ASN QBank Pearls - AKI, ICU Nephrology, HTN, and Pharmacology Flashcards
(93 cards)
1
Q
what filtration fraction is associated with increased clotting on CVVH?
A
> 25-30%
POSTfilter=(QR + UF)/(QB x (1-Hct)) x 60 min/hr
PREfilter=(QR + UF)/((QB x (1-Hct)) x 60 min/hr) + QR
2
Q
total body water (TBW)
A
weight x % body water
- male 0.6, elderly male 0.5
- female 0.5, elderly female 0.45
3
Q
Na+ requirement formula
A
TBW x (desired Na+ - serum Na+)
4
Q
infusion rate formula for hyponatremia
A
(Na+ requirement x 1000)/(infusate Na+ x time)
- Na+ requirement = TBW x (desired Na+ - serum Na+)
5
Q
Na+ concentration in 3% saline
A
513 meq/l
6
Q
total water deficit formula
A
TBW x (1 - desired Na+/serum Na+)
7
Q
electrolyte-free water clearance (EFWC) formula
A
urine volume × (1 − ((UNa+ + UK+)/SNa+))
8
Q
free water clearance (FWC) formula
A
urine volume × (1 − (Uosm/Sosm)
9
Q
indications for HD in lithium toxicity
A
- > 5 withOUT CKD
- > 4 WITH CKD
- > 2 with neurologic or cardiac effects and AKI
10
Q
clearance rate formula
A
- equal to effluent rate
- (QR + UF) x 1 hr/60 min
11
Q
fluid overload at time of dialysis initiation has been a/w increased risk of
A
mortality
12
Q
have any RRT modalities shown that removal of myoglobin can shorten or prevent the course of AKI from rhabdomyolysis?
A
no
13
Q
- in a patient with acute brain injury, what dialysis modality should be avoided?
- why?
- how?
A
- iHD
- may worsen neurological status
- compromises cerebral perfusion pressure d/t hypotension and disequilibrium
preferir - CRRT
- slow removal of fluids and solutes decreases risk of worsening acute brain injury
14
Q
what is the MC acid-base disturbance in the immediate postoperative period and is most prominent during the first 24-48 hours after surgery?
A
metabolic alkalosis
large citrate load from stored PRBC and FFP that’s metabolized to bicarbonate
15
Q
what are the benefits of using bicarbonate as a buffer in the dialysate or replacement fluid of AKI patients with circulatory problems or liver dysfunction?
A
- better correction of acidosis
- lower lactate levels
- improved hemodynamic tolerance
16
Q
what is the likelihood of identifying adrenal cancer or a hyperfunctioning lesion (pheochromocytoma, primary aldosteronism, Cushing’s) in the setting of discovering an adrenal “incidentaloma” mass?
A
10-20%
17
Q
what is the BEST way to dose antibiotics for a patient on CRRT at 25 ml/kg/hr?
A
measure effluent UF and dialysate and calculate a CrCl
18
Q
what is an independent risk factor for AKI in a patient undergoing surgery?
A
obesity
19
Q
what is the most important risk factor for AKI in a patient undergoing surgery?
A
CKD
20
Q
what is the “gold standard” test to diagnose white coat HTN?
A
MAPA
21
Q
ARB exposure during the second and third trimesters has been a/w
A
neonatal renal failure and death
22
Q
can diuretics be continued during pregnancy?
A
yes, especially in women with sodium-sensitive HTN or edema and when they were already on them
23
Q
treatment of resistant HTN
A
- lifestyle modifications
- w/d of interfering meds
- correction of secondary HTN causes
- MR antagonists (spironolactone, amiloride, eplerenone)
24
Q
a trial published in 2008 demonstrated that antihypertensive therapy in patients > 80 yoa is a/w
A
- decrease in stroke
- decrease in cardiovascular mortality
25
older patients with HTN are more likely to be salt-sensitive and responsive to what therapy?
diuretics
26
in pregnant women with DM what is associated with a high incidence of fetal malformations?
poor glycemic control in the first trimester
27
patients with AKI in the setting of decompensated liver disease may have HRS, but what must be ruled out first and how?
- intravascular volume depletion
- evaluating clinical response to IVF
28
- increased hemodynamic instability
- worsening respiratory failure with increased airway pressures and increasing difficulty with oxygenation
- tense abdomen on exam
- oliguric kidney failure
abdominal compartment syndrome
diagnostico pressao intravesical
29
intervention a/w greatest reduction in the risk for contrast-induced nephropathy
isotonic crystalloids prior to and following iv contrast
30
acyclovir, methotrexate, ethylene glycol toxicity and TLS can all present with
crystalluria
needle shaped crystals -> acyclovir crystals
amorphous brown-colored precipitates in urine->methotrexate
31
dumbbell and needle-shaped calcium oxalate monohydrate crystals, and envelope-shaped calcium oxalate dihydrate crystals ->
ethylene glycol toxicity
32
what is the probability that AKI is d/t AIN when urinary eosinophils are present?
30%
33
single most probable cause of secondary HTN is
fibromuscular dysplasia
34
fibromuscular dysplasia is most likely to be identified on
CT angiography
35
localized kidney ischemia and/or infarction from dissection/contusion of the kidney following trauma
Page kidney
perinephric hematoma compressing renal parenchyma, causing renal ischemia and RAAS activation
tto=RAAS blockade
36
MOST useful data regarding the salvageability of renal function with renal revascularization
LOW resistive indices
37
what is the MOST helpful procedure post revascularization during annual f/u renovascular disease?
renal artery duplex US
38
how do NSAIDs cause hyperkalemia?
- inhibit PGs --> reduces renin --> inhibits RAAS pathway --> hypoaldosterone state --> hyperkalemia
39
how do NSAIDs cause hyponatremia?
- reduces PGE2 --> increased ADH effect --> increased H2O reabsorption
- counteract effect of diuretics by reducing RBF --> increased proximal urine Na+ reabsorption --> and increased urine concentrating ability
40
drug toxicity
- protease inhibitors
nephrolithiasis
41
drug toxicity
- nucleoside reverse transcriptase inhibitors (eg, stavudine, didanosine)
- lactic acidosis
- hepatic steatosis
42
drug toxicity
- nucleotide reverse transcriptase inhibitors (eg, tenofovir)
- ATN
- Fanconi syndrome
43
drug toxicity
- interferon
nephrotic syndrome
44
chronic lithium use can lead to which renal syndrome?
- nephrogenic DI
- distal, type 1, RTA
- CKD
- MCD
- FSGS
45
lithium nephrotoxicity may be prevented by use of
amiloride
46
a known, serious complication of stem cell transplantation
hepatic veno-occlusive disease (VOD), aka sinusoidal obstruction syndrome
47
hepatic veno-occlusive disease (VOD), aka sinusoidal obstruction syndrome clinical presentation
- similar to HRS
- AKI
- low BP
- sodium retentive state
48
pathophysiology of hepatic veno-occlusive disease (VOD), aka sinusoidal obstruction syndrome
sinusoidal obstruction --> portal HTN --> microvascular intrahepatic portosystemic shunting
49
what is the mechanism of proteinuria following bevacizumab therapy?
loss of vascular endothelial growth factor (VEGF)
50
- HL
- massive kidneys on CT scan
- AKI
lymphomatous infiltration of kidneys
51
what is the MOST effective therapy to lower methotrexate levels in a patient with AKI?
glucarbidase
52
- bone marrow suppression
- stomatitis (painful swelling and sores inside the mouth)
- AKI
methotrexate toxicity
53
can dialysis remove methotrexate?
need high flux HD for 8-12 hours (otherwise, rebound)
54
MOST effective oral treatment to remove sustained release lithium from GI tract
polyethylene glycol (PEG)
55
- AKI
- severe HTN
- GI bleeding
- following invasive vascular procedure
cholesterol embolization (AED)
56
- acute myelomonocytic leukemia (AMML); tissue invasive leukemia
- large kidneys on US
- AKI
leukemic infiltration of renal interstitium
57
- HTN
- AKI
- proteinuria
- MAB against VEGF
- decreased NO
- increased endothelin
bevacizumab
58
enters proximal tubular cells via APICAL membrane megalin receptor pathway
genatmicin
59
enters cells via BASOlateral organic ANion transporter pathway
tenofovir
60
enter proximal tubular cells via BASOlateral organic CATion transporter pathway
- cimetidine
- ifosfamide
- trimethoprim
- "CIT CAT"
61
tenofovir causes proximal tubular injury, AKI and Fanconi syndrome, through what mechanism?
mitochondrial dysfunction
62
drug that can cause AKI, Fanconi syndrome, and nephrogenic DI?
tenofovir
63
what medication is most likely to cause nephrolithiasis?
atazanavir
64
what urine pH is atazanavir most soluble in?
< 4.5
65
MCC of AKI in ecstasy (MDMA) ingestion
nontraumatic rhabdomyolysis
66
AKI in setting of;
- overdosing of abx
- alkaline urine
- underlying kidney injury
- old age
ciprofloxacin-associated crystalline nephropathy
67
MOST common adverse effect of rasburicase therapy
hemolytic reaction in patients who have underlying G6PD deficiency
68
dose adjustment for rasburicase in renal and/or liver failure
none needed
69
rasburicase metabolism
peptide hydrolysis
70
which IV vasopressor can raise serum K+ concentration and potentially worsen hyperkalemia?
phenylephrine
71
how can phenylephrine cause hyperkalemia?
nonselective α-agonist that blocks cellular uptake of K+
72
which vasopressors can cause hypokalemia?
epinephrine and norepinephrine
73
how can epinephrine and norepinephrine cause hypokalemia?
β2 agonism increases cellular uptake of K+
74
why is CRRT the best option for a patient awaiting liver transplant?
slow removal of solutes --> decreased risk of osmotic disequilibrium and increase in ICP
75
MOST likely mechanism of HTN and proteinuria in preeclampsia
decreased VEGF (vascular endothelial growth factor)
76
- LOW PRA
- high renin level
- low AG2
- low PAC
aliskiren (renin inhibitor)
77
- HIGH PRA
- high renin level
- LOW AG2
- low PAC
ACEI
78
- HIGH PRA
- high renin level
- HIGH AG2
- low PAC
ARB
79
- HIGH PRA
- HIGH renin level
- HIGH AG2
- HIGH PAC
- antagonize MR
spironolactone (aldosterone antagonist)
80
what type of replacement fluid for CVVH is a/w higher solute clearance?
POSTfilter
81
what is the most effective way to increase urea clearance in a patient on CVVH with a QB of 150 ml/min?
increase QB
82
first step in evaluation and management in a patient with a differential diagnosis of prerenal azotemia secondary to volume depletion, HRS, or ATN
adequate volume repletion with IV isotonic crystalloid
83
- AKI
- anemia
- hypercalcemia
- low AG
- discrepancy between urine dipstick (trace protein) and UPC
MM with light chain cast nephropathy
84
amyloidosis can also be associated with presence of paraprotein, like MM, but on urine studies what is different?
significant albuminuria and NO discrepancy between protein by urine dipstick and UPC
85
- decompensated cirrhosis
- progressively worsening renal function
- low BP
- low urine Na+
HRS
86
pathophysiology of AKI in setting of heart failure
- venous congestion --> activates sympathetic and RAA systems --> intrarenal vasoconstriction
- increased intraabdominal pressure
87
best initial treatment to reduce risk of intratubular cast formation and AKI in rhabdomyolysis
rapid infusion of IV 0.9% saline
88
antibiotics, plasmapheresis, antimotility agents, and antiplatelet agents are not recommended in what condition?
diarrhea-associated HUS
89
home BP measurements have been established to lead to
improved medication adherence
90
patients with renovascular disease treated with what have reduced morbidity and mortality as compared with treatment with other agents?
RAAS blockade
91
treatment in a patient with renovascular HTN with a solitary functioning kidney
endovascular stent placement of renal artery for functioning kidney
92
elevated renin levels represent a loss of perfusion pressure to the juxtaglomerular apparatus, not a
decrease in oxygen levels
93
best treatment for a pregnant patient with increase in BP 2/2 FMD
renal angiography and percutaneous transluminal renal angioplasty (PTRA)
