AKI Flashcards Preview

Nephro > AKI > Flashcards

Flashcards in AKI Deck (53):
1

Vasodilator prostaglandins

Prostacyclin, Prostaglandin E2, kallikrein, kinins and NO

2

Tubuloglomerular feedback

Decreases in solute delivery to the macula densa elicit dilatation of the of the juxtaposed afferent arteriole to maintain glomerular perfusion

3

NSAIDs mechanism in AKI

Limit renal afferent vasodilation

4

ACEi/ARBS mechanism AKI

Limit renal efferent vasoconstriction

5

Small vessels

Glomerulonephritis
Vasculitis
TTP/HUS
DIC
Atheroemboli
Malignant HTN
Calcineurin inhibitors
Sepsis

6

Tubules

Toxic ATN (Endogenous-Rhabdomyolysis, Hemolysis
Exogenous (contrast, cisplatin gentamicin)
Ischemic ATN
Sepsis

7

Intratubular

Endogenous (Myeloma proteins,uric acid, cellular debris)
Exogenous( Acyclovir, Methotrexate)

8

Large Vessel

Renal Artery embolus, dissection, vasculitis
Renal vein thrombosis
Abdominal compartment syndrome

9

Interstitium

Allergic (PCN, Rifampin)
Infection ( Severe, pyelonephritis, Legionella, sepsis)
Infiltration (lymphoma, leukemia)
Inflammatory ( Sjogrens, Tubulointerstitial nephritis, uveitis, sepsis)

10

Risk factors for Nephrotoxin Associated AKI

Older age
Chronic Kidney Disease
Prerenal Azotemia

11

Clinical Course of Contrast Induced AKI

Rise in SCr beginning 24-48 h following exposure
Peaking within 3-5 days
Resolving within 1 week

12

Amphotericin B

Dose and Duration dependent
Clinical Features: Polyuria, Hypogmagnesia, Hypocalcemia, Nongap Metabolic acidosis

13

Acyclovir

Cause AKI by tubular obstruction especially in high doses (500 mg/m2) or in setting of hypovolemia

14

Manifestations of Ifosfamide AKI

Hemorrhagic cystitis, tubular toxicity
Type II RTA, Polyuria, Hypokalemia, modest decline in GFR

15

Components of TUMOR LYSIS Syndrome

Hyperuricemia
Hyperkalemia
HYperphosphatemia
Hypocalcemia

16

Definition of AKI

Rise in SCr at least 0.3 mg/dL withinn 48 hours or at least 50% higher than baseline within 1 week or a reduction in urine output to less than 0.5 ml/kg for longer than 6 hours

17

Proteinuria in AKI

Mild Proteinuria (<1g/day) from AKI from Ischemia or Nephrotoxins
Heavy proteinuria (nephrotic range >3.5 g/day) glomerulonephritis, vasculitis, interstitial nephritis

18

Urine casts of AKI fr ATN due to ischemic injury/Sepsis

Pigmented “muddy brown” casts and tubular epithelial cell casts

19

Urine casts in Glomerulonephritis

Dysmorphic red blood cells or RBC casts

20

Casts in Interstitial Nephritis

WBC cass

21

RBCs/RBC casts

Vasculitis
Malignant Hypertension
Thrombotic microangiopathy

22

WBC casts

Interstitial Nephritis
GN
Pyelonephritis
Allograft rrejection
Malignant infiltration of the kidney

23

Renal Tubular Epithelial Casts

ATN
Tubulointerstitial nephritis
Acute cellular allograft rejection
Myoglobinuria
Hemoglobinuia

24

Granular casts

ATN , GN
Vasculitis
Tubulointerstitial Nephritis

25

Eosinophiluria

Allergic Interstitial nephritis
Atheroembolic disease
Pyelonephritis
Cystitis
Glomerulonephritis

26

Crystalluria

Acute uric nephropathy
Calcium oxalate (ethylene glycol intoxication)
Drugs or toxins(acyclovir, indinavir, sulfadiazine, amoxicillin)

27

Causes of inc BUN

UGIB
Hyperalimentation
Increased tissue catabolism
Glucocorticoid use

28

Fractional excretion of Sodium

Fraction of filtered sodium load that is reabsorbed by the tubules
Depends on the sodium intake, effective intravascular volume, GFR, diuretic intake, intact tubular reabsorptive mechanisms

29

Obstruction can be present without radiologic abnormalities in the following conditions

1. Volume depletion
2. Retroperitoneal fibrosis
3. Encasement with tumor
4. In early course of the obstruction

30

Novel biomarkers of AKI

Kidney Injury Molecule 1
Neutrophil Gelatinase asociated lipocalin
Interleukin 18
L type fatty-acid binding protein

31

Definitive treatment of Hepatorenal Syndromme

Orthotropic Liver transplantation

32

Major complications of AKI

1. Arrythmias
2. Pericarditis
3. Pericardial effusion

33

Example of potassum binding resins

Calcium resonium
Sodium polystyrene

34

Classic lesion of secondary hyperparathyroidism

Osteitis fibrosa cystica

High bone turnover with increased PTH levels

35

Low bone turnover with low or normal PTH levels

Adynamic bone disease & osteomalacia

36

FGF 23 defends normal serum phosphorus

1. Inc renal phosphate excretion
2. Stimulation of PTH
3. Suppression of formation of 1,25 (OH) 2D3

37

Clinical manifestation of hyperparathyroidism

Bone pain and fragility
Brown tumors
Compression syndromes
Erythropoietin resistance

38

Complications of adynamic bone disease

Increased incidence of fracture
Bone pain
Inc vascular and cardiac calcification
Tumoral calcinosis

39

This complication starts as livedo reticularis and advances to patches of ischemic necrosis on the legs, thighs, abdomenn and breasts

Calciphylaxis(Calcific Uremic arteriopathy)

40

Non calcium containing phosphate binders

Sevelamer
Lanthanum

41

Calcium containing phosphate binders

Calcium acetate
Calcium carbonate

42

Target PTH level

150–300 pg/mL

43

Traditional risk factors for ischemic vascular disease

Hypertensionn
Hypervolemia
Dyslipidemia
Sympathetic overactivity
Hyperhomocysteinemia

44

CKD related risk factors for Ischemic Vascular Disease

Anemia
Hyperphosphatemia
Hyperparathyroidism
Inc FGF 23
Sleep apnea
Generalized Infammation

45

Target BP of CKD patients with DM or proteinuria >1 g/24 hrs

BP:130/80

46

Classic ECG finding in Pericarditis

PR-interval depression
Diffuse ST segment elevation

47

Causes of Anemia in CKD

Relative deficiency of EPO
Diminished RBC survival
Bleeding diathesis
Iron deficiency
Hyperparathyroidism/Bone marrow fibrosis
Chronic inflammation
Folate or Vit B12 deficiency
Hemogobinopathy
Comorbid conditions: Hypo/Hyperthyroidism, pregnancy, HIV associated , autoimmune disease, immunosuppresive drugs

48

Target hemoglobin concentration

Hgb: 110-115 mg/dL

49

Abnormal bleeding time and coagulopathy may be reversed with

1. Desmopressin (DDAV
2. Cryoprecipitate
3. IV conjugated estrogens
4. Blood transfusions
5. ESA therapy

50

Skin condition unique to CKD which consists of progressive subcutaneous induration especially on the arms and legs

Nephrogenic Fibrosing Dermopathy

51

CKD would usually have bilaterally small kidneys except in these diseases

1. DM Nephropathy
2. Amyloidosis
3. HIV nephropathy

52

Contraindications to Kidney Biopsy

1. Bilaterally small kidneys
2. Uncontrolled hypertension
3. Active UTI
4. Bleeding diathesis
5. Severe obesity

53

Indications fo RRT

Uremic pericarditis
Encephalopathy
Intractable muscle cramping, anorexia and nausea
Intractable Hyperkalemia/ECFV overload