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Y4R3 - Medicine II 🩺 > L1: AKI > Flashcards

L1: AKI Flashcards

(112 cards)

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1
Q

Def of AKI

A
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2
Q

Epidemeology of AKI

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3
Q

Dx Criteria of AKI

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4
Q

S. Cr in AKI

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5
Q

Urine Output in AKI

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6
Q

Staging Cr in AKI

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7
Q

Stage I AKI

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8
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Stage II AKI

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9
Q

Stage III AKI

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10
Q

Urinary obstruction must be excluded as a cause of low urine output.

A

..

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11
Q

The most abnormal parameter is used for classifications.

A

..

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12
Q

Etiology of AKI

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13
Q

Pre-Renal Causes of AKI

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14
Q

Pre-Renal Causes of AKI

  • Hypovolemia
A
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15
Q

Pre-Renal Causes of AKI

  • ## Shock
A

Septic, Cardiogenic or Anaphylactic

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16
Q

Pre-Renal Causes of AKI

  • Drugs
A
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17
Q

Renal Causes of AKI

A
  • Glomerular
  • Tubulo-interstitial
  • Vascular
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18
Q

Renal Causes of AKI

  • Glomerular
A

Glomerulonephritis (Especially rapidly progressive glomerulonephritis) → Discussed separately.

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19
Q

Renal Causes of AKI

  • Interstitial
A

AIN = Acute Interstitial Nephritis

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20
Q

Renal Causes of AKI

  • Tubular
A
  • Ischemic ATN
  • Toxic ATN
  • Sepsis
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21
Q

Causes of ATN

A
  • Ischemic ATN
  • Toxic ATN
  • Sepsis
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22
Q

Ischemic ATN

A
  • ALL CAUSES OF PRERENAL DISEASE particularly if SEVERE, PROLONGED & accompanied by hypotension, surgery, and/or sepsis can cause ATN.
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23
Q

Types of Toxic ATN

A
  • Endogenous & Exogenous
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24
Q

Types of Endogenous Nephrotoxins

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25
Protein Endogenous Nephrotoxins
26
Crystals as endogenous nephrotoxins
Uric acid → in Tumor lysis syndrome.
26
Types of Exogenous Nephrotoxins
- Drugs - Toxic Manifestations - Heavy Metals - Contrast Agents
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Exogenous Nephrotoxins - Drugs
▪ Antibiotics: Aminoglycosides. ▪ Antifungal: Amphotericin B. ▪ Antiviral: Acyclovir – Cidofovir. ▪ Chemotherapeutic agents: Cisplatin, Methotrexate.
28
Exogenous Nephrotoxins - Toxic Ingestions
Ethylene glycol
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Exogenous Nephrotoxins - Heavy Metals
Mercury – Lead – Arsenic
30
Renal Causes of **AKI** - Vascular
Intrinsic renal vascular diseases directly affect both SMALL & LARGE sized blood vessels within the kidneys.
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Vascular Causes of **AKI** - Small Blood Vessels
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Vascular Causes of **AKI** - Large Blood Vessels
â‘  Renal infarction from aortic dissection or renal artery abnormality (such as aneurysm). â‘¡ Acute renal vein thrombosis.
33
Post-Renal Causes of **AKI**
34
Pathophysiology Stages of **AKI**
- Initiating Event (Kidney Injury) - Oliguric / Anuric (Maintenance) - Polyuric (Diuretic) - Recovery
35
Pathophysiology Stages of **AKI** - Initiating Injury
36
Pathophysiology Stages of **AKI** - Oliguric / anuric (Maintainence) Phase
37
Decreased GFR Mehcanisms in Oliguric / anuric (Maintainence) Phase
◈ Toxins + Ischemia → Necrosis & Sloughing of tubular epithelial cells into tubular lumen → obstruction of tubules → Increased intraluminal pressure. ◈ Back-leak of tubular fluid to renal interstitium. ◈ Excess renin activation → Afferent vasoconstriction.
38
Complications of Oliguric / anuric (Maintainence) Phase
① Fluid retention → Dilutional hyponatremia. ② Electrolyte retention → Hyperkalemia & Hyperphosphatemia. ③ Ca++: Decreased (May still normal). ④ Increases S. Creatinine, Urea & H+ (Metabolic acidosis).
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Duration of Oliguric / anuric (Maintainence) Phase
1–3 weeks
40
Pathophysiology Stages of **AKI** - Polyuric (Diuretic) Phase
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Mechanism of Polyuric (Diuretic) Phase
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Complications of Polyuric (Diuretic) Phase
① Loss of water (dehydration). ② Loss of electrolytes (hyponatremia, hypokalemia etc…).
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Duration of Polyuric (Diuretic) Phase
∼ 2 weeks
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Polyuric (Diuretic) Phase is characteristic for which type of **AKI**?
Ischemic (renal)
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Pathophysiology Stages of **AKI** - Recovery
Kidney function & urine production normalize
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CP of **AKI**
Symptoms of the cause + .........
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CP of **AKI** - Volume Status
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CP of **AKI** - Sodium
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CP of **AKI** - Potassium
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CP of **AKI** - Other electrolyres
Increased P & Decreased Ca
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CP of **AKI** - Metabolic Acidosis
52
CP of **AKI** - Urine Output
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Non-oliguric AKI (absence of oliguria) argues against ......
a pre-renal etiology.
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..... AKI reveals nothing about the etiology
Oliguric
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Anuric AKI Most often seen in .....
shock & complete bilateral urinary tract obstruction.
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CP of **AKI** - Uremic Manifesfations
Refer to Chronic kidney Disease (CKD)
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CP of **AKI** - Cardiac Complications
58
CP of **AKI** - Nutritional Symptoms
59
Steps in Dx of **AKI**
- Is it AKI or Not? - What Type? - Role of Bx?
60
Dx of **AKI** Diffrence Between AKI & CKD
61
Compare between AKI & CKD in Terms of - Hx
62
Compare between AKI & CKD in Terms of - Renal Size
63
Compare between AKI & CKD in Terms of - Hb
64
Urine Sediment in Pre-Renal AKI
- Normal or near normal. - Hyaline casts &/or fine granular casts may be seen
65
Compare between AKI & CKD in Terms of - Renal Osteodystrophy
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Compare between AKI & CKD in Terms of - Serum Creatinine
67
Lab Results in Pre-Renal AKI
68
US in Pre-Renal AKI
Normal
69
Response to Acute TTT in Pre-Renal AKI
Rapid improvement in renal function following acute intervention
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Urine Sediments in **Renal AKI**
71
Labs in **Renal AKI**
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US in **Renal AKI**
May be enlarged (Due to inflammation or edema)
73
Response to Acute TTT in **Renal AKI**
lack of response to acute intervention
74
Urine Sediment in **Post-renal AKI**
May be hematuria & pyuria
75
Labs in **Post-renal AKI**
76
US in **Post-renal AKI**
Bilateral hydronephrosis
77
Response to acute TTT in **Post-renal AKI**
Rapid improvement in renal function following resolution of the obstruction
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..... is the preferred test for distinguishing between prerenal disease & intrinsic renal.
FENa+
79
FENa+ is not utilized during diuretic therapy (as in prerenal conditions can be > 1)
...
80
Indications of Biopsy in **AKI**
81
CI of Bx in **AKI**
82
CI of Bx in **AKI** - kidney Status
83
CI of Bx in **AKI** - Patient Status
84
- Most contraindications are relative rather than absolute. - Clinical circumstances that necessitate urgent renal biopsy may be overridden, EXCEPT FOR uncontrolled bleeding diathesis.
..
85
- In advanced chronic kidney disease and ultrasound imaging of reduced kidney volume, the renal biopsy is generally contraindicated.
...
86
Approach to Specifc underling Causes of AKI - Hemolysis
87
Approach to Specifc underling Causes of AKI - Rhabdomyolysis
88
Approach to Specifc underling Causes of AKI - Tumor Lysis Syndrome
89
Managment aspects of **AKI**
- TTT of Cause - Supportive - KRT
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Managment aspects of **AKI** - TTT of underlying Causes
91
Managment aspects of **AKI** - Supportive Care
92
Goals of Supportive Care
â‘  Avoid further renal insult & potentially aggravating factors. â‘¡ Support adequate kidney perfusion. â‘¢ Ensure early identification & treatment of complications.
92
Aspects of Supportive Care of AKI
① Medications ② Volume status ③ Electrolytes ④ Acid-base disturbances ⑤ Others (Nutritional support, Contrast agents & Hyperuricemia)
93
Supportive Care of **AKI** - Volume Status
94
Supportive Care of **AKI** - medications
95
Supportive Care of **AKI** - Electrolytes
96
Supportive Care of **AKI** - Electrolytes (Hyperkalemia)
97
Supportive Care of **AKI** - Electrolytes (Hyponatremia)
98
Supportive Care of **AKI** - Electrolytes (hyperphosphatemia)
99
Supportive Care of **AKI** - Electrolytes (Hypocalcemia)
100
Supportive Care of **AKI** - Metabolic Acidosis
101
When should Treating Metabolic Acidosis by Bicorbonate Avoided? and What is the alternative?
102
Nutitional Support in **AKI** - Protein
103
Nutitional Support in **AKI** - Calories
20 to 30
104
Nutitional Support in **AKI** - Salt & Fluid
Restricted → To correct hypervolemia
105
Nutitional Support in **AKI** - K
Restricted → To correct hyperkalemia
106
Nutitional Support in **AKI** - P
Restricted → To correct hyperphosphatemia
107
Nutitional Support in **AKI** - Ca
Allowed
108
contrast agents in AKI?
109
TTT of Hyperuricemia in AKI
Acute treatment is usually not required except in the setting of tumor lysis syndrome.
110
Indications of KRT in AKI

Y4R3 - Medicine II 🩺 (35 decks)

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