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24 Cards in this Set
- Front
- Back
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What is the most common cause of ARF
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Acute kidney injury
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Why do you get HTN with kidney disease
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decreased profusion leads to increase RAAS
or increase in Na retention |
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there are 2 etiologies of AKI, what are they
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Ischemic
Toxic |
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What causes ischemic AKI?
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decreased effective blood flow
(Decrease blood volume, perfusion pressure, impaired blood flow) |
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Drug reactions, IV contrast, and heavy metals or organic solvents can cause what kind of AKI?
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Nephrotoxic
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Heavy metals (e.g., Hg [heme]) are what type of toxin for nephrotoxic aki?
what about organic solvents |
Heavy metals: Endogenous
Organic Solvents: Exogenous |
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What is the pathogenesis underlying AKI?
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Tubular injury
Tubular epithelial cells are particularly sensitive to hypoxia and Luminal obstruction Sloughed epithelial cells and protein casts increase intratubular pressure Decrease GFR |
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What morphological changes will you see (in the urine) with AKI?
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Tubular casts: Tamm-Horsfall protein
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in AKI what will you see evidence of on LM?
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tubular epithelial cells in the tubules are necrotic
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Ischemia vs Hypoxia
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Ischemia: decreased blood flow (everything is lower, O2, nutrients, etc)
Hypoxia: decreased Oxygen (with adequate blood flow; anemia) |
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What are the 3 phases of AKI?
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Initiation (~ 36 hrs):
inciting event Initial ↓in GFR with mild increase in BUN and ↓in U/O Maintenance: Sustained ↓in U/O (40-400 ml/24 hr) Salt and water overload; hyperkalemia; metabolic acidosis; azotemia; uremia Recovery increase in U/O (may reach 3000 ml/24 hr) Hypokalemia |
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50% of AKI is _____, with ____ prognosis
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non-oliguric
good |
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What 2 things can lead to acute tubular necrosis again?
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Hypox/Ischemia
Luminal obstruction |
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pyelonephritis can cause what?
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Tubulointerstitial disease
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most common cause for pyelonephritis/UTI
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E. Coli
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In an immunocompromised pt what would likely be the cause of pyelonephritis?
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Viral infections
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***** comes in with a rash, she has been on some NSAIDs, she has eosinophilia. What she got
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Acute Tubulointerstitial Nephritis
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UV reflux can cause what problem associated with flank pain and WBC casts
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pyelonephritis
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Why does UV reflux often occur
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Persons with a congenitally short intravesical ureter have no mucosal flap, because the angle of entry of the ureter into the bladder approaches a right angle. Thus, micturition forces urine into the ureter
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LM findings of: Patchy interstitial suppurative inflammation with intratubular aggregates of PMNs is associated with?
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Acute Pyelonephritis
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Gross findings of Papillary necrosis (especially with diabetes or obstruction) and resolution leading to scarring (fibrosis) is associated with?
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Acute Pyelonephritis
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A 22 year old woman in the 2nd trimester of pregnancy presents with flank pain fever and chills. Hemoglobin is 13.4 Peripheral blood CBC shows WBC of 13,500, with 78% PMNs. Her platelet count is 265000. Urine shows numerous WBCs and WBC casts. What is the most likely cause of this?
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E coli
(gram neg) |
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30 yr old woman complains of severe headaches and dizziness. Her BP is 180/110 and her BUN and Cr are elevated at 38 and 2.8 respectively. A CT of the lower abdomen reveals small, somewhat irregularly shaped kidneys. A renal biopsy is performed. She has a history of recurrent UTIs. What does she have
Acute pyelonephritis Acute Tubular Necrosis Chronic pyelonephritis |
Chronic Pyelonephritis
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56 year old woman has ARF. She has birefringent intratubular deposits of uric acid crystals. This finding suggests she had recently been treated for which of the following
Chronic Hep B Leukemia TB RA Amyloidosis |
Leukemia
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