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SM 195 Flashcards

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1
Q

What are the effects of AKI on renal function?

A

AKI is responsible for:

Excretion of nitrogenous waste products
Maintain fluid balance
Maintain electrolyte balance

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2
Q

What populations are AKI more common in?

A

Hospitalized patients who are septic and critically ill are more likely to develop AKI

Especially those with pre-existing CKD

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3
Q

What changes in serum creatinine define AKI?

A

Serum creatinine increases of 0.3 mg/dL within 48hrs or an increase in serum creatinine by 1.5x baseline within 7 days

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4
Q

What changes in urine volume define AKI?

A

Urine volume decreases of 0.5mL for 6 hours

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5
Q

What defines oliguria?

A

< 500 mL urine output over 24hrs

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6
Q

What defines anuria?

A

< 50 mL urine output over 24hrs

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7
Q

What systemic manifestations effect AKI?

A

Hyperkalemia due to Metabolic Acidosis inhibiting the Na/K ATPase
Anemia due to decreased EPO from kidney injury
ECV expansion such as HTN, CHF

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8
Q

What defines prerenal AKI?

A

Reduced GFR from decreased renal perfusion that can be reversed with a restoration of renal perfusion

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9
Q

How does a loss of renal perfusion setup prerenal AKI?

A

RAAS is activated in response to decreased NaCl delivery to the Macula Densa from lower perfusion, causing vasoconstriction to the Kidney in an attempt to restore perfusion to the heart and brain

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10
Q

What can cause prerenal AKI?

A

DHPS

Decreased CO
Hypovolemia
Peripheral Vasodilation
Selective Renal Ischemia

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11
Q

How can prerenal AKI be diagnosed, in terms of history and PE.?

A

HPI: diarrhea, diuretics
PE: signs of dehydration

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12
Q

How can prerenal AKI be diagnosed, in terms of labs?

A

BUN:Cr > 20:1

FENa < 1%

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13
Q

What FENa suggests prerenal disease?

A

FENa < 1% suggests prerenal disease

FENa > 2% suggests ATN

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14
Q

What are limitations of the FENa?

A

FENa only suggests a disease and is not diagnostic

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15
Q

What is postrenal kidney failure?

A

Obstruction in the urinary tract that causes renal failure, due increased capsule hydrostatic pressure lowering GFR

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16
Q

What can cause postrenal kidney failure?

A

Bladder obstruction from prostate hypertrophy, uretrhal obstruction, ureter obstruction

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17
Q

What are the HPI and PE for a patient with postrenal kidney failure?

A

Distended bladder, enlarged prostate

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18
Q

How is postrenal kidney failure managed?

A

Rapid diagnosis and relief of urinary obstruction leading to postobstructive diuresis is essential to preserve kidney function

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19
Q

What can cause intrinsic renal failure?

A

ATN (tubular), interstitial vascular, and glomerular issues can cause intrinsic renal failure

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20
Q

What do muddy brown casts in urinalysis suggest?

Study These Flashcards
A

Acute Tubular Necrosis

21
Q

What do red blood cell casts in urinalysis suggest?

Study These Flashcards
A

Glomerulonephritis

22
Q

What do white blood cell casts in urinalysis suggest?

Study These Flashcards
A

Infection, allergies

23
Q

How should acidosis be managed?

Study These Flashcards
A

Bicarbonate therapy

24
Q

How should hyperkalemia be managed?

Study These Flashcards
A 
Modify Diet (low K)
Insulin and Epinephrine
Kalexylate to promote Na/K exchange in the gut
25
How should hyperphosphatemia be managed?
Calcium Containing Binders | Sevelamer (anti-phosphatemia drug)
26
How do creatinine levels compare during the initial injury period and while the injury is ongoing?
Creatinine levels increase as GFR falls during the injury itself After the injury, a steady state of constant Creatinine level is re-established with elevated GFR and an increased Serum Creatinine, relative to before the injury
27
How does AKI vary among stages?
AKI at higher stages has higher increases in serum creatinine and lower urine output for longer periods of time
28
What are the 4 possible outcomes of AKI?
AKI can progress to: Full recovery AKI to CKD Acute on Chronic Kidney Disease (AKI on pre-existing CKD) AKI to ESRD
29
How can AKI present?
Most people are asymptomatic, but: Malaise, flank pain, edema, HTN, and SOB are possible
30
What type of AKI is produced by abnormalities of renal perfusion?
Pre-renal AKI
31
What type of AKI is produced by abnormalities within the kidney?
Intrinsic AKI
32
What type of AKI is produced by abnormalities of urine output?
Post-renal AKI
33
Does pre-renal AKI involve structural injury to the kidney?
No, the Kidney is just hypoperfused, so it recovers quickly after perfusion is restored
34
What can cause hypovolemia?
Intravascular volume depletion Third Spacing Decreased CO
35
How do prostaglandins and angiotensin II regulate GFR?
Prostaglandins dilate the afferent arteriole to increase blood flow to the glomerulus and raise GFR Antiogensin II constricts the efferent arteriole to decrease blood flow
36
How does aldosterone effect glomerular filtration?
Aldosterone stimulates sodium reabsorption in the CD, raising the ECV
37
How does ADH effect glomerular filtration?
ADH prevents the insertion of sodium channels in the CD, lowering sodium reabsorption and promoting fluid loss
38
Orthostatic hypotension, poor skin turgor, dry mucosa and edema suggest which type of AKI?
Pre-renal AKI
39
What is Hepatorenal Syndrome?
Liver failure that causes AKI due to systemic vasodilation that is compensated by profound vasoconstriction in the Kidneys, leading to impaired sodium/water handling and oliguria that does not respond to volume repletion
40
What are the types of ATN?
Ischemic and Toxic ATN
41
What is the most common cause of Intrinsic AKI?
ATN, due to reduced oxygen supply causing ischemia and cell death of tubular cells
42
What class of drugs can cause Tubular ATN?
Aminoglycosides
43
What syndromes can cause Tubular ATN?
Rhabdomyolysis, Hemolysis, Tumor Lysis Syndrome, Myeloma drugs
44
What type of sediment does ATN produce on urinalysis?
Dark, muddy brown sediment = ATN
45
What can cause Interstitial ATN?
Autoimmune diseases (Sjorgens, Lupus, Sarcoid) HIV Penicillins, Rifampin, NSAIDS
46
What is glomerulonephropathy?
A type of Intrinsic AKI (like ATN)
47
What are the types of glomeruloneprhapthy?
``` Rapidly Progressive Glomerulonephritis (RPGN) IgA Nephropathy Post Infection (PIGN after Strep) Immune-complex mediated FSGS Minimal Change Disease ```
48
What does the ANA test diagnose?
Lupus
49
What can cause Vascular Intrinsic AKI?
Small or medium vessel inflammation due to: Cholesterol atheroembolisms Hemolytic Uremic Syndrome (E coli infections) Scleroderma

Renal (19 decks)

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