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26 Cards in this Set
- Front
- Back
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Which of the following is false about the RIFLE definition of AKI?
a) serum creatinine, GFR, and urine output are used to grade severity b) End stage kidney disease is greater than 3 months loss of renal function c) Loss and ESKD are used to grade severity d) RIFL are on a bi-directional continuum and stage can change any day |
c) Loss and ESKD are used to grade severity
Loss and ESKD are used to grade outcome Risk, injury and failure are used to grade severity |
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What are the urine volume/day for oliguria and anuria? What is the significance of non-oliguiric AKI?
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Oliguiria: <400 ml/day
Anuria: <100 ml/day Non-oliguric AKI has better outcomes than AKI with oliguria or anuria. |
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What is the standard approach to AKI? Approx. how prevalent are each of these causes of AKI?
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Pre-renal (decreased perfusion, normal nephron structure and function) - 20-30%
Renal (abnormal structure and function of nephrons) - 50-60% Post-renal/obstructive (urine outflow passages are blocked and secondarily abnormal function of the nephrons) - 10% |
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What does a low fractional excretion of sodium [FeNa] (<1%) indicate? High (>2%)?
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Low FeNa means normal tubular reabsorption [type of AKI: pre-renal or early post-renal]
High FeNa means sodium wasting from intrarenal damage. [type of AKI: ATN, late post-renal] |
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What are some causes of pre-renal AKI?
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-Decreased intravascular volume -extracellular volume depletion [diarrhea, vomit, diueretics, bleed] or decreased effective circulating volume [CHF cirrhosis, nephrosis, peritonitis, sepsis]
Hypotension -decreased CO [tamponade, sepsis] -Impaired renal vasculature - renal artery embolus or occlusion; Increased resistance in afferent-efferent arterioles: (NSAIDs, anesthesia.) -Decreased intraglomerular pressure - ACEi, ARBs vasoconstricting drugs - cyclosporin |
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What is the prognosis of pre-renal AKI?
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Usually reversible if renal blood flow restored and volume status is corrected quickly.
However, if prolonged, can progress to intrarenal kidney damage. |
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If a person's had a normal sodium reabsorption [FeNa], normal urine concentrating ability and a normal urine pH, what type of AKI might they have?
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Pre-renal
Also, negative urinalysis for RBC, WBC, proteinuria |
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What are post-renal causes of AKI?
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Bilateral ureteric obstruction
- intraureteral - stones, clots - extraureteral - bladder/prostate/cervical ca Bladder neck obstruction - prostate bladder ca - autonomic nueropathy |
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What are some ways to manage pre-renal AKI?
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Maintain normal BP, CO
Maintain euvolemia/IV fluids Avoid nephrotoxins Hold ACEi, ARB, NSAIDs Tx sepsis |
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What is involved in the management of post-renal AKI?
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Insert urinary Foley catheter
Urology and radiology for UT obstruction (lithotripsy, trans-pubic catheter) Monitor volume status |
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What is a 3 category approach to intra-renal AKI?
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Glomerular
TubularoInterstital Vascular |
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What is a diagnostic urinalysis for RPGN?
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1. RBC casts
2. dysmorphic RBC 3. protein |
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What are causes of rapidly progressing glomerular nephritis?
and what are they categorized by? |
1. Pauci-immune (aka vasculitis) (90%)
2. Anti-GBM (8%) 3. Immune complex mediated (2%) immunofluorescence |
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What are 3 types of vasculitis that cause inflammation of the blood vessels?
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i) granulomatosis with polyangitis (GPA)
ii) microscopic polyangitis/arteritis (MPA) iii) Churg-Straus |
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Match the lab test to the RPGN disease.
GPA, Microscopic polyangitis, Churg-Straus, Anti-GBM disease LAB TESTS: +anti GBM antibodies +ve anti-MPO +ve antiproteinase (c-ANCA)" |
GPA -anti-proteinase (c-ANCA)
Microscopic polyangitis - +ve anti-MPO Churg-Straus (none specified) Anti-GBM disease anti- GBM & sometimes +ve cANCA |
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What are symptoms of Churg-Straus?
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Multi-organ system involvement
Predominant worsening of asthma (rare) |
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Which disease affects middle age men & women and presents with up. reps tract (nose/sinus, throat), lungs & kidney symptoms?
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Granulomatosis with polyangitis (GPA)
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What are some common conditions associtated with immune complex mediated disease causing RPGN?
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Lupus
IgA disease Membranoproliferative disease (hep b/c) Post infectious glomerulonephritis |
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If a patient had non-specific symptoms (i.e. fever, weight loss, myalgias), but also had sudden renal failure or pulmonary hemorrhage, and/or skin, CNS and GI tract symptoms, which vasculitis would most likely be present?
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Microscopic polyangitis
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What's the most predominant symptom of Churg-Strauss?
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worsening of asthmatic symptoms
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What is the name of the syndrome where antibodies attack capillaries in aveolar walls?
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Good pasture's syndrome
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What are some symptoms in anti-GBM?
what's the pathophys? |
hemoptysis, fever, wt loss, n/v, renal failure
lab: +ve ANCA in some and anti-GBM antibodies usually present antibodies against the the GBM, in the lungs the antibodies attack the alveolar walls |
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Why is a renal biopsy needed for RPGN and in the biopsy, what may indicate severe glomerular injury?
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Used for definitive diagnosis
Crescents=sign of severe glomerular injury. They are an accumulation of epithelial cells and circulatory monocytes/macrophages in Bowman's space." |
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What are the absolute indications for dialysis?
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Acidosis
Electrolytes: hyperkalemia, hypercalcemia Intoxication (ASA, toxic EtOH, Li) Overload (volume) Uremic encephalopathy, pericarditis, pleuritis AEO - when refractory to medical treatment |
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What is the specific management for ANCA+ anti-GBM?
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Immunosuppressive therapy +/- plasmaphoresis
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What are some of the toxicities/side effects to be aware of in the treatment of RPGN?
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Cyclophosphamide: amenorrhea, cystitis, bladder cancer
Prednisone: fractures, diabetes, cataracts Opportunistic infections: 6% pneumocystis carinii pneumonia. Use prophylactic trimethoprim-sulfamethothoxazole 3X/week |
