarenal

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21
Q

hypoadrenalism means

A

low cortisol and aldosterone

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22
Q

low cortisol and aldosterone from addison’s means the nephron can’t______

A

reabsorb Na and water leading to hypotension and hypoatremia

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23
Q

symptoms of Addisons

Study These Flashcards
A 
salt craving 
weakness
abdo pain 
syncope 
higher pigmentation 
uremia
24
Q

lab results for Addison’s (5)

Study These Flashcards
A 
hypotension 
hyponatremia 
hyperkalaemia 
elevated BUN:cr ratio 
acidosis
25
treatment of Addison's
cortisol replacement -hydrocortisone or prednisolone | mineralocorticoid replacement -fludrocortisone
26
hepatorenal syndrome=
idiopathic prerenal failure with pre-existing liver disease
27
symptoms of hepatorenal syndrome
jaundice pruritis asterixis uremia
28
most common cause of intrinsic AKI
acute tubular necrosis
29
what happens to the epithelial cells in acute tubular necrosis
When epithelial cells become damaged, they slough off, accumulate and aggregate together in the renal tubule forming an obstruction→ high pressure behind obstruction reducing GFR
30
cells most affected by ischaemia in acute tubular necrosis
PCT and TAL
31
4 types of insult to the epithelial cells in Acute tubular necrosis
ischaemic toxic drugs contrast induced
32
2 toxic causes of acute tubular necrosis
rhambdomylosis | heme
33
rhambdomylosis=
muscle injury
34
damaged muscle causes
-fluid sequestration in the damaged muscle induces volume depletion, activation of the sympathetic nervous system, ADH secretion and RAS activation all of which favor vasoconstriction and renal salt and water preservation
35
what can myoglobin from muscle injury do
myoglobin can cause direct tubular obstruction
36
2 drugs causing acute tubular necrosis
aminoglycosides | amphotericin B
37
what does contrast do to the tubules (2)
- causes vasoconstriction in nephrons | - can cause direct tubular toxicity and ischaemia
38
a form of inter-renal AKI caused by infiltration of neutrophils and eosinophils into the interstitium inducing inflammation
acute interstitial nephritis
39
presentation of acute interstitial nephritis
eosinophils fever rash
40
main cause of acute interstitial nephritis=
drug allergies
41
common drug allergies causing acute interstitial nephritis (4)
Beta lactams PPIs NSAIDs diuretics
42
what type of reaction is acute interstitial nephritis
hypersensitivity reaction
43
treatment of acute interstitial nephritis
cessation of inflammatory inducing medications
44
if the hypersensitivity reaction of acute interstitial nephritis continues what is it called
renal papillary necrosis
45
less common cause of acute interstitial nephritis
pyelonephritis
46
pathology of pyelonephritis causing acute interstitial nephritis
chemokines and cytokines secreted by offending pathogens leads to inflammatory cell infiltration and direct damage to the interstitium
47
glomerular cause of intra-renal AKI
glomerulonephritis (inflammation of the glomerulus)
48
possible negative consequence of glomerulonephritis
membranous nephropathy -widespread thickening of the glomerular basement membrane
49
findings of glomerulonephritis (5)
- decreased GFR - oliguria - oedema - hypertension - azotemia
50
what is often the cause of glomerulonephritis
antigen-antibody complex in the glomerulus
51
what causes post-renal AKI
obstruction of the flow of urine
52
causes of post-renal obstruction
- BPH - intra-abdominal tumour - renal calculi - kidney stone - inflammation: stricture - post-urethral valves - infection: TB, schistosomiasis
53
what does the obstruction cause
back flow of urine causing increased pressure in the tubules reducing the pressure gradient reducing GFR .
54
what can high pressure in the tubules due to absorption
encourages reabsorption of Na, water and urea
55
what is the long term effect of high pressure in tubules from obstruction
causes the tubular epithelial cells to die impairing reabsorption and secretion
56
lab results of post renal AKI
azotemia oliguria increase BUN;cr ratio
57
what does the obstruction need to be to cause AKI
bilateral

Block 34 metabolic -Ellen (8 decks)

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