AKI, CKD, and Dialysis

Question 1

What is another name for acute kidney injury

Answer 1

Acute renal failure but AKI preferred

Question 2

What does AKI increase your risk of

Answer 2

mortality 5x
progression to CKD

Question 3

how do you define AKI

Answer 3

acute reduction in function (GFR, UOP) and accumulation of nitrogenous wastes (BUN/creatinine)

Question 4

what are the three different formal definitions of AKI

Answer 4

acute dialysis quality improvement initiative (ADQI) RIFLE scheme
Acute Kidney injury Network definition (AKIN)
Acute kidney injury working group of KDIGO

Question 5

what does ADQI stand for

Answer 5

acute dialysis quality improvement

Question 6

what does AKIN stand for

Answer 6

acute kidney injury netrowk

Question 7

what does KDIGO stand for

Answer 7

kidney disease: improving global outcomes

Question 8

What is RIFLE criteria

Answer 8

Risk
injury
failure
loss
ESRD
changes must be within 7 days

Question 9

what is AKIN criteria

Answer 9

exclude easily reversible causes first
make sure adequately resuscitated
changes in 48 hours

Question 10

What are the diagnostic criteria for AKI with KDIGO

Answer 10

increase in SCr by 0.3+ mg/dL within 48 hours
increases in SCr 1.5+ times baseline, known or presumed in last 7 days
urine volume less than 0.5 mL/kg/h for 6 hours

Question 11

what are the three types of AKI

Answer 11

pre-renal
intra-renal
post-renal

Question 12

what is pre-renal AKI

Answer 12

most common
hypoperfusion: low volume, bad pump, vasodilation, intra-renal vasoconstruction

Question 13

what is intra-renal AKI

Answer 13

85% due to ATN: ischemic, nephrotoxic
glomerulonephritis

Question 14

what is post-renal AKI

Answer 14

obstruction

Question 15

What is ATN

Answer 15

Acute Tubular Necrosis
aka acute renal tubular necrosis

Question 16

what is the number one cause of intra-renal aki

Answer 16

acute tubular necrosis

Question 17

what can cause acute tubular necorsis

Answer 17

ischemic
infection
nephrotoxins

Question 18

what is the presentation of AKI

Answer 18

many asymptomatic
may have encephalopathy
may have bleeding/anemia
may have normal or abnormal urine output (UOP)

Question 19

what antibiotics are nephtrotoxic

Answer 19

AG abx (aminoglycosides)
amp B
sulfa, acyclovir
tenofovir, vanco
etc.

Question 20

what is oliguria

Answer 20

< 400mL/day

Question 21

what is anuria

Answer 21

< 100 mL/day

Question 22

What labs are ordered with concerns for AKI

Answer 22

CBC
CMP
Urinalysis: sodium osmolality, specific gravity, microscopic exam, FENa

Question 23

if urine sodium is <20 what is the likely cause of AKI

Answer 23

pre-renal

Question 24

what is the urine sodium level for AKI with intra-renal cause

Answer 24

> 40

Question 25

What is FENa

Answer 25

Fractional excretion of sodium helps to differentiate between pre-renal and intrarenal (ATN) *need urine and blood

Question 26

what is a FENa of < 1%

Answer 26

pre-renal cause

Question 27

what is a FENa of >2%

Answer 27

intra-renal cause

Question 28

what is the UOP with pre-renal AKI

Answer 28

decreased because less volume

Question 29

what is the first line imagine for AKI

Answer 29

renal ultrasound looks for obstruction

Question 30

when is renal biopsy indicated

Answer 30

if pre- and post-renal causes and ATN is excluded

Question 31

what is the treatment of AKI

Answer 31

supportive: avoid additional injury, maintain perfusion/volume, +/- renal replacement therapy (RRT) Prevention (KDIGO reccomendations)

Question 32

What is CKD

Answer 32

chronic kidney disease

Question 33

what are risk factors for CKD

Answer 33

hypertension DM small birth weight childhood obesity hx immune d/o increasing age black race +fhx structural/anatomic abnormalities

Question 34

what manifests as gradual decline in kidney function weeks to years

Answer 34

CKD

Question 35

how do we measure the decrease in kidney function

Answer 35

GFR

Question 36

What is the presentation of CKD

Answer 36

early on, asymptomatic (stage 1 and 2) Stage 3-4 +/- vague symptoms: HTN, anemia, fatigue, decreased appetite, malnutrition, electrolyte abnormalities Stage 5 (ESRD) worsening nutrition, electrolyte and mineral disturbances

Question 37

what is uremic syndrome

Answer 37

symptoms due to accumulations of nitrogenous waste

Question 38

what are symptoms of uremic syndromes

Answer 38

fatigue anorexia nausea metallic taste irritability, insomnia memory impairment restless leg, paresthesias, muscle twitching puruitis decreased libido, menstrual changes asterixis, myoclonus

Question 39

What is the hallmark lab for CKD

Answer 39

persistent reduced GFR > 3 months

Question 40

what is the study of choice for CKD

Answer 40

renal US

Question 41

how do we manage CKD

Answer 41

goal is to limit progression good control of DM good BP control good control of cholesterol achieve and maintain healthy DMI optimize CVD risk factors maintain healthy diet dose adjust meds as needed avoid nephrotoxins

Question 42

What is the mainstay of treatment for ESRD

Answer 42

renal replacement therapy (RRT) hemofiltration, hemodialysis, peritoneal dialysis

Question 43

what is the definitive treatment of CKD

Answer 43

renal transplant

Question 44

what are complications of CKD

Answer 44

#1 cause of mortality in CKD is CVD #1 complication of VCD is HTN metabolic bone disease anemia coagulopathy hyperglycemia

Question 45

What is RRT

Answer 45

techniques that 'replace' the filtration of the dysfucntional kidneys

Question 46

What does RRT include

Answer 46

hemofiltration hemodialysis: continuous, intermittent peritoneal hemodialysis

Question 47

What is the most common RRT modality

Answer 47

intermittent hemodialysis

Question 48

when is continuous hemodialysis used

Answer 48

AKI and unstable patients

Question 49

Who gets RRT

Answer 49

fluid overload unresponsive to diuretics hyperkalemia, hypercalcemia and metabolic acidosis unresponsive to treatment uremia GFR <10 if no DM; GRF < 15 in DM certain toxins

Question 50

What are the two processes of RRT

Answer 50

Diffusion and oconvection

Question 51

what is diffusion RRT

Answer 51

movement of particles down a concentration gradient

Question 52

what is convection RRT

Answer 52

movement of particles AND WATER down a pressure gradient (hydrostatic pressure)

Question 53

what does dialysis remove (solutes)

Answer 53

Na+, Cl-, K+, HCO3-, Ca2+, Mg2+, urea, creatinine, uric acid