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Senior - GU Test 1 > 11 - Acute Kidney Injury > Flashcards

11 - Acute Kidney Injury Flashcards

1
Q

Azotemia is?

A

Abnormally high serum levels of nitrogenous substances

  • urea
  • creatinine

Nitrogen+emia = blood condition

Azotemia = nirogen in blood

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2
Q

Uremia is

A

Clinical syndrome that results from abnormally high serum levels of nitrogenous substances

Uremia = urine in blood

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3
Q

Azotemia and uremia?

A

Azotemia -> -> Uremia

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4
Q

Abrupt drop in GFR results in?

A

Inability to maintain acid/base or fluid/electrolyte balance

Inability to excrete nitrogenous waste

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5
Q

Nonspecific symptoms of AKI/AFR?

A

Due to azotemia or its underlying cause

- prolonged azotemia can cause uremic syndrome

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6
Q

Urine with AKI or ARF?

A

Volume
- <400-500 mL/day
- or <20mL/hr
= oliguria

Can also be impaired renal concentration
- high or normal volume

Rarely anuria

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7
Q

Marker for severity with AKI/ARF?

A

Serum cratnine concentratino increase by 1-1.5 mg/dL/day

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8
Q

As GFR decreasees?

A

Tubular secretion of Cr increases so

- in early disease stages a large reduction in GFR is necissary to rase serum creatinine

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9
Q

RIFLE criteria?

A 
Risk
Injury
Failure
Loss
ESRD
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10
Q

AKI/ARF categories?

A
  1. Prerenal causes
  2. Intrinsic renal disease
  3. Postrenal causes
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11
Q

1st step toward treating AKI/ARF?

A

Identifying the cause

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12
Q

MC cause of AKI?

A

Rerenal azotemia (40-80%)

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13
Q

Cause of prerenal azotemia?

A

Due to renal hypoperfusion

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14
Q

Why is the prognosis of prerenal azotemia

A

If reversed quickly w renal restoration of renal blood flow -> renal parenchymal damage is prevented

If hypoperfusion persists -> ischemia -> intrinsic renal injury

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15
Q

Causes of renal hypoperfusion with prerenal azotemia?

A
  • L intravascular volume
  • Change in vascular resistance
  • Low cardiac output

Basically: Hypovolemia and Shock

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16
Q

Decrease in intravascular volume can be caused by?

A
  • hemorrhage,
  • GI losses,
  • dehydration,
  • excessive diuresis,
  • extravascualr space sequestration,
  • pancreatitis,
  • burns,
  • trauma,
  • peritonitis
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17
Q

Change in vascular resistance can be caused by?

A
  • sepsis
  • anaphylaxis
  • anesthesis
  • afterload-reducing drugs
  • renal artery stenosis
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18
Q

Low cardiac output can be caused by?

A
  • Cariogenic shock
  • CHF
  • PE
  • pericardial tamponade
  • arrhythmia
  • valvular disorders
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19
Q

prerenal Azotemia + NSAIDS + ACEI can lead to?

A

Hypovolemia - reduced kidney perfusion
+
NSAIDS - block vasodilatary prostaglandins at Afferent arteriole
+
ACEI - prevent Efferent arteriole vasoconstrition
=
Acute Renal Failure

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20
Q

Pts with prerenal azotemia present with?

A

Dehydration from renal or extrarenal fluid losses

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21
Q

Labs for prerenal azotemia?

A

BUN: Creatinine ratio >20:1

H urine osmolality

Urinary sedement - bland or hylaine casts

Una <20 mEq/L

FEna <1%

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22
Q

What lab did he make a huge deal about?

A

BUN: creatinine ration > 20:1

Be able to calculate it

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23
Q

Differentiates prerenal and intrinsic renal disease?

A

FE(na) <1%

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24
Q

Tx for prerenal azotemia?

A
  • admit
  • achievement of euvolemia
  • fix serum electrolytes
  • NO NEPHROGENIC DRUGS
  • monitor unrine output (should go up)
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25
Q

Least common cause of AKI?

A

POSTrenal azotemia (5-10%)

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26
Q

Why is it important to detect POSTrenal azotemia?

A

It is reversible (if you find it)

Its obstructed urinary flow

27
Q

Pathophys of Postrenal azotemia?

A

Obstruction

  • > H intraluminal pressure
  • > parenchymal damage
  • > L GFR
28
Q

Causes of postrenal azotemia?

A

Obstruction of both ureters/renal pelvises

Bladder dysfunction/obstruction

29
Q

MC cause of urethral obstruction in men?

A

BPH

30
Q

Other causes of postrenal azotemia?

A
  • anticholinergic meds
  • cancer
  • retroperitoneal fibrosis
  • ## neurogenic bladder
31
Q

Less common causes of postrenal azotemia?

A
  • blood clots
  • bilateral ureteral stones
  • urethral stones/stricture
  • bilateral papillary necrosis
32
Q

Presentation of postrenal azotemia?

A

Anuria or Polyuria

Lower abd pain

33
Q

PE for postrenal azotemia?

A

Enlarged prostate
Pelvic mass
Distended bladder

34
Q

Labs for postrenal azotemia?

A
  • BUN:creatinine ratio >20:1
  • H urine osmolality -> later L urine osmolality
  • urine sediment: bland (benign)
  • Fe(na) variable
  • U(na) variable
35
Q

Tx for postrenal azotemia?

A
  • Admit
  • bladder catheterization
  • find cause (US, CT, MRI)
  • correct obstruction
  • postobstructive diuresis
36
Q

After relieving long-term bladder outlet obstruction beware of?

A

Postobstructive diuresis -> hypovolemia

37
Q

After pre and post renal causes are excluded look at?

A

Intrinsic renal disease

38
Q

Sites of injury that cause intrinsic renal disease?

A
  • tubules
  • interstitium
  • vasculature
  • glomeruli
39
Q

Acute tubular necrosis (ATN) =?

A

AKI/ARF due to tubular damage

- 85% of intrinsic AKI/ARF

40
Q

Major causes of ATN?

A

Ischemia

Nephrotoxin exposure

41
Q

What is ischemic ATN?

A

Tubular damage due to low perfusion -> tubular necrosis and apoptosis
- begins as prerenal azotemia

42
Q

Ischemic ARF is characterized by?

A

Inadequate GFR
Inadequate renal blood flow
- inability to maintain parenchymal cellular perfusion

43
Q

Ischemic ATN occurs?

A

In the setting of prolonged HOTN or hypoxemia

- (volume depletion, shock, trauma etc)

44
Q

Nephrotoxic ATN causes?

A

Exogenous (MC)

Endogenous

45
Q

Exogenous nephrotoxins?

A 
Aminoglycosides
Vanc
Amphotericin B
IV acyclovir
Cephalosporins
Radiographic contrast
Cyclosporine
Antineoplastics
Heavy metals
46
Q

Endogenous nephrotoxins?

A 
Heme-containing/mimicking products
- myoglobin (rhabdo)
- hemoglobin (intravascular hemolysis)
Uric acid (hypouriecmia)
- rapid cell turnover and lysis  (chemo)
Paraproteins 
- bence jones protein (multiple myeloma)
47
Q

ATN presentation?

A 
Gen swelling
N/V
Oliguria
Signs of Hypovolemia
decreased LOC
Anorexia
Gi bleed
Muscle weakness/twitching
48
Q

ATN labs?

A 
Active urine sediment
- muddy brown cysts
- renal tubular epithelial cysts/casts
Urine output: oliguric/nonoliguric
BUN:creat <20:1
UA(na) >20
FE(na) >1-2%
Hyperkalemia
Hyperphosphatemia (Common)
49
Q

Tx for ATN

A 
Admit ICU
Avoid volume overload
- dieuritics
- monitor pulmonary edema
Mantai fluid electrolyte and acid/base
- avoid hyperK
Nutritional support
- protein restriction 
Dialysis
50
Q

ATN tx indication for dialysis

A 
Life-threat electrolyte disturbancy
Volume overolad unresponsive to diuretics
Worsening acidosis 
Uremic complications
- encephalopathy, pericarditis, seizures
51
Q

3 phases (clinical course) of ATN?

A

Initial injury
Maintenance (1-3 wks or months)
Recover - heralded by diuresis

52
Q

Mortality with ATN?

A

Varies 20-70%

Causes

  • infection
  • fluid/electrolyte disturbances
  • worsening underlying disease
53
Q

Acute interstitial nephritis (AIN) essentials for diagnosis?

A 
Fever
Transient maculopapular rash
Acute renal insufficiency
Pyruria (eosinophils) - WBC casts
Hematuria
54
Q

Causes of AIN?

A

Drugs (70%)
Infectious diseases
Idiopathic conditions

Full list on 41

55
Q

AIN presentation

A

Fever (80%)
Rash
Arthralgias
Peripheral blood eosinophilia (80%)

56
Q

Classic triad of AIN?

A

Fever
Rash
Arthralgias

10-15% of cases

57
Q

AIN labs?

A 
Bun:creat <20:1
UA
- RBC
- WBC
- WBC casts
- eosinophiluria
Proteinura
Peripheral blood smear: eosinophilia
58
Q

AIN tx?

A

– Nephrology consult
– Supportive measures
– Removal of inciting agent
– If renal failure persists → short course of steroids
– Good prognosis w/ recovery usually w/in weeks-months – Acute dialysis therapy may be necessary in 1/3 of
patients
• Rarely progress to ESRD

59
Q

Vascular ARF causes?

A

Renal vein thrombosis
Renal infarction
Malignant HTN

60
Q

Acute glomerulonephritis and AKI/ARF?

A

Uncommon cause - 5%

61
Q

Essentials for diagnosis w acute glomerulonephritis?

A

hematuria

  • dysmorphic RBC
  • RBC casts
  • mild proteinuria

Dependent edema and HTN
Acute renal insufficiency

62
Q

Intrinsic renal disease comparison?

A

Slide 46

Might be a good one

63
Q

Homeopathic surgery

A

“Quick nurse, hand me nothing”

Senior - GU Test 1 (13 decks)

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