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21 Cards in this Set
- Front
- Back
Traditional definition of acute renal failure?
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- 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 |
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RIFLE definition of acute kidney injury?
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R risk
I injury F failure L loss E endstage kidney disease |
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What is the approach to Acute Kidney Injury?
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Pre-renal
Renal Post-renal |
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List the reasons for pre-renal AKI and some of the mechanisms behind them
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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 |
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List some post-renal causes of AKI
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Bilateral ureteric obstruction
- stones, clot, extraureteral - bladder, prostate ca/cerival ca, retroperitoneal fibrosis Bladder neck obstruction - prostate, bladder cancer, autonomic neuropathy, urethral obstruction |
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3 branches of renal causes of AKI?
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glomerular, tubulointerstitial, vascular
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Does a renal ultrasound need to be done immediately in AKI?
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Yes
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How does the kidney look in chronic kidney disease?
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small kidneys, thin cortex, echogenic kidneys (but there can be CKD without this)
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Another name for a glomerular cause of AKI?
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Rapidly progressive glomerulonephritis (RPGN)
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What will a urinalysis look like in RPGN?
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protein, dysmorphic RBCs, RBC casts
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How are causes of RPGN categorized? What are the 3?
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Categorized by immunofluoresence
1. Pauci-immune 2. Anti-GBM 3. Immune-complex mediated |
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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 |
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What are the absolute indications for hemodialysis?
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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 |
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Most common type of tubular AKI?
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acute tubular necrosis (ATN)
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What are some causes of acute tubular necrosis?
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ischemia - prolonged, severe Hypoperfusion
Toxins Exogenous - radiocontrast dye, antibiotics, more endogenous - hemoglobinuria, myoglobinuria, uric acid crystals, multiple myeloma |
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What is pathognomonic for ATN on urinalysis?
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muddy brown casts
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Cause of interstitial AKI?
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acute interstitial nephritis
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Causes of acute interstitial nephritis?
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Drugs (allergic interstitial nephritis)
Malignant infiltration glomerulonephritis pyelonephritis autoimmune disorders |
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What kind of casts can you see in AIN? (allergic)
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WBC casts
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Other than tubular, interstitial, and glomerular, what is another renal cause of AKI? and what are some reasons why?
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Vascular
- vasomotor - NSAID and ACEi/ARB stuff - small vessel disease - cholesterol emboli |
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What is the approach to initial management of AKI? (4 points)
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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 |