Nephrology And Urology

Question 1

RIFLE criteria for AKI

Answer 1

R: risk of kidney injury
Cr- 1.5*base line
Uo- < 0.5 mL/kg/h for > 6 h

I: Injury to the kidney
2*base line
<0.5 mL/kg/h for > 12 h

F: failure of kidney function
3*baseline or SCr>4 with an acute rise >0.5 mg/dl
<0.3 mL/kg/h for > 24 h or anuria for >12 h

L: loss of kidney function
Persistent renal failure for >4 week

E: End-stage disease
Persistent renal failure for> 3 months

Question 2

Causes of AKI

Answer 2

1- Prerenal
2- Renal
3- Postrenal

Question 3

Prerenal causes:
( reduced renal perfusion)

Answer 3

True volume depletion :
a-hemorrhage
b-renal or extra-renal loss (GI, Skin)

Decreased effective blood loss (ebv)
a- CHF. b- Hepatorenal syndrome
c-third space fluid accumulation

Increased renal vascular resistance
A-Hypercalcemia
B-NSAIDs
C-Calcineurin inhibitors:
cyclosporine ,tacrolimus, ACEI, ARBs

Question 4

Renal causes

Answer 4

A-Glomerular: RPGN, PSGN, HUS, ANTI-GBM

B- Tubular: ATN (ischaemic/toxin)

C- Interstitial: AIN
( Allergy, infection, infiltration)

D- Vascular: Renal artery stenosis/thrombosis

Question 5

Post-renal causes:

Answer 5

1- INTRA-URINARY TRACT:
A- intraluminal: stone, blood clots, sloughed papillae, crystal
B- intramural: tumor, infection, neurogenic drug, stricture

2- EXTRA-URINARY TRACT:
Prostate: hypertrophy, cancer
Retroperitoneal fibrosis, lymphoma

Question 6

AKI Complication

Answer 6

Metabolic acidosis
Pulmonary edema
Hyperkalemia
Pericarditis
Arrhythmias
Hypertension
Hyperuricemia

Question 7

Mx of AKI

Answer 7

1-Pre-renal: correct volume depletion with fluid challenge/ improve circulatory volume

2- Renal: remove toxins/ ischemic insult
Supportive tx of : A- intravascular volume overload . B-hyperkalemia
C- metabolic acidosis

3- Post-renal : Relive obstruction (specific aetiology-dependent )
Possible therapy includes: @ in-dwelling bladder catheter. @nephrostomy. @Stenting

Question 8

RRT indication for AKI
(RENAL REPLACEMENT THERAPY)

Answer 8

• EDEMA ( pulmonary)
  -HYPERKALEMIA ( refractory)
  -PERICARDITIS
  -ACIDOSIS (refractory)
  -ELEVATED BUN (>35mM)
  -ENCEPHALOPATHY

Question 9

Contrast Induced Nephropathy
Presentation:

Answer 9

Relatively common cause of AKI but is rarely associated with irreversible loss of kidney function.
1- It can present as oliguria or nonoliguria

2- THE ONSET OCCURS WITHIN 24-48 hr after exposure, reaches a peak within 3-5 days, and subsides within 7-10 days

Question 10

Contrast induced nephropathy
RISK FACTORS:

Answer 10

• Age>55
  -Preexisting renal insufficiency
  -Diabetic nephropathy
  -Volume depletion
  -Low CO
  -MM
  -Large volume of contrast

Question 11

CKD

Answer 11

Kidney damage or
GFR < 60 mL/min/1.73m2 for 3 months or longer