59 Questions
What is the main characteristic of Acute Kidney Injury (AKI)?
Reversible increase in blood concentration of creatinine and nitrogenous waste products
What is the RIFLE classification based on for Acute Kidney Injury (AKI)?
Serum Creatinine and Urine Output evaluation
What is a common association with Acute Kidney Injury?
Oliguria
What is the primary function that the kidneys fail to perform in Acute Kidney Injury?
Regulate fluid and electrolyte homeostasis
What is the most common complication of peritoneal dialysis?
Peritonitis, Infections, obstruction
What method provides direct filtration of blood by osmosis and diffusion across an artificial membrane?
Haemodialysis
What is contained in a balanced electrolyte dialysate solution or 'bath' to be returned to the blood during haemodialysis?
Substances that need to be retained in the blood
What is universally accepted as the treatment of choice for children with end-stage renal disease (ESRD)?
Kidney transplantation
What method results in better survival than dialysis for pediatric patients of all ages?
Renal transplant
What is the most common complication of haemodialysis?
All of the above
What is the surgical procedure required for haemodialysis?
Creation of vascular access
What allows for significant improvement in delayed skeletal growth, sexual maturation, and cognitive performance in children with ESRD?
Kidney transplantation
What is the most common complication of peritoneal dialysis that may result in loss of membrane integrity?
Peritonitis
What are the advantages of haemodialysis?
Immediate improvement in fluid and chemical status
What method provides less independence than peritoneal dialysis?
Haemodialysis
What is the most common complication of haemodialysis that poses vascular access difficulties?
Clotting
Which classification system combines RIFLE and AKIN classifications to establish a unified AKI classification?
The KIDIGO classification
How does KDIGO define AKI?
An increase in serum creatinine by 0.3mg/dL within 48 hours
What do pre-renal causes of acute kidney injury include?
Sepsis
What are intrinsic renal causes of acute kidney injury related to?
Acute tubular necrosis
How does KDIGO define AKI based on urine output?
Urine output less than 0.5 mL/kg/h for 6 hours
What is the primary method to differentiate between pre-renal and renal AKI?
Assessing urine osmolality
What are post-renal causes of acute kidney injury related to?
Tumors
What are the indications for dialysis in chronic kidney disease management?
Symptoms of uremia
What is the primary advantage of peritoneal dialysis in children and infants?
More independence for the patient
What is the surgical procedure required for hemodialysis?
Creation of an arteriovenous fistula or graft
Which method utilizes the body's peritoneum as a filter for dialysis?
Continuous ambulatory peritoneal dialysis
What is the most common complication of peritoneal dialysis?
Peritonitis
Match the following complications with the corresponding dialysis method:
Peritonitis and catheter problems = Peritoneal dialysis Vascular access difficulties and clotting = Haemodialysis Immediate improvement in fluid and chemical status = Haemodialysis Loss of membrane integrity prohibiting further use of the peritoneum as a filter = Peritoneal dialysis
Match the following advantages with the corresponding dialysis method:
Less demand on the family and child for performing procedures at home = Haemodialysis Greater dietary and fluid compliance = Haemodialysis Immediate improvement in fluid and chemical status = Haemodialysis Less independence than with peritoneal dialysis = Haemodialysis
Match the following statements with the corresponding renal management method:
Provides direct filtration of blood by osmosis and diffusion across an artificial membrane = Haemodialysis Utilizes the body's peritoneum as a filter for dialysis = Peritoneal dialysis Universally accepted as the treatment of choice for children with ESRD = Renal transplant Results in better survival than dialysis for pediatric patients of all ages = Renal transplant
Match the following characteristics with their association to Acute Kidney Injury (AKI):
Oliguria = Commonly associated with AKI Abrupt Elevation in Serum Creatinine = Commonly associated with AKI Dys-electrolyteamia and acid base disturbances = Commonly associated with AKI Reversible increase in blood concentration of creatinine and nitrogenous waste products = Characteristic of AKI
Match the following classifications with their defining features:
RIFLE classification = Considers three severity classes of AKI (Risk, Injury and Failure), and two outcome classes (Loss of kidney function and Endstage kidney disease) Multiple definitions for AKI = Led to a great disparity in the reported incidence of AKI Consensual and accurate definition of AKI = Crucial to establish due to various classifications by various nephrology bodies
Match the causes of AKI with their classifications:
Aetiology of AKI = Classifies into pre-renal, intrinsic renal, and post-renal causes Pathophysiology of AKI = Describes pre-renal AKI from decreased renal blood flow, intrinsic AKI from direct renal parenchymal damage or dysfunction, and post-renal AKI from obstructive processes Intrinsic AKI = Commonly caused by acute tubular necrosis (ATN) after prolonged hypoperfusion and nephrotoxin exposure Post-renal AKI = Results from obstructive processes that block urine flow
Acute Kidney Injury (Acute renal failure) is always irreversible.
False
The RIFLE classification for AKI is based on Serum Creatinine and Urine Output evaluation.
True
Acute Kidney Injury is commonly associated with oliguria, abrupt elevation in Serum Creatinine, and dys-electrolyteamia.
True
The KDIGO defines AKI based on both urine output and Serum Creatinine levels.
True
Peritoneal dialysis is associated with greater dietary and fluid compliance compared to hemodialysis
False
Hemodialysis is performed 2 to 4 times a week
True
Hemodialysis provides immediate improvement in fluid and chemical status
True
Hemodialysis poses less demand on the family and child for performing procedures at home
True
Renal transplant results in better survival than dialysis for pediatric patients of all ages
True
Five year survival rates in transplant patients are close to 95% whereas in dialyzed patients the survival rates are about 80%
True
Kidney transplantation is universally accepted as the treatment of choice for children with end-stage renal disease (ESRD)
True
Vascular access difficulties are a common complication of hemodialysis
True
Peritonitis is the most common complication of peritoneal dialysis that may result in loss of membrane integrity
True
Peritoneal dialysis provides less independence than hemodialysis
False
The child with a well functioning kidney transplant can enjoy a quality of life that cannot be achieved by any form of dialysis therapy
True
Successful transplantation in children with ESRD not only ameliorates uremic symptoms but also allows for significant improvement of delayed skeletal growth, sexual maturation, cognitive performance, and psychosocial functioning
True
RIFLE classification includes stages such as Risk, Injury, Failure, Loss, and End stage renal Disease
True
Pediatric RIFLE criteria include parameters such as reduction in GFR, creatinine increase, urine output, and outcome parameters
True
KDIGO classification is based on serum creatinine increase and urine output for defining acute kidney injury (AKI)
True
Stage 1-3 of AKI have specific criteria for serum creatinine increase and urine output for each stage
True
Acute tubular necrosis (ATN) is a common cause of intrinsic AKI resulting from prolonged hypoperfusion and nephrotoxin exposure
True
Post-renal AKI results from obstructive processes that block urine flow
True
Parameters for urine osmolality, specific gravity, sodium, plasma creatinine ratio, plasma urea ratio, and seizures can help differentiate pre-renal and renal AKI
True
Continuous ambulatory and continuous cycling are variations of peritoneal dialysis, offering advantages and ease of performance
True
Peritoneal dialysis provides better haemodynamic stability, metabolic control, cost-effectiveness, and freedom for children to attend school
True
Study Notes
Acute Kidney Injury Classification
- The RIFLE classification system categorizes acute kidney injury into risk, injury, failure, loss, and end-stage renal disease.
- The pediatric RIFLE criteria assess kidney injury based on the percentage reduction in glomerular filtration rate, creatinine increase, and urine output.
- The Kidney Disease Improving Global Outcomes (KIDIGO) combined RIFLE and AKIN classifications to establish a unified AKI classification in 2012.
- KDIGO defines AKI as an increase in serum creatinine by 0.3mg/dL or more within 48 hours, or to 1.5 times baseline within the last 7 days, or urine output less than 0.5 mL/kg/h for 6 hours.
- The stages of AKI are based on serum creatinine levels, urine output, and the need for renal replacement therapy.
- Acute kidney injury can be classified into pre-renal, intrinsic renal, and post-renal causes.
- Pre-renal causes include circulatory insufficiency, dehydration, sepsis, and heart failure.
- Intrinsic renal causes involve direct renal parenchymal damage or dysfunction, including acute tubular necrosis and nephrotoxin exposure.
- Post-renal causes result from obstructive processes that block urine flow, such as tumors or stones.
- Differentiating between pre-renal and renal AKI involves assessing urine osmolality, specific gravity, sodium levels, and plasma creatinine and urea ratios.
- Management of chronic kidney disease includes indications for dialysis, such as symptoms of uremia, fluid overload, calcium/phosphate imbalance, and hypertensive pericarditis.
- Peritoneal dialysis, utilizing the body's peritoneum as a filter, can be performed through continuous ambulatory or continuous cycling methods, offering advantages in children and infants.
Acute Kidney Injury Classification and Criteria
- RIFLE classification: Risk, Injury, Failure, Loss, End stage renal Disease
- Pediatric RIFLE criteria: Stages, reduction in GFR, creatinine increase, urine output, and outcome parameters
- KDIGO classification: Definition of acute kidney injury (AKI) based on serum creatinine increase and urine output
- Stage 1-3 of AKI: Criteria for serum creatinine increase and urine output for each stage
- Aetiology of AKI: Classification into pre-renal, intrinsic renal, and post-renal causes
- Pathophysiology of AKI: Pre-renal AKI results from decreased renal blood flow, intrinsic AKI refers to direct renal parenchymal damage or dysfunction, and post-renal AKI results from obstructive processes
- Intrinsic AKI: Common causes include acute tubular necrosis (ATN) after prolonged hypoperfusion and nephrotoxin exposure
- Post-renal AKI: Results from obstructive processes that block urine flow
- Differentiating pre-renal and renal AKI: Parameters for urine osmolality, specific gravity, sodium, plasma creatinine ratio, plasma urea ratio, and seizures
- Chronic kidney disease management: Dialysis indications and symptoms, and peritoneal dialysis as a treatment option
- Peritoneal dialysis variations: Continuous ambulatory and continuous cycling, advantages, and ease of performance
- Peritoneal dialysis advantages: Better haemodynamic stability, metabolic control, cost-effectiveness, and freedom for children to attend school
Acute Kidney Injury Classification and Criteria
- RIFLE classification: Risk, Injury, Failure, Loss, End stage renal Disease
- Pediatric RIFLE criteria: Stages, reduction in GFR, creatinine increase, urine output, and outcome parameters
- KDIGO classification: Definition of acute kidney injury (AKI) based on serum creatinine increase and urine output
- Stage 1-3 of AKI: Criteria for serum creatinine increase and urine output for each stage
- Aetiology of AKI: Classification into pre-renal, intrinsic renal, and post-renal causes
- Pathophysiology of AKI: Pre-renal AKI results from decreased renal blood flow, intrinsic AKI refers to direct renal parenchymal damage or dysfunction, and post-renal AKI results from obstructive processes
- Intrinsic AKI: Common causes include acute tubular necrosis (ATN) after prolonged hypoperfusion and nephrotoxin exposure
- Post-renal AKI: Results from obstructive processes that block urine flow
- Differentiating pre-renal and renal AKI: Parameters for urine osmolality, specific gravity, sodium, plasma creatinine ratio, plasma urea ratio, and seizures
- Chronic kidney disease management: Dialysis indications and symptoms, and peritoneal dialysis as a treatment option
- Peritoneal dialysis variations: Continuous ambulatory and continuous cycling, advantages, and ease of performance
- Peritoneal dialysis advantages: Better haemodynamic stability, metabolic control, cost-effectiveness, and freedom for children to attend school
Test your knowledge of acute kidney injury classification with this quiz. Explore the RIFLE and KIDIGO criteria, stages of AKI, and differentiation between pre-renal and intrinsic renal causes. Learn about management options, including indications for dialysis and peritoneal dialysis methods.
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