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Clin Med: GU (block 3) > AKI & CKd > Flashcards

AKI & CKd Flashcards

1
Q

Renal functions

A
  • Waste Removal**
  • Water Management
  • Electrolyte Balance
  • pH Regulation (Acid/Base)
  • Regulation of Blood Pressure
    –> RAAS system
  • Blood Production
    –> Erythropoietin
  • Bone Health
    –> Activation of Vit D
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2
Q

What is most commonly used to assess renal function?

A

Serum Cr

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3
Q

What is creatinine?

A

product of breakdown of Creatinine phosphate

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4
Q

How creatinine excreted & measured?

A
  • excreted by kidneys
  • measured in blood
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5
Q

Does serum creatinine vary based on muscle mass?

A

yes, b/c they are produced by the muscles

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6
Q

What is BUN?

A
  • blood urea nitrogen
  • Comes from PRO waste product after metabolism in the liver
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7
Q

What happens to the BUN levels in renal pts?

A

elevated

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8
Q

What other reasons can elevate BUN be?

A
  • GI bleed
  • Corticosteroid use
  • High PRO diet/parenteral nutrition
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9
Q

What is GFR?

A
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10
Q

Are we able to truly measure GFR? What is closest thing?

A
  • NO
  • Closest equivalent - 24hr Urine CrCl
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11
Q

What must the GFR formula take into account?

A
  • creatinine
  • sex
  • age
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12
Q

What can we used GFR clinically?

A

only is stable renal function

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13
Q

What is most commonly shown on a UA?

A
  • Hematuria*
    –> Blood in urine
  • Proteinuria*
    –> Proteins in urine
  • WBCs w/o other markers of infx
    –> Urine sediment
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14
Q

Different types of Urine Sediments.

A
  • RBCs & RBC Casts
  • WBCs & WBC casts
  • Eosinophiluria
  • Crystalluria
  • (+) blood but no RBCs on microscopic part
  • Bland Sediment (not active)
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15
Q

What condition(s) usually causes RBCs & RBC casts?

A

Glomerulonephritis

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16
Q

What condition(s) usually causes WBCs and WBC casts?

A
  • Pyelonephritis
  • Acute Interstitial Nephritis (also w/ eosinophils)
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17
Q

What condition(s) usually causes Eosinophilia?

A
  • Acute Interstitial Nephritis
  • Cholesterol Emboli
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18
Q

What condition(s) usually causes Cystalluria?

A
  • Uric acid crystals in Tumor Lysis Syndrome
  • Calcium oxalate - ethylene glycol intoxication
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19
Q

What condition(s) usually causes positive blood but no RBCs on microscopic part?

A

Pigmenturia - hemoglobinuria or myoglobinuria; sickle cell crisis, rhabdomyolysis

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20
Q

What condition(s) usually causes Bland Sediment (not active)?

A

Acute Tubular Necrosis
- muddy casts

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21
Q

What two miscellaneous tests are used to differentiate prerenal AKI from ATN?

A
  • BUN/Cr
  • FENa
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22
Q

What are the limitations to a FENa test?

A
  • Multiple causes of low FENa other than prerenal AKI
  • Can’t use in pts w/ salt wasting nephropathy or diuretic use
  • Small sample size of studies supporting its use
23
Q

What imaging can be used for the kidneys?

A
  • renal US
  • CT +/- contrast
  • MRI
24
Q

What is the study of choice for nephrolithiasis?

A

CT w/o contrast

25
Q

When do we used contrasted CT?

A

RCC staging

26
Q

What is a major complication of doing an MRI in a CKD patient?

A

Gadolinium based contrast can cause nephrogenic systemic fibrosis

27
Q

Describe when we do a kidney biopsy?

A
  • Last resort
  • Used when workup either unclear or (-) for etiology of kidney dz
  • Done outpt setting.
28
Q

Define AKI

A

Abrupt decr in renal function or filtering ability

29
Q

Describe KDIGO (2012)

A
  • Incr in SCr ≥ 0.3 mg/dL w/n 48 hrs OR
    Incr in SCr ≥ 1.5 times baseline (known or presumed to have occurred w/n 7 days prior)
    OR
    Urine volume < 0.5 mL/kg/h for 6hrs
30
Q

Draw the flow chart of AKI

A

DONE

31
Q

What can cause hypovolemia seen in AKI?

A
  • Hemorrhage
  • Cutaneous losses-burns & sweat
  • GI losses-vomiting & diarrhea
  • Renal losses-diuretic effect
32
Q

What can cause decr effective blood volume seen in AKI?

A
  • CHF
  • Cirrhosis
  • Nephrotic syndrome
33
Q

What can cause change in vascular resistance seen in AKI?

A
  • Bilateral renal artery stenosis (or unilateral in solitary functioning kidney)
  • NSAIDs
34
Q

In post-renal AKI, what causes an upper tract obstruction?

A
  • Nephro/ureterolithiasis
    –> Bilateral unless solitary kidney
  • Malignancy/adenopathy
  • Retroperitoneal fibrosis
35
Q

In post-renal AKI, what causes an lower tract obstruction?

A
  • BPH
  • Stricture or phimosis
  • Neurogenic bladder
36
Q

What are the 3 types of Intrinsic AKI?

A
  • Acute Tubular Necrosis (ATN)
  • Acute Interstitial Nephritis (AIN)
  • Acute Glomerulonephritis (GN)
37
Q

Ischemic things that can cause ATN?

A
  • Hypotension
    –>If prolonged
  • Hypovolemic shock
    –> If prolonged
  • Cardiopulmonary arrest
38
Q

Nephrotoxic things that can cause ATN?

A
  • Drugs (iodinated contrast, aminoglycosides, amphotericin, cisplatin, IV vanc, warfarin, several HIV txs)
  • Pigment-myoglobinuria (rhabdomyolysis), hemoglobinuria
  • Crystal-tumor lysis, ethylene glycol, methotrexate
  • Paraprotein-multiple myeloma
39
Q

List the drugs that can cause Acute Interstitial Nephritis.

A

-PCNs
- Quinolones
- -Sulfonamides
- PPIs
- NSAIDs
- Diuretics

40
Q

List the systemic dz that can cause Acute Interstitial Nephritis.

A
  • SLE
  • Sjögren’s
  • Sarcoidosis
41
Q

What is Acute Glomerulonephritis?

A

Broad category of dz that cause damage to the glomerulus

42
Q

Examples of GNs are:

A
  • Post-streptococcal GN
  • IgA nephropathy (Berger’s dz)
  • Lupus nephritis
  • Anti-neutrophilic cytoplasmic - antibody (ANCA) assoc. GN
  • Anti-GBM GN (Goodpasture’s dz)
43
Q

S/S of Acute GN

A
  • HTN
  • Edema
  • Hypercoagulability
  • Constitutional symptoms
  • Dz specific symptoms
44
Q

Lab Eval for Acute GN

A
  • Hematuria &/or proteinuria
    –> RBC cast & pigmented cast
  • C3 and C4
  • ANCAs
  • Anti-GBM
  • ANA
  • Anti-dsDNA
  • Hep B, Hep C, and HIV
  • SPEP, FLC, and IFE
  • +/- renal biopsy
45
Q

Define CKD

A
  • abnormal measurement of the actual or estimated GFR for 3mo or more
    OR
  • In situations where GFR is normal but renal pathology exists
46
Q

What are the most common causes of CKD in the US?

A

DM & HTN

47
Q

Write out the stages of CKD

A

Stage 1 (eGRF 90 or greater & Mild kidney damage)

Stage 2 - (eGFR 60 -90 & mild kidney damage)

Stage 3a - (eGFR 45 - 59 & mild to mod kidney damage)

Stage 3b - (eGFR 30 - 44 & mild to moderate kidney damage)

Stage 4 - (eGFR 15 - 29 & Moderate to severe kidney damage)

Stage 5 - (eGFR less than 15 & kidneys are close to failure or have completely failed. Dialysis or kidney transplant)

48
Q

Waste removal in CKD

A

elevated BUN & serum creatinine

49
Q

Water management in CKD

A

evidence of volume overload

50
Q

Electrolyte balance in CKD

A
  • hyperK+
  • hypoNa+
51
Q

pH regulation in CKD

A

metabolic alk

52
Q

Blood production in CKD

A

anemia & poss platelet dysfunction

53
Q

Bone Health in CKD

A
  • hypocalcemia
  • hyperphosphatemia
  • secondary hyperparathyroidism/ renal osteodystrophy
  • osteopenia

Clin Med: GU (block 3) (7 decks)

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