Acute Kidney Injury Case Study

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Questions and Answers

What does an elevated creatinine level of 139.82 mmol/L (1.58 mg/dL) indicate?

Normal kidney function

Improved kidney health

Possible kidney impairment (correct)

Chronic kidney disease is confirmed

Which of the following tests can suggest kidney function impairment?

Elevated creatinine levels (correct)

Elevated blood urea nitrogen

Low urinary volume

Normal creatinine levels

What does a thickened bladder wall and reduced bladder volume potentially indicate?

Cystitis (correct)

Normal urinary function

Dehydration

Obstructive uropathy

What condition can urinary retention lead to if not properly managed?

Acute kidney injury (AKI) Signup and view all the answers

What significance does a blood urea nitrogen level of 5.64 mmol/L have in relation to creatinine levels?

It provides context suggesting impaired function despite being in normal range Signup and view all the answers

What is the primary characteristic of Acute Kidney Injury (AKI) compared to Chronic Kidney Disease (CKD)?

AKI can be reversible if addressed promptly. Signup and view all the answers

What is the most common cause of intrinsic AKI?

Ischemic or toxic insult causing structural damage. Signup and view all the answers

Which laboratory finding is indicative of decreased renal function in this patient?

Creatinine level of 139.82 mmol/L. Signup and view all the answers

What type of acute kidney injury is caused by obstruction of urine flow downstream from the kidney?

Post-renal. Signup and view all the answers

Considering the patient's lifestyle, which factor may significantly contribute to his risk of developing Acute Kidney Injury?

Diet consisting mainly of fast food. Signup and view all the answers

What is the purpose of subclassifying AKI as per the Acute Disease Quality Initiative (ADQI)?

To predict the recovery time from AKI. Signup and view all the answers

Which of the following parameters is NOT commonly used to assess kidney function?

Lipid profiles. Signup and view all the answers

What could be a potential consequence of not addressing AKI promptly?

Progression to Chronic Kidney Disease. Signup and view all the answers

What characterizes the distinction between Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD)?

AKI occurs rapidly while CKD develops over months to years. Signup and view all the answers

Which pathophysiological mechanism is NOT associated with Acute Kidney Injury (AKI)?

Alterations in renal perfusion leading to vasodilation. Signup and view all the answers

What is a consequence of severe injury following an ischemic or toxic insult in AKI?

Formation of obstructive casts in the tubules. Signup and view all the answers

What is a critical factor in the management of Acute Kidney Injury?

Early identification and intervention based on cause. Signup and view all the answers

Which statement correctly describes the effects of metabolic alterations in AKI?

They disrupt tubular balance impacting glomerular function. Signup and view all the answers

Which term describes the stages of kidney function loss associated with RIFLE criteria?

Risk, Injury, Failure, Loss, End-stage. Signup and view all the answers

What contributes to intratubular obstruction in Acute Kidney Injury?

Development of obstructive casts from cell debris. Signup and view all the answers

What is the main impact of loss of cytoskeletal integrity in tubular cells during AKI?

Compromise of cell polarity and function. Signup and view all the answers

Which symptom is most likely associated with acute kidney injury (AKI)?

Shortness of breath Signup and view all the answers

What is a potential consequence of the kidneys' reduced ability to regulate fluid balance?

Fluid accumulation in the body Signup and view all the answers

Which condition could present with fever and drug-related rash?

Interstitial nephritis Signup and view all the answers

In cases of post-renal acute kidney injury, which symptom might indicate a urinary obstruction?

Prostate enlargement Signup and view all the answers

Which of these findings is consistent with fluid overload in patients?

Lower extremity edema Signup and view all the answers

A 61-year-old male presents with shortness of breath and chest pain. Which could be a likely underlying issue?

Pulmonary edema due to AKI Signup and view all the answers

What is a possible complication from vascular catheterization or surgery?

Atheroembolic disease Signup and view all the answers

Which of the following conditions can lead to symptoms consistent with infectious illness?

Interstitial nephritis Signup and view all the answers

What is the maximum duration of impaired kidney function for it to be classified as acute kidney injury (AKI)?

7 days Signup and view all the answers

At what point does acute kidney injury transition into acute kidney disease (AKD)?

When kidney function is impaired beyond 7 days Signup and view all the answers

Which of the following statements best describes chronic kidney disease (CKD)?

Impaired kidney function lasting over 90 days Signup and view all the answers

What indicates that a patient has progressed to stage 3 in the KDIGO classification of AKI?

Initiation of renal replacement therapy Signup and view all the answers

Which of the following accurately describes the kidney size associated with chronic kidney disease (CKD)?

Small kidneys indicating atrophy Signup and view all the answers

What is a common characteristic of acute kidney injury (AKI) according to the criteria provided?

Oliguria or changes in GFR or SCr Signup and view all the answers

How is acute kidney disease (AKD) defined within the context of kidney function?

Persistent kidney function impairment beyond 7 days Signup and view all the answers

In the AKIN classification of AKI, what does a '2-fold' increase indicate?

High risk of progression to CKD Signup and view all the answers

What distinguishes the RIFLE classification from the KDIGO and AKIN classifications?

RIFLE does not include urine output criteria Signup and view all the answers

Which of the following is NOT a characteristic of AKI according to the classifications provided?

Increase in urine output Signup and view all the answers

What is the primary physiological response to hypovolemia in the context of pre-renal acute kidney injury?

Increased efferent arteriolar constriction Signup and view all the answers

Which factor is noted as the most prominent site of ischemic injury in intrinsic acute kidney injury?

Proximal tubule (S3 segment) Signup and view all the answers

What is the primary consequence of persistent intrarenal vasoconstriction during the maintenance phase of acute kidney injury?

Prolonged reduction in glomerular filtration rate Signup and view all the answers

In post-renal acute kidney injury, what occurs due to early obstruction?

Increased glomerular filtration due to compensatory mechanisms Signup and view all the answers

Which of the following drugs is contraindicated in cases of acute kidney injury due to volume depletion?

NSAIDs Signup and view all the answers

Which process contributes to the reduction of GFR following the acute onset of obstruction in post-renal AKI?

Progressive arteriolar vasoconstriction Signup and view all the answers

Which clinical finding is associated with post-renal acute kidney injury?

Increased intraluminal pressure upstream from the obstruction Signup and view all the answers

What type of nephrotoxin is known to induce acute kidney injury following a specific duration of exposure (7-10 days)?

Cisplatin Signup and view all the answers

What essential mediator is released from damaged endothelial cells that plays a role in maintaining low GFR during AKI?

Vasoactive mediators Signup and view all the answers

Which sequence characterizes the phases of acute kidney injury (AKI)?

Initiation, Extension, Maintenance, Recovery Signup and view all the answers

What is a common consequence of acute kidney injury that lasts beyond the initial insult?

Long-term detrimental effects from brief AKI episodes Signup and view all the answers

Which condition is most likely to cause intrarenal vasoconstriction and promote acute kidney injury?

Hypercalcemia Signup and view all the answers

What physiological change is typical during the recovery phase of acute kidney injury?

Increase in the glomerular filtration rate Signup and view all the answers

Study Notes

Patient Case: Acute Kidney Injury (AKI)

Patient: 61-year-old Filipino male, 70kg, 165cm
Presenting Symptoms: Shortness of breath, chest pain, lower extremity edema
Vitals: Blood pressure 120/80 mmHg, Pulse rate 92 bpm, Respiratory rate 40 breaths/min, O2 saturation 88%, Body temperature 36.4°C
Medical History: Smoker, hypertensive, on Losartan 100mg daily, no history of previous surgeries, no known allergies, diet primarily fast food
Occupation: Manufacturing firm manager

Laboratory Results

Blood Urea Nitrogen (BUN): 5.64 mmol/L
Creatinine: 139.82 mmol/L (1.58 mg/dL)
Hemoglobin: 15.6 g/L
Hematocrit: 48%
Other lab values: (Various WBC, RBC, and other counts shown)

Ultrasound Results

Kidneys: Normal size, small cysts present (bilateral)
Urinary Bladder: Thickened wall, volume 48.07 cc (cystitis)

AKI Classification

AKI (Acute Kidney Injury): Abrupt decrease in kidney function, typically within 48 hours or 7 days
Types: Pre-renal, Intrinsic, Post-renal
Staging: KDIGO is a staging system, using serum creatinine (SCr) and urine output to classify and defines how severe AKI is.
KDIGO: Staging of AKI uses serum creatinine levels (SCr)

Additional Information:

AKI is a serious clinical issue characterized by a rapid decline in kidney function
Early diagnosis and intervention is vital for positive patient outcome
AKI progression may lead to chronic kidney disease (CKD)
Patient currently has an elevated BUN and serum creatinine, which are markers of kidney impairment.
Patient is overweight (BMI 25.71)

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Description

This quiz examines a detailed patient case of Acute Kidney Injury (AKI) presented through symptoms, medical history, and laboratory findings. It aims to deepen your understanding of kidney function impairment and its clinical implications. Engage with the case to enhance your diagnostic skills in renal health.