AKI + congenital/stricture disorders Flashcards

(36 cards)

1
Q

Increased BP, failure of fluid homeostasis, accumulation of waste productions → N/V, malaise, AMS, pericarditis/pericardial effusion
Symptoms due to underlying problem

Severe = arrhythmias (hyperkalemia), platelet dysfunction, neuro changes

A

AKI

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2
Q

failure of excretion, acid/base disturbance, electrolyte imbalance

A

renal/tubular problem

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3
Q

patient unable to pee, pain

A

postrenal

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4
Q

what are RF for AKI?

A

NSAID use, diuretics

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5
Q

Rapid increase in serum Cr → rapid loss of kidney function

A

AKI

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6
Q

normal Cr

A

Men .7-1.3
Women .6-1.1

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7
Q

Initiation → anuric/oliguric (kidneys working to concentrate urine) → diuretic (urine no longer concentrated, body is losing water) → recovery

A

AKI

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8
Q

MC: hypoperfusion, dehydration, shock, clot, liver, meds, heart (cardiorenal syndrome, often from sepsis), vasoconstriction, HOTN

A

prerenal AKI

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9
Q

glomerulus (nephritic, nephrotic), tubule (ATN), interstitium (AIN) from prolonged prerenal azotemia, radiocontrast dye, AGs, vancomycin

A

renal AKI

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10
Q

obstruction (prostate, neurogenic bladder, retroperitoneal fibrosis, kidney stone, tumors, urinary retention meds)

A

postrenal AKI

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11
Q

What are the three diagnostic tools you could use with AKI?

A

Cr increase of >/= .3 mg/dL in 48 hours
Cr 1.5x baseline in 7 days
UO <.5 ml/kg/6 hours

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12
Q

Elevated Cr, metabolic acidosis, hyperkalemia, hypocalcemia, hyperphosphatemia, anemia, prolonged bleeding time

A

AKI

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13
Q

low sodium, increased osmolality, increased specific gravity, FeNA <1% (if on diuretics, FeUrea <35%)
BUN:Cr = >20:1 (BUN has risen)

A

prerenal AKI

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14
Q

rule out pre/post renal – urine abnormalities with Cr increase, urine osmo lower than normal, same as plasma, increased sodium, muddy brown casts
BUN:Cr = <20:1 (Cr has risen as well, with ratio normal, but both elevated)

A

renal AKI

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15
Q

US → distended bladder, kidneys, ureter
BUN:Cr not helpful
>Cr = bilateral kidney involvement
US most beneficial for this type

A

postrenal AKI

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16
Q

stages of AKI

A

Stage I: 1.5-1.9 fold increase in Cr or decline in UO to <.5 ml/kg/hr over 6-12 hours
Stage II: 2-2.9 increase in Cr or decline to <.5 ml/kg/hour over 12 hours or longer
Stage III: 3x greater Cr or increase to >/= 4 or decline in UO <.3 for 24+ hours or anuria for 12+ hours or initiation of kidney replacement therapy

17
Q

How do you treat AKI?

A

Prerenal: Volume repletion to restore volume + renal perfusion
– return of Cr to previous baseline w/n 24-72 hours is considered correction

Renal: remove offending agent/s and IV fluids first line

Postrenal: remove obstruction

18
Q

Asymptomatic and often found incidentally
May have: UTIs, vesicoureteral reflux (retro flow of urine from bladder into upper urinary tract often in children which can cause lots of complications), ureteropelvic junction obstruction is most common, nephrolithiasis, malignancies, trauma

→ increased risk for pyelonephritis and kidney stone formation, renal carcinoma

A

horseshoe kidney

19
Q

Lower poles of kidneys fused together (connected = isthmus)

Embryological abnormality – IMA hooks over isthmus and they do not ascend properly

Higher incidence with other congenital syndromes, teratogenic drugs (thalidomide), alcohol consumption, poor glycemic control

A

horseshoe kidney

20
Q

Can be diagnosed on routine fetal US – suspect in those with hydronephrosis in infancy, abdominal mass, any complications indicating renal abnormality
* US or CT
CT and MRI best for anatomy + structures
CT urogram for stones and urinary blockages, UPJ
MRI for diminished renal function

A

horseshoe kidney

21
Q

voiding cystourethrogram and radionuclide cystogram is best to diagnose

A

Vesicoureteral reflux

22
Q

How do you treat horseshoe kidney?

A

Mostly no treatment needed

Vesicoureteral reflux = prophylactic antibiotics to prevent UTI

Treat obstruction, stones, infection as needed

23
Q

Pain in side and back/flank, abdomen, groin, painful urination, increased/decreased urinary frequency, incomplete urination, incontinence

Acute renal failure + anuria = bilateral

A

hydronephrosis

24
Q

Enlargement of renal pelvis due to build-up of urine (generally to UTO), dilation of collecting system
MCC = BPH
Cancer, stones
Unilateral = blockage occurs above the bladder
Bilateral = blockage at or below the bladder
Can also be from congenital abnormalities, blood clot, scarring, pregnancy, UTI

A

hydronephrosis

25
* US Confirm diagnosis with XR, CT, MRI Increased Cr with bilateral obstruction or unilateral obstruction with underlying kidney disease Hematuria and pyuria Chronic obstruction = hyperkalemic renal tubular acidosis
hydronephrosis
26
how do you treat hydronephrosis?
Address underlying cause (stone, infection) Catheter or nephrostomy tube to drain urine
27
Abdominal or flank pain, hematuria History of UTIs and nephrolithiasis First symptom commonly HTN, may have “berry” aneurysms, MVP, colonic diverticula
polycystic kidney disease
28
Family history Autosomal recessive – can cause death in first month of life (lung immaturity b/c of insufficient amniotic fluid) – formation of cysts on kidney More at risk for cerebral aneurysms and other vascular problems
polycystic kidney disease
29
PE: large kidneys may be palpable on exam, renal impairment (microscopic/gross hematuria) *US (if unclear, CT scan) Brain MRA if family history is +, employed in high risk profession, or undergoing elective surgery with high risk for post op HT
polycystic kidney disease
30
how do you treat polycystic kidney disease?
Lifestyle modifications – healthy diet, decreased sodium intake, weight management, exercise, don’t smoke, drink water, avoid caffeine BP meds – statins, tolvaptan, bed rest and analgesics for pain Chronic pain = cyst decompression Hematuria = bed rest + hydration – recurrent bleeding = renal cell cancer (esp. in men >50) Renal infection = antibiotics (fluoroquinolones, bactrim)
31
Refractory HTN New onset HTN in older patients Pulmonary edema with poorly controlled BP AKI with ACEI or ARB Audible abdominal bruit Unexplained HTN in woman <40 (consider fibromuscular dysplasia), <20 or >50
renal vascular disease
32
What are RF for renal vascular disease?
HTN >45 CKD Diabetes Tobacco use
33
Atherosclerosis causing renal artery stenosis → MCC of secondary HTN! Fibromuscular dysplasia is MCC in women <50 years
renal vascular disease
34
Abdominal US – asymmetric kidney size, small hyperechoic kidneys if bilateral Hypokalemia If corrective procedure considered, screen with: Dopper US (sensitive + specific) but poor for obese, supine, bowel issues CT angio MRA $$ Renal angiography – performed after a positive screening test String of beads = fibromuscular dysplasia
renal vascular disease
35
how do you treat renal vascular disease?
Medical management: BP control, lipid management, glucose control, tobacco cessation → ACEI or ARBs, except in those with bilateral stenosis or solitary kidney Angioplasty w/ or w/o stenting Surgical bypass
36
how do you treat fibromuscular dysplasia?
percutaneous transluminal angioplasty is curative