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STEP 2 Cardio + Renal > Renal. AKI+Nsaids+contrasAIN+IN+papil (07-23) (1) > Flashcards

Renal. AKI+Nsaids+contrasAIN+IN+papil (07-23) (1) Flashcards

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1
Q

UW. Prerenal AKI.
etiology? main mechanism

A

Decreased renal perfusion

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2
Q

UW. Prerenal AKI.
etiology 5 that were in table

A
  1. True volume depletion
  2. Decreased EABV (eg. Hf, cirrhosis)
  3. Displacement of intravascular fluid (increased vascular permeability in sepsis, pancreatitis)
  4. Renal artery stenosis
  5. Afferent arteriole vasoconstriction (eg NSAIDs).
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3
Q

UW. Prerenal AKI.
What mechanism of nsaids etiology?

A

afferent arteriole vasoconstriction

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4
Q

UW. Prerenal AKI.
clinical? 5

A

incr. creatinine
Decr. urine output
BUN/Cr ratio > 20:1
Fract. Na < 1 proc.
Unremarkable urine sidement

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5
Q

UW. Prerenal AKI.
main treatment?

A

restoration of renal perfusion

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6
Q

UW. Prerenal AKI.
Presentation - oliguria. how much ml?

A

<500 ml day

OR < 0,5 ml/kg/h

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7
Q

UW. Prerenal AKI.
BUN/Cr ratio?
what if high urea?

A

> 20:1

anion gap metabolic acidosis

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8
Q

UW. Prerenal AKI.
FeNa?

A

< 1 proc.

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9
Q

UW. Prerenal AKI.
Urine sodium (uNa)?

A

<10 (kai kur raso <20)

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10
Q

UW. Prerenal AKI.
FeUrea?

A

< 35 proc.

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11
Q

UW. Prerenal AKI. treatment? 4

A

place catheter
if volume down -> iv fluids
if volume up (cardiorenal syndrome) –> diuresis
Avoid nephrotoxic drugs - metformin, ACEI, ARB.

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12
Q

UW. Prerenal AKI. Cardiorenal syndrome mechanism. Left heart failure?

A

LHF –> decr. Sv, CO –> decr. renal perfusion –> dec. GRF (renal injury) –> RAAS activation –> SNS tone and incr. Na and H2O absorption –> back to the first point ie LFH

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13
Q

UW. Prerenal AKI. Cardiorenal syndrome mechanism. Right heart failure?

A

RHF –> incr. CVP, RVP –> decr. glomerular capillary pressure gradient –> dec. GRF (renal injury) –> RAAS activation –> SNS tone and incr. Na and H2O absorption –> back to the first point ie RHF

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14
Q

UW. Postrenal AKI.
Causes?ureter

A

cancer and stones

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15
Q

UW. Postrenal AKI.
Causes?bladder

A

cancer, stones, neurogenic bladder (spinal cord injury, stroke)

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16
Q

UW. Postrenal AKI.
Causes?urethra

A

cancer, stones, BPH, Foley’s cath.

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17
Q

UW. Postrenal AKI.
Causes?
one very common case
what drug group?

A

postoperative urinary retention
First generation antihistamines (or drugs, containing anticholinergic activity) -> detrusor hypoactivity

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18
Q

UW. Postrenal AKI.
workup? 2

A

US or CT scan

look for hydroureter or hydronephrosis

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19
Q

UW. Postrenal AKI.
workup. what first thing to do in post-op?

A

check catheter

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20
Q

UW. Postrenal AKI.
treatment?

A

relieve obstruction - either Foley, surgery or nehrostomy

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21
Q

UW. Intrarenal AKI.

A
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22
Q

UW. Intrarenal AKI.
3 groups?

A

GN
Acute interstitial nephritis
Acute tubular necrosis

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23
Q

UW. Intrarenal AKI.
GN - UA finding.
What to rule out?

A

finding - RBC casts

rule out - nephrotic syndrom (> 3,5 g/dl, edema, inc. cholesterol)

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24
Q

UW. Intrarenal AKI.
acute interstitial nephritis. UA findings?

A

WBC casts, WBC, eosinophils.

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25
UW. Intrarenal AKI. acute interstitial nephritis - causes?
Drugs - sulfadrugs (TMP-SMX(, penicillin, cephalosporins, NSAIDS, allopurinol, PPIs)
26
UW. Intrarenal AKI. acute interstitial nephritis presentation? 4
eosinophilia, eosinophiluria, fever, wbc casts, skin rash, hematuria
27
UW. Intrarenal AKI. acute interstitial nephritis onset?
onset variable. 5 day to several weeks/month following exposure
28
UW. Intrarenal AKI. ATN. 2 groups?
ischemia and exposure to toxins
29
UW. Intrarenal AKI. ATN. what are toxins?
IV contrast, AMG, myoglobin (rhabdomyolysis) GN
30
UW. Intrarenal AKI. ATN. what to do prior radiologic procedures?
evaluate kidney function before administergin IV CONTRAST
31
UW. Intrarenal AKI. ATN. what lab incr. in case of rabdomyolysis?
potassium and creatin kinase.
32
UW. Intrarenal AKI. ATN. Multiple myeloma also cause (??)
.
33
UW. Acute interstitial neph. symptoms?
fever, rash (DONT FORGET IT), arthralgias, eosinophilia, hematuria, sterile pyuria, WBC casts, eosinophiluria renal: AKI, on byopsy inflammatory infiltrates in kidney interstitium
34
UW. Intrarenal AKI. ATN. DIsease course? phases 4
prodrome - cr rises oliguric phase polyuric phase: urine output increases recovery phase
35
UW. Intrarenal AKI. ATN. treatment?
discontinue affending drug/toxin vigorous IV fluids
36
UW. Intrarenal AKI. ATN. BUN/cr?
typically normal <15:1
37
UW. Intrarenal AKI. ATN. UNa?
>40
38
UW. Intrarenal AKI. ATN. Na exc? proc.
> 2 proc.
39
UW. Intrarenal AKI. ATN. urine osmolality?
~ 300
40
UW. prerenal AKI. urine osmolality?
> 500
41
UW. Intrarenal AKI. ATN. urine specific gravity?
<1.020
42
UW. prerenal AKI. urine specific gravity?
> 1.020
43
UW. Intrarenal AKI. ATN. Microscopy?
muddy brown casts
44
UW. prerenal AKI. Microscopy?
bland
45
UW. Contrast induced nephropathy. 4 risk factors?
Age > 75 CKD (esp. diabetic nephropathy) Reduced renal perfusion (eg hypotension) High contrast load
46
UW. Contrast induced nephropathy. prevention? 3
periprocedural saline hydration Lowest possible volume of agent Hold NSAIDs
47
UW. Contrast induced nephropathy. workup?
History and physical exam Urinalysis BUN/Cr ratio < 20:1 (jeigu pagal ATN lentele < 15) sometimes need biopsy
48
UW. Contrast induced nephropathy. treatment?
Disease specific. Discontinue of nephrotoxic agent. Supportive care. Dialysis
49
UW. intrarenal. GN. what urinalysis?
RBC casts/RBC
50
UW. Analgesic nephropathy. it the most common cause of drug-inducec CKD.
.
51
UW. Analgesic nephropathy. 2 most common pathologies?
Chronic tubulointerstitial nephritis Papillary necrosis
52
UW. Analgesic nephropathy. what 3 risk in general due to chronic analgetics use?
premature aging atherosclerotic vascular disease Urinary tract cancer
53
UW. Analgesic nephropathy. what common scenario?
long term use of 1 or multiple anagetics for chronic headaches or other somatic complaints
54
UW. Analgesic nephropathy. what usually symptoms?
usually asymptomatic but can have chronic tubulointerstitial nephritis or hematuria due to papillary necrosis
55
UW. Analgesic nephropathy.
56
UW. Analgesic nephropathy. diagnosis. blood labs?
incr. creatinine
57
UW. Analgesic nephropathy. diagnosis. urinalysis?
hematuria sterile pyuria mild proteinuria (<1,5 g/d)
58
UW. Analgesic nephropathy. diagnosis. what shows CT?
small kidneys with bilateral renal papillary calcifications
59
UW. papillary necrosis. rare cause of non-glomerular hematuria
.
60
UW. papillary necrosis. mechanism?
occurs due to sloughing of the renal papilla
61
UW. papillary necrosis. risk factors - mneumonic NSAID.
N - Nsaids (cause constriction of medullary blood vessels - vasa recta) Sickle cell disease Analgesic abuse Infection (pyelonephritis) DM
62
UW. Contrast induced nephropathy. when onset?
Acute rise in Cr within 24-48h post contrast administration, following gradual return to baseline
63
FA. prerenal mechanism?
decr. renal perfusion
64
FA. intrarenal mechanism?
injury within nephron
65
FA. posternal mechanism?
urinary outflow obstruction
66
FA. prerenal. what urine finding may be, but considered as normal (in volume depletion)?
hyaline casts

STEP 2 Cardio + Renal (55 decks)

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