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Harrison's Nephro > AKI > Flashcards

AKI Flashcards

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1
Q

Vasodilator prostaglandins

A

Prostacyclin, Prostaglandin E2, kallikrein, kinins and NO

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2
Q

Tubuloglomerular feedback

A

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

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3
Q

NSAIDs mechanism in AKI

A

Limit renal afferent vasodilation

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4
Q

ACEi/ARBS mechanism AKI

A

Limit renal efferent vasoconstriction

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5
Q

Small vessels

A 
Glomerulonephritis
Vasculitis
TTP/HUS
DIC
Atheroemboli
Malignant HTN
Calcineurin inhibitors
Sepsis
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6
Q

Tubules

A

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

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7
Q

Intratubular

A

Endogenous (Myeloma proteins,uric acid, cellular debris)

Exogenous( Acyclovir, Methotrexate)

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8
Q

Large Vessel

A

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

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9
Q

Interstitium

A

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

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10
Q

Risk factors for Nephrotoxin Associated AKI

A

Older age
Chronic Kidney Disease
Prerenal Azotemia

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11
Q

Clinical Course of Contrast Induced AKI

A

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

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12
Q

Amphotericin B

A

Dose and Duration dependent

Clinical Features: Polyuria, Hypogmagnesia, Hypocalcemia, Nongap Metabolic acidosis

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13
Q

Acyclovir

A

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

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14
Q

Manifestations of Ifosfamide AKI

A

Hemorrhagic cystitis, tubular toxicity

Type II RTA, Polyuria, Hypokalemia, modest decline in GFR

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15
Q

Components of TUMOR LYSIS Syndrome

A

Hyperuricemia
Hyperkalemia
HYperphosphatemia
Hypocalcemia

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16
Q

Definition of AKI

A

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

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17
Q

Proteinuria in AKI

A 
Mild Proteinuria (<1g/day) from AKI from Ischemia or Nephrotoxins
Heavy proteinuria (nephrotic range >3.5 g/day) glomerulonephritis, vasculitis, interstitial nephritis
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18
Q

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

A

Pigmented “muddy brown” casts and tubular epithelial cell casts

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19
Q

Urine casts in Glomerulonephritis

A

Dysmorphic red blood cells or RBC casts

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20
Q

Casts in Interstitial Nephritis

A

WBC cass

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21
Q

RBCs/RBC casts

A

Vasculitis
Malignant Hypertension
Thrombotic microangiopathy

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22
Q

WBC casts

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A 
Interstitial Nephritis
GN 
Pyelonephritis
Allograft rrejection
Malignant infiltration of the kidney
23
Q

Renal Tubular Epithelial Casts

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A 
ATN
Tubulointerstitial nephritis
Acute cellular allograft rejection
Myoglobinuria
Hemoglobinuia
24
Q

Granular casts

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A

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

Harrison's Nephro (4 decks)

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