AKI

Question 0

AKI can be __ or ___

which is worse?

Answer 0

oliguric
non-oliguric
*oliguric is worse

Question 1

acute kidney injury definition

Answer 1

GFR decreases by >/ 25% within hours to days

Question 2

three categories acute kidney injury

Answer 2

hemodynamic or pre-renal-imbalance of blood supply an ddemand
intrinsic or renal-okay blood supply with direct injury
obstructive or post-renal

Question 3

what phase persists as long as insult is present?

Answer 3

apoptosis and sloughing phase

Question 4

what do sympethetics do in renal injury

Answer 4

vasocon–>decrease renal BF–>increase NA reabs

Question 5

pre-renal azotemia

Answer 5

littel, concentrated low Na urine; pre-renal

Question 6

muddy brown casts

Answer 6

acute tubular necrosis

Question 7

what is the main shift between AKI and ATN

Answer 7

urine osmolarity becomes isothenuric to the plasma

Question 8

clinical causes of hemodynamic acute kidney injury

Answer 8

decrease in ECFV

• -hypobvolemia (hemorrhage, diarrhea)
• -hypervolemia (edematous state)
• -euvolemia (sepsis, SIRS, cap leak)

Question 9

three types of intrinsic (renal) AKI

Answer 9

glomerular
tubulo-interstital
vascular

Question 10

three ways tubular injury causes a decrease in GF

Answer 10

sloughing off cells decreases GFR
back-leak- holes in tubule let filtered blood go back
macula densa senses increased Na and Cl flow–>increases afferent tone–> decreases GFR

Question 11

when does allergic interstital nephritis start

Answer 11

7ish days after causative agent

Question 12

what will you see with AIN

Answer 12

WBC in urine

Question 13

hallmark of rhabdo

Answer 13

pink urine + for heme but no blood on microscopy

Question 14

treat of rhabdo

Answer 14

hydration and alkalinization of urine

Question 15

Ig light chain

Answer 15

usually a marker of MM and non-oliguric

Question 16

why do you get hyperuricemia

Answer 16

tumor lysis or inherent errors of purine metabolism

Question 17

how does uric acid fuck up the kidney

Answer 17

crystallyzes in tubules and reabsorbed by PCT into tubulointerstium–>produces inflammatory rxn with giant cell

Question 18

treatment of uric acid issues

Answer 18

volume expansion/alkalosis

xanthien oxidatse inhibitors (allopuritinol)

Question 19

labs for uric acid issue

Answer 19

oliguric or non-oliguric
urine sediment bland or with crystals
serum UA >10
increase circulating phoshphatase and LDH

Question 20

exogenous toxins that mess up kidneys

Answer 20

NSAIDs
iodinated contrast-moa
calcineurin inhib (cyclosporine, tacrolimus)–vasocon
aminoglycoside antibiotics-moa –>tubulue specific (RTA)
amphotericin B–>distal RTA, nephrogenic DI
Cisplatinum:distal tubular tox

Question 21

crystals taht mess up kidneys

Answer 21

acyclovir
idinavir
methotrexate
sodium phosphate 
quinolone

Question 22

what else do aminoglycoside antibiotics cause

Answer 22

ototoxicity

Question 23

renal vein occlusion

Answer 23

non-oliguric
loin pain
occurs in hypercoag states (cancer, nephrotic syndrome, sepsis)

Question 24

thrombotic microangiopathies

Answer 24

occlusion of vessels with proliferating endothelial and platelet/fibrin thrombi

Question 25

what do you see with thrombotic microangiopathies

Answer 25

oliguric aki | no cells or casts

Question 26

post-renal AKI

Answer 26

obstruvtive

Question 27

how does obstructive aki present

Answer 27

``` NOT oliguric back pressure is lower than GFR but highte than medullary capillary pressure nonanion gap acidosis (type IV) dilute urine hyperkalemia! ```

Question 28

obstruction quick word

Answer 28

type IV RTA

Question 29

polyuria with medication

Answer 29

induced nephrogenic diabetes insipidus

Question 30

proximal RTA

Answer 30

myeloma aminoglycosides platinum

Question 31

suggestive of bence jones protein

Answer 31

elevated urine protein with negative dipstick

Question 32

indications for dialysis

Answer 32

volume overload hyperkalemia acidosis uremia

Question 33

multiple organ failure patients

Answer 33

cant do dialysis so solution is continuous venous-venous filtration which replaces plasma with electrolyte soln

Question 34

definition of oliguria

Answer 34

<30 ml/hr