Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
21 Cards in this Set
- Front
- Back
|
Traditional definition of acute renal failure?
|
- abrupt elevation of serum creatinine
- 44umol/L above baseline - >50% rise above baseline (some say 25%) - 50% fall in GFR - acute decrease in urine output - acute dialysis requirement |
|
|
RIFLE definition of acute kidney injury?
|
R risk
I injury F failure L loss E endstage kidney disease |
|
|
What is the approach to Acute Kidney Injury?
|
Pre-renal
Renal Post-renal |
|
|
List the reasons for pre-renal AKI and some of the mechanisms behind them
|
Decreased intravascular volume
- hemorrhage, GI losses, skin loss, third space loss Decreased CO - CFH, cardiogenic shock, tamponade, PE increase vascular resistance - anesthesia, hepatorenal syndrome, PG inhibitors, NSAIDs Vasoconstricting drugs - CONTRASTS, cyclosporin, FK decreased ingraglomerulor pressure - ACEis, ARBs |
|
|
List some post-renal causes of AKI
|
Bilateral ureteric obstruction
- stones, clot, extraureteral - bladder, prostate ca/cerival ca, retroperitoneal fibrosis Bladder neck obstruction - prostate, bladder cancer, autonomic neuropathy, urethral obstruction |
|
|
3 branches of renal causes of AKI?
|
glomerular, tubulointerstitial, vascular
|
|
|
Does a renal ultrasound need to be done immediately in AKI?
|
Yes
|
|
|
How does the kidney look in chronic kidney disease?
|
small kidneys, thin cortex, echogenic kidneys (but there can be CKD without this)
|
|
|
Another name for a glomerular cause of AKI?
|
Rapidly progressive glomerulonephritis (RPGN)
|
|
|
What will a urinalysis look like in RPGN?
|
protein, dysmorphic RBCs, RBC casts
|
|
|
How are causes of RPGN categorized? What are the 3?
|
Categorized by immunofluoresence
1. Pauci-immune 2. Anti-GBM 3. Immune-complex mediated |
|
|
What is pauci-immune RPGN caused by?
What are 3 types of this? |
Vasculitis - inflammation of blood vessels
1. GPA (Wegener's) 2. microscopic polyangiitis 3. Churg-Strauss |
|
|
What are the absolute indications for hemodialysis?
|
A - acidosis
E - electrolyte disturbance - hyperkalemia, hypercalcemia I - intoxication - aspirin, lithium, toxic alcohols, etc O - overload (volume) U - uremic encephalopathy, pericarditis, pleuritis AEO must be refractory to medical therapy |
|
|
Most common type of tubular AKI?
|
acute tubular necrosis (ATN)
|
|
|
What are some causes of acute tubular necrosis?
|
ischemia - prolonged, severe Hypoperfusion
Toxins Exogenous - radiocontrast dye, antibiotics, more endogenous - hemoglobinuria, myoglobinuria, uric acid crystals, multiple myeloma |
|
|
What is pathognomonic for ATN on urinalysis?
|
muddy brown casts
|
|
|
Cause of interstitial AKI?
|
acute interstitial nephritis
|
|
|
Causes of acute interstitial nephritis?
|
Drugs (allergic interstitial nephritis)
Malignant infiltration glomerulonephritis pyelonephritis autoimmune disorders |
|
|
What kind of casts can you see in AIN? (allergic)
|
WBC casts
|
|
|
Other than tubular, interstitial, and glomerular, what is another renal cause of AKI? and what are some reasons why?
|
Vascular
- vasomotor - NSAID and ACEi/ARB stuff - small vessel disease - cholesterol emboli |
|
|
What is the approach to initial management of AKI? (4 points)
|
1. Treat precipitating insult and co-insults
2. Initiate specific therapies for underlying insult & injury 3. Dose-adjust renally excreted medications 4. Treat complications / metabolic consequences |
