subtypes of AKI - amboss Flashcards
acute tubular necrosis
85% of intrinsic AKIs
injury occurs secondary to decreased renal blood flow, nephrotoxic substances or sepsis or infections
causes of decreased renal blood flow
severe hypotension, especially in the context shock, hypovolaemic (eg. haemorrhage severe dehydration) septic, cardiogenic (eg. heart failure) or neurogenic shock
thromboembolism
thrombotic microangiopathy
cholesterol embolism (atheroemboli)
causes of toxic damage to kidneys
injury occurs directly due to nephrotixic substances
contrast induced nephropathy
aminoglycosides, cisplatin, amphotericin, lead, ethylene glycol
pigment nephropathy: due to heme containing pigments eg. heamoglobin, myoglobin on proximal renal tubular cells
acute uric acid nephropathy
when might pigment nephropathy occur
due to heme containing pigments
eg
myoglobinuria due to rhabdomyolysis
hemoglobinuria associated with hemolysis
pathophysiology of acute tubular necrosis
necortic proximal tubular cells fall into the tubular lumen
debris obstructs tubules
decreased GFR
sequence of pathophysiological events similar to prerenal failure
blood findings of acute tubular necrosis
azotemia, hyperkalaemia and metabolic acidosis
urinary findings of acute tubular necrosis
increased fractional excretion of sodium
myoglobinuria
hemoglobinuria
urinary sediment - granular casts, epithelial cell casts, free renal tubular epithelial cells (due to denudation of the tubular basement membrane)
prognosis of acute tubular necrosis
after 1-3 weeks, most patients with ATN will experience tubular re-epithelialization and spontenous full recovery is common
can be lethal if AKI is severe and not managed adequately eg. dialysis may be required for oliguric patients with volume overload or severe hyperkalemia
renal cortical necrosis
rare cause of AKI by acute generalised ischaemic necrosis of the renal cortex in both kidneys
aetiologies of renal cortical necrosis
septic shock
disseminated intravascular coagulation
hemolytic uremic syndrome (HUS)
obstetric complications
pathophysiology of renal cortical necrosis
vasospasms and microvascular injury with vascular thrombosis
prolonged severe renal ischaemia
diffuse or patchy destruction of the renal cortex
clinical features of renal cortical necrosis
flank pain, CVA tenderness and signs of AKI
management of renal cortical necrosis
dialysis can improve outcomes
high mortality rates without treatment
contrast induced nephropathy
AKI after IV administration of iodinated contrast medium
risk factors for contrast induced kidney injury
chronic kidney disease
congestive heart failure
nephrotoxic drugs esp. NSAIDs
anaemia
dehydration