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19 Cards in this Set
- Front
- Back
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Can CKD have AKI or AKD?
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Yes, both. (think hospitalized pts w/ acute kidney injury)
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What are limitations of creatinine for GFR?
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Slow to measure (about 3 days for steady state)
-also affected by body mass and hydration level |
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Best way to differentiate between AKD and CKD?
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compare to older information
also, AKD will have dec urine output Small kidneys on U/S can be CKD (not sensitive) |
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3 main classifications for AKD
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pre-renal, intra-renal, post-renal
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Causes of dec renal perfusion
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low ECF volume (GI losses, hemorrhage, diuretics)
altered RBF (sepsis, CHF, cirrhosis, hypercalcemia (causes afferent arteriole vasoconstriction), medications (think NSAIDs, ACEi), vascular disease |
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3 main types of tubulointerstitial disorders causing intra-renal disease
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acute interstitial nephritis, tubular obstruction, acute tubular necrosis (think perfusion or medications)
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Post-renal causes of AKI
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blockage anywhere along urinary tract
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4 steps to evaluate AKI
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review history
physical exam (check volume status) exclude urinary tract obstruction Examine urine (check sediment) |
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What is seen on urinalysis with ATN?
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granular "muddy brown" casts
-captures renal tubular epithelial cells (decently sensitive) |
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Which cast type is normal in urine?
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hyaline
(Tamm-Horsfall proteins) |
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Key differences between pre-renal and ATN causes in urine indices.
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Check FEna (<1% is pre-renal, >2% is ATN)
pre-renal is more concentrated (tubules working) and less Na b/c of reabsorbing. Na will be affected by water reabsorption |
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Formula for FENa
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UNa * Scr / Ucr*SNa x 100
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4 exceptions for FENa (won't be pre-renal w/ <1%)
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glomerulonephritis
radiocontrast ATN + chronic pre-renal condition nonoliguric ATN (early) |
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2 exceptions for FENa when >2% (won't be ATN necessarily)
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chronic kidney disease
diuretic use in 24-48 hours |
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Formula for fractional excretion of urea
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Uurea*Scr / Ucr*BUN x 100
<35% suggests pre-renal >50% suggests ATN |
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when should fractional excretion of urea be used?
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with diuretics
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Tx for pre-renal cause (low flow)
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administer 1L of normal saline and discontinue HCTZ
and stop NSAID |
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How do NSAIDs affect RPF?
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block intra-renal prostaglandins, so dec afferent dilation
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Most common cause of AKI following cardiac catheterization
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radiocontrast nephropathy
also think atheroembolic disease (can see livedo reticularis, eosinophilia, Low C3) |
