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Clin Med GU > AKI, CKD, Dialysis > Flashcards

AKI, CKD, Dialysis Flashcards

1
Q

what is AKI

A

An acute reduction in function (GFR) and accumulation of nitrogenous waste (BUN, creatinine)

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2
Q

What is the progression of kidney injury

A

Risk- injury - failure - loss - ESRD

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3
Q

What is stage 1 AKI

A

increase in SCr by .3+ in 48 hours
increase SCR 1.5-1.9x baseline
urine volume less than .5 for 6-12 hours

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4
Q

Etiology of pre-renal AKI

A

Intrarenal vasoconstriction
volume depletion
Systemic vasodilation

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5
Q

What is stage 2 AKI

A

increase SCr 2 - 2.9x baseline
urine volume less than .5mL/Kg/h for 12+HRS

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6
Q

What is stage 3 AKI

A

increase SCr 3x baseline
SCr 4.0+
Initiation of RRT
GFR decreases to <35 (<18y/o)
Anuria for 12+ hours

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7
Q

What are the 3 distinct types of AKI

A

Pre-renal (m/c) - hypoperfusion
intra-renal (due to ATN)
post-renal (obstruction)

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8
Q

What is the etiology of renal AKI

A

Glomerulonephritis
interstitial nephritis
tubular nephritis
vascular

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9
Q

What is the number 1 cause of intra-renal AKI

Which patients are at higher risk

A

acute tubular necrosis (ATN)

hospitalized patients

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10
Q

Which AKI improves with fluids

Which does not respond to fluid

Which has a hx of stones, BPH, and cancer

A

pre-renal

renal and post renal

post-renal

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11
Q
A
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12
Q

What will be seen on microscopic exam with AKI

A

Casts
*few hyaline casts are normal

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13
Q

What does renal tubular epithelial casts indicate

RBC casts?

muddy brown casts?

WBC casts?

A

ATN/AIN

glomerulonephritis, AIN

ATN

AIN

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14
Q

What is the treatment for AKI

A

Supportive

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15
Q

What does FeNa help distinguish between

What is normal

A

It helps differentiate between pre-renal and intra-renal AKI

between 1-2%

less than 1% = pre-renal and >2% is renal AKI

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16
Q

What are the risk factors for CKD

A

Hypertension
DM
*others but these are the biggest contributers

17
Q

What is CKD

How many stages

A

A gradual decline in Kidney function (weeks-years)

5

18
Q

How is Kidney decline measured

A

GFR

19
Q

How does stage 1 & 2 CKD present

stage 3 & 4?

A

generally asymptomatic

vague symptoms if they are present

20
Q

How does stage 5 CKD present?

A

worsening nutrition
electrolyte / mineral disturbances

21
Q

What is a hallmark lab finding for CKD

A

persisten reduced GFR (>3months)

22
Q

What electrolyte imbalance occurs with fluid retention in CKD

Fluid loss?

A

Hypernatremia

Hyponatremia

23
Q

What will cause an elevated PTH in CKD

What does reduced ammonia production cause

A

Hypocalcemia and low vitamin D

metabolic acidosis

24
Q

what is the imaging study of choice with CKD

A

Renal US

25
Q

What is the average wait time for a kidney

A

3-5 years

26
Q

What diet modifications need to be made with CKD management

What foods are high is phosphorus

A

salt restriction
potassium / phosphorus restriction
focus on a plant based diet

meat, cheese, seeds, milk, cola, canned fish, fast food

27
Q

What is the mainstay treatment for ESRD

What is the definitive treatment for CKD

A

renal replacement therapy

renal transplant

28
Q

What is the #1 cause of mortality with CKD

A

coronary vascular disease

29
Q

What is the #1 complication of CKD

What are some other complications

A

hypertension

Anemia, coagulopathy, hypoglycemia, metabolic bone disease

30
Q

What is renal replacement therapy

What are the different procedures

What is most common

A

technique that replaces the filtration of the dysfunctional kidneys

Dialysis, hemofiltration, peritoneal dialysis

intermittent HD

31
Q

Which patients will receive RRT

A

Fluid overload (unresponsive to diuretics)
hyperkalemia
hypercalcemia
uremia
metabolic acidosis
GFR <10
GFR<15 w/ DM
Certain toxins
**all unresponsive to other treatment

32
Q

What are the 2 processes that drive RRT

A
  • Diffusion: movement of partivles down a concentration gradient
  • Convection: movement of particles & water down a pressure gradient
33
Q

What is hemofiltration

A

Convection RRT
- takes off larger molecules (myoglobin/cytokines)
- removes water & solutes (replace fluid)

34
Q

What type of RRT is Dialysis

A

Diffusion RRT
- removes the smaller molecules (filtration solutes)

35
Q

What are the most common causes of nephrotexic acute tubular necrosis

A

Hemoglobin/myoglobin (red/brown casts in Collecting Tubule)
Vancomycin (inflammatory response

36
Q
A

Clin Med GU (11 decks)

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