AKI

Question 1

AKI due to scleroderma (scleroderma renal crisis) should be treated with

Answer 1

ACE inhibitors.

Question 2

for hepatorenal syndrome:
Bridge therapies that have shown promise include terlipressin (a vasopressin analog), combination therapy with octreotide (a somatostatin analog) and midodrine (an a1-adrenergic agonist), and norepinephrine, in combination with what intravenous fluid?

Answer 2

albumin (25–50 g, maximum 100 g/d)

Question 3

Idiopathic TTP-HUS is a medical emergency and should be treated promptly with

Answer 3

plasma exchange

Question 4

Early and aggressive volume repletion is mandatory in patients with rhabdomyolysis, who may initially require

Answer 4

10 L of fluid per day

Question 5

Alkaline fluids may be beneficial in preventing tubular injury and cast formation, but carry the risk of worsening _______.

Answer 5

• 75 mmol/L sodium bicarbonate added to 0.45% saline

* hypocalcemia

Question 6

According to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines, patients with AKI should achieve a total energy intake of

Answer 6

20–30 kcal/kg per day

Question 7

Protein intake should vary depending on the severity of AKI: 0.8–1.0 g/kg per day in noncatabolic AKI without the need for dialysis; 1.0–1.5 g/kg per day in patients on dialysis; and up to a maximum of ______ if hypercatabolic and receiving continuous renal replacement therapy.

Answer 7

1.7 g/kg per day

Question 8

a technology similar to hemodialysis except at lower blood flow and dialysate flow rates.

Answer 8

CRRT Continuous renal replacement therapy can also be performed by diffusive clearance (continuous venovenous hemodialysis [CVVHD]

Question 9

in which large volumes of plasma water (and accompanying solutes) are forced across the semipermeable membrane by means of hydrostatic pressure;

Answer 9

Continuous renal replacement therapy (CRRT) can be performed by convective clearance (continuous venovenous hemofiltration [CVVH]

Question 10

A hybrid therapy combines both diffusive and convective clearance

Answer 10

continuous venovenous hemodiafiltration [CVVHDF]

Question 11

To achieve some of the advantages of CRRT without the need for 24-h staffing of the procedure, some physicians favor _____ or extended daily dialysis (EDD).
In this therapy, blood flow and dialysate flow are higher than in CVVHD, but the treatment time is reduced to ≤12 h.

Answer 11

slow low-efficiency dialysis (SLED)

Question 12

If available, is often preferred in patients with severe hemodynamic instability, cerebral edema, or significant volume overload.

Answer 12

CRRT

Continuous renal replacement therapy

Question 13

Common causes of community-acquired AKI include

Answer 13

volume depletion
heart failure
adverse effects of medications
obstruction of the urinary tract
malignancy

Question 14

The most common clinical settings for hospital-acquire AKI are

Answer 14

sepsis
major surgical procedures
critical illness involving Heart or liver failure
nephrotoxic medication administration

Question 15

is the most common form of AKI. It is the designation for a rise in SCr or BUN concentration due to inadequate renal plasma flow and intraglomerular hydrostatic pressure to support normal glomerular filtration

Answer 15

Prerenal azotemia

Question 16

Prolonged periods of prerenal azotemia May lead to ischemic injury, often termed

Answer 16

acute tubular necrosis (ATN)

Question 17

Glomerular filtration can be maintained despite reduced renal bloodflow by _____, which-maintains glomerular capillary hydrostatic pressure closer to normal and thereby prevents marked reductions in GFR if renal blood flow reduction is not excessive

Answer 17

angiotensin II–mediated renal efferent vasoconstriction

Question 18

Intrarenal biosynthesis of vasodilators such as____

increase in response to low renal Perfusion pressure

Answer 18

prostaglandins(prostacyclin, prostaglandin E2), kallikrein and kinins,and possibly nitric oxide (NO)

Question 19

Even in healthy adults, renal autoregulation usually fails once the systolic blood pressure falls below

Answer 19

80 mmHg

Question 20

can also occur following percutaneous catheterization of the aorta, or spontaneously, is due to cholesterol crystal embolizationresulting in partial or total occlusion of multiple small arteries withinthe kidney.

Answer 20

AKI from atheroembolic disease

Question 21

Individuals undergoing massive fluid resuscitation for trauma, burns, and acute pancreatitis can also develop _______, where markedly elevated intraabdominal pressures, usually >20 mmHg, lead to renal vein compression and reduced GFR

Answer 21

the abdominal compartment syndrome

Question 22

The most common clinical course of contrast nephropathy is characterized by a rise in SCr beginning ___ following exposure, peaking within 3–5 days, and resolving within 1 week

Answer 22

24–48 h

1-2days (nor exceeding 2 days and after 1 day post exposure)

Question 23

transient tubule obstruction with precipitated contrast material agents implicated as a cause of AKI are

Answer 23

1. high-dose gadolinium used for magnetic resonance imaging (MRI) and
2. oral sodium Phosphate solutions used as bowel purgatives.
3. Iodinated contrast agents use din CV CT SCANS

Question 24

Antibiotics that cause AKI

Answer 24

Vancomycin
Aminoglycosides and amphotericin B
Acyclovir

Question 25

Clinical features of amphotericin B nephrotoxicity include

Answer 25

polyuria, hypomagnesemia hypocalcemia, non-gap metabolic acidosis.

Question 26

Antibiotic that can precipitate in tubules and cause AKI by tubular “obstructions” particularly when given as an intravenous bolus at high doses (500 mg/m2) or in the setting of hypovolemia.

Answer 26

Acyclovir

Question 27

are also frequently associated withAKI due to tubular toxicity

Answer 27

``` Acyclovir Foscarnet pentamidine tenofovir cidofovir ```

Question 28

may Cause hemorrhagic cystitis and tubular toxicity, manifested as type II renal tubular acidosis (Fanconi’s syndrome), polyuria, hypokalemia,and a modest decline in GFR.

Answer 28

Ifosfamide

Question 29

Chemotherapeutic agents casing AKI

Answer 29

Ifosfamide Cisplatin and carboplatin bevacizumab

Question 30

Toxic Ingestions causing AKI

Answer 30

Ethylene glycol HEAA Diethylene glycol Aristolochic acid

Question 31

the most common protein in urine and produced in the thick ascending limb of the loop of Henle

Answer 31

uromodulin

Question 32

may follow initiation of cytotoxic therapy in patients with high-grade lymphomas and acute lymphoblastic leukemia; massive release of uric acid (with serum levels often exceeding15 mg/dL) leads to precipitation of uric acid in the renal tubules and AKI (Other features include hyperkalemia and hyperphosphatemia

Answer 32

Tumor lysis syndrome

Question 33

contamination of foodstuffs has led to nephrolithiasis and AKI, eitherthrough intratubular obstruction or possibly direct tubular toxicit

Answer 33

Melamine

Question 34

distinctions-of ckd to AKI ,clues suggestive of CKD can come from

Answer 34

radiologic studies (small,shrunken kidneys with cortical thinning on renal ultrasound, or evidence of renal osteodystrophy) or laboratory tests such as normocytic anemia in the absence of blood loss or secondary hyperparathyroidism with hyperphosphatemia and hypocalcemia

Question 35

Prerenal azotemia should be suspected in the setting of

Answer 35

vomiting, diarrhea, glycosuria causing polyuria, and several medications including diuretics, NSAIDs, ACE inhibitors, and ARBs. Physical signs of orthostatic hypotension, tachycardia, reduced jugular venous pressure, decreased skin turgor, and dry mucous membranes

Question 36

Recent manipulation of the aorta or other large vessels; may occur spontaneously or after anticoagulation;retinal plaques, palpable purpura,livedo reticularis, GI bleed Labs: Hypocomplementemia, eosinophiluria(variable), variable amounts ofproteinuria

Answer 36

Atheroembolic disease

Question 37

Complete anuria early in the course of AKI is uncommon except in thefollowing situations:

Answer 37

``` complete urinary tract obstruction, renal artery Occlusion, overwhelming septic shock, severe ischemia (often with cortical necrosis), or severe proliferative glomerulonephritis or vasculitis ```

Question 38

In CKD, kidneys are usually smaller unless the patient has

Answer 38

diabetic nephropathy, HIV-associated nephropathy, or infiltrative diseases.

Question 39

In cases-of oliguric AKI, the urinary flow rate in response to bolus intravenous furosemide 1.0–1.5 mg/kg can be used a prognostic test: urine outputof less than ____ after intravenous furosemide may identify patients at higher risk of progression to more severe AKI, and the need for renal replacement therapy.

Answer 39

200 mL over 2 h

Question 40

The definitive treatment of the hepatorenal syndrome is

Answer 40

orthotopic liver transplantation

Question 41

AKI due to scleroderma(scleroderma renal crisis) should be treated with

Answer 41

ACE inhibitors

Question 42

Early and aggressive volume repletion is mandatory in patients withrhabdomyolysis, who may initially require

Answer 42

10 L of fluid per day Alkaline diuretics Alkaline fluids (e.g., 75 mmol/L sodium bicarbonate added to 0.45% saline Diuretics may be used if fluid repletion is adequate but unsuccessful in achieving urinary flow rates of 200–300 mL/h.

Question 43

Management of Tumor lysis syndrome:

Answer 43

aggressive intravenous fluids and allopurinol or rasburicase

Question 44

Management for Volume overload

Answer 44

Salt and water restriction Diuretics Ultrafiltration

Question 45

In severe cases of volume overload, furosemide may be given as a bolus

Answer 45

(200 mg) followed by an intravenous drip (10–40 mg/h), with or without a thiazide diuretic

Question 46

Hyperphosphatemia is commonin AKI and can usually be treated by limiting intestinal absorption of phosphate using phosphate binders:

Answer 46

``` calcium carbonate calcium acetate lanthanum sevelamer or aluminum hydroxide ```

Question 47

According to the Kidney Disease Improving Global Outcomes(KDIGO) guidelines, patients with AKI should achieve a total energy intake of

Answer 47

20–30 kcal/kg per day

Question 48

According to the Kidney Disease Improving Global Outcomes(KDIGO) guidelines, patients with AKI should achieve a total protein intake of

Answer 48

1.7 g/kg per day if hypercatabolic and Receiving continuous renal replacement therapy