Clin Med - Acute Kidney Injury
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What is the definition of acute kidney injury (AKI) according to the text?

  • An increase in serum creatinine of 0.3 mg/dL or more in 48 hours, or serum creatinine at least 1.5 times baseline in the last seven days, or urine output less than 0.5 mg/kg/hr for at least 6 hours (correct)
  • Urine output less than 0.3 mg/kg/hr for at least 6 hours
  • Serum creatinine at least 2 times baseline in the last seven days
  • An increase in serum creatinine of 0.5 mg/dL or more in 48 hours

    • Which of the following is NOT a cause of post-renal AKI mentioned in the text?

  • Urinary retention
  • Obstruction from a tumor
  • Urethral obstruction
  • Acute tubular necrosis (correct)

    • What is the typical fractional excretion of sodium (FENa) in pre-renal AKI?

  • Less than 1 percent (correct)
  • Between 1 and 2 percent
  • Greater than 5 percent
  • Greater than 2 percent

    • What is the most common cause of intrinsic renal AKI according to the text?

    <p>Rapidly progressive glomerulonephritis (C)</p> Signup and view all the answers

    What is the typical fractional excretion of urea (FEUrea) in pre-renal AKI?

    <p>Less than 35 percent (B)</p> Signup and view all the answers

    What is the key distinguishing feature of post-renal AKI compared to other types of AKI?

    <p>Obstruction of urine outflow (C)</p> Signup and view all the answers

    Which of the following medications can cause pre-renal AKI due to hypotension?

    <p>NSAIDs, ACEi and ARB (D)</p> Signup and view all the answers

    How is post-renal AKI typically differentiated from other types of AKI?

    <p>By performing an ultrasound of the kidneys (B)</p> Signup and view all the answers

    What is the key characteristic of the urine output in patients with acute kidney injury?

    <p>Oliguria (decreased urine output) (A)</p> Signup and view all the answers

    What is a common etiology for post-renal AKI?

    <p>Benign prostatic hyperplasia (A)</p> Signup and view all the answers

    Which condition can cause ureteral obstruction leading to post-renal AKI?

    <p>Retroperitoneal fibrosis (C)</p> Signup and view all the answers

    What can cause intrinsic renal AKI due to tubular obstruction from crystals?

    <p>Dehydration (B)</p> Signup and view all the answers

    Which medication can contribute to post-renal AKI by causing urinary retention?

    <p>Anticholinergic drugs (D)</p> Signup and view all the answers

    Post renal AKI is reversible in the first few days

    <p>True (A)</p> Signup and view all the answers

    Acute tubular necrosis, acute interstitial nephritis and tubular obstruction from crystals can cause intrinsic renal AKI

    <p>True (A)</p> Signup and view all the answers

    What type of AKI

    <p>Drop in glomerular perfusion; often reversible, but can progress to tubular necrosis = Pre-renal AKI Glomerular disease, especially rapidly progressive glomerulonephritis (RPGN); more on glomerular disease later = Intrinsic AKI Urine obstruction -&gt; backs up into collecting system -&gt; renal vasoconstriction -&gt; ischemic tubular injury -&gt; interstitial fibrosis = Post-renal AKI match A = matched A</p> Signup and view all the answers

    Which laboratory finding is indicative of acute tubular necrosis?

    <p>Fractional excretion of sodium (FENa) greater than 2 percent (C)</p> Signup and view all the answers

    What is the key finding in the urine sediment of a patient with acute tubular necrosis?

    <p>Muddy brown pigmented, coarse granular casts (D)</p> Signup and view all the answers

    Which of the following is the primary management strategy for acute tubular necrosis?

    <p>Supportive care and preserving volume status (C)</p> Signup and view all the answers

    What is the underlying cause of acute tubular necrosis according to the text?

    <p>Ischemia or nephrotoxins (B)</p> Signup and view all the answers

    Which of the following is an example of a nephrotoxin that can cause acute tubular necrosis?

    <p>Iodinated contrast (B)</p> Signup and view all the answers

    A patient presents with concerns of "bloody/red urine." Labs show: serum creatine kinase (CK) highly elevated at 5000. Urine dipstick is positive for heme, but without RBC’s on microscopy. What is likely?

    <p>Rhabdomyolysis (B)</p> Signup and view all the answers

    Contrast-induced nephropathy presents with a raise in serum creatinine rise usually _____ hours after contrast

    <p>24-48 (C)</p> Signup and view all the answers

    Which of the following is NOT a common cause of acute interstitial nephritis?

    <p>Aminoglycoside antibiotics (D)</p> Signup and view all the answers

    In acute interstitial nephritis, peripheral eosinophilia, rash, and fever may be present, EXCEPT in cases caused by:

    <p>Non-steroidal anti-inflammatory drugs (NSAIDs) (C)</p> Signup and view all the answers

    Which of the following findings in the urine is suggestive of acute interstitial nephritis?

    <p>Presence of <strong>white blood cells</strong> and <strong>eosinophils</strong> (D)</p> Signup and view all the answers

    In the absence of improvement after withdrawing the offending medication, what is the next recommended step in the management of acute interstitial nephritis?

    <p>Perform a renal biopsy and consider steroid therapy (D)</p> Signup and view all the answers

    Which of the following is a key strategy to prevent acute kidney injury (AKI)?

    <p>Maintain adequate volume and blood pressure (A)</p> Signup and view all the answers

    Which of the following medications should be held on the day of major procedures to help prevent AKI?

    <p>ACEi's/ARB's and diuretics (C)</p> Signup and view all the answers

    What does a high fractional excretion of sodium (FENa%) suggest in acute kidney injury?

    <p>Intrinsic renal disease (C)</p> Signup and view all the answers

    Which type of AKI is indicated by a low fractional excretion of sodium (FENa%)?

    <p>Prerenal cause (D)</p> Signup and view all the answers

    Which of the following is a key indication for starting renal replacement therapy (dialysis) in a patient with acute kidney injury (AKI)?

    <p>Presence of acidosis that cannot be managed with bicarbonate (B)</p> Signup and view all the answers

    What is a common phenomenon that can occur after a severe acute renal insult, such as acute tubular necrosis (ATN) or relief of obstruction?

    <p>Post-AKI diuresis (A)</p> Signup and view all the answers

    Which of the following laboratory tests is crucial in helping differentiate the underlying cause of acute kidney injury (AKI)?

    <p>Urinalysis and urine microscopy (D)</p> Signup and view all the answers

    What is a key strategy in the management of acute kidney injury (AKI) according to the text?

    <p>Identifying and reversing the underlying cause (B)</p> Signup and view all the answers

    What is a hallmark finding for glomerular disease when conducting urine microscopy?

    <p>Presence of red blood cell casts and dysmorphic RBC (A)</p> Signup and view all the answers

    Which syndrome presents with hypoalbuminemia, edema, and hyperlipidemia?

    <p>Nephrotic syndrome (A)</p> Signup and view all the answers

    What is the distinguishing feature in nephritic syndrome that is NOT present in nephrotic syndrome?

    <p>Hematuria (B)</p> Signup and view all the answers

    Which condition is considered a nephrologic emergency that can lead to advanced kidney disease in a matter of weeks to months?

    <p>Rapidly progressive glomerulonephritis (D)</p> Signup and view all the answers

    What is a common risk associated with glomerular disease other than kidney-related complications?

    <p>Hypertension (A)</p> Signup and view all the answers

    A hallmark finding associated with Rapidly progessive glomerulonephritis (RPGN)is:

    <p>“glomerular crescents” on biopsy (C)</p> Signup and view all the answers

    Which type of nephrotic syndrome is the most common primary form in adults in the United States?

    <p>Focal segmental glomerulosclerosis (FSGS) (C)</p> Signup and view all the answers

    Which of the following is a common characteristic of the clinical presentation of focal segmental glomerulosclerosis (FSGS)?

    <p>Presence of proteinuria and/or nephrotic syndrome (C)</p> Signup and view all the answers

    What is the primary treatment approach for focal segmental glomerulosclerosis (FSGS)?

    <p>Immunosuppression (steroids and/or calcineurin inhibitors) (B)</p> Signup and view all the answers

    What is the most common cause of secondary nephrotic syndrome, the most common glomerulopathy, as well as the most common cause of end-stage kidney disease in the United States?

    <p>Diabetic nephropathy (C)</p> Signup and view all the answers

    What is the most common cause of primary nephrotic syndrome in children according to the text?

    <p>Minimal change disease (A)</p> Signup and view all the answers

    What is a key difference in the presentation of patients with nephrotic syndrome compared to nephritic syndrome?

    <p>High proteinuria (D)</p> Signup and view all the answers

    Which glomerular condition is treated with immunosuppression therapy like steroids and calcineurin inhibitors?

    <p>Focal Segmental Glomerulosclerosis (FSGS) (B)</p> Signup and view all the answers

    What is the primary nephrotic syndrome in adults in the United States?

    <p>Focal Segmental Glomerulosclerosis (FSGS) (C)</p> Signup and view all the answers

    Which glomerular disease presents with thick capillary walls and antibodies to Phospholipase A2 receptors?

    <p>Membranous Nephropathy (B)</p> Signup and view all the answers

    Which glomerular condition is most common in children as the primary cause of nephrotic syndrome?

    <p>Minimal Change Disease (C)</p> Signup and view all the answers

    What symptom is commonly observed in patients with nephritic syndrome but not in those with nephrotic syndrome?

    <p>Hypertension (B)</p> Signup and view all the answers

    What is a hallmark finding associated with Rapidly Progressive Glomerulonephritis (RPGN)?

    <p>&quot;Glomerular crescents&quot; on biopsy (D)</p> Signup and view all the answers

    What is a common presentation seen in patients with Focal Segmental Glomerulosclerosis (FSGS)?

    <p>Hypoalbuminemia (D)</p> Signup and view all the answers

    Which of the following is a common secondary cause of Membranous Nephropathy?

    <p>Lupus, Penicillamine, Malignancies (A)</p> Signup and view all the answers

    How is FSGS typically treated?

    <p>Immunosuppression therapy such as steroids and calcineurin inhibitors (C)</p> Signup and view all the answers

    What is a significant risk factor for renal vein thrombosis in patients with Membranous Nephropathy?

    <p>Hyperlipidemia (A)</p> Signup and view all the answers

    Which glomerular condition can be due to a genetic predisposition, idiopathic, or secondary to another cause?

    <p>Focal Segmental Glomerulosclerosis (FSGS) (C)</p> Signup and view all the answers

    Which ethnic group has a higher risk of developing diabetic nephropathy?

    <p>Native American, Mexican American, and African American individuals (B)</p> Signup and view all the answers

    What is the first recognizable abnormality in diabetic nephropathy according to the text?

    <p>Albuminuria (A)</p> Signup and view all the answers

    What is the typical presentation of diabetic neuropathy according to the text?

    <p>Worsening proteinuria, hypertension, and a progressive decline in GFR (A)</p> Signup and view all the answers

    What is the primary treatment for diabetic nephropathy?

    <p>Blood glucose control and hypertension control with an ACE-I or ARB (A)</p> Signup and view all the answers

    Which type of glomerulonephritis is often ANCA-positive according to the text?

    <p>Pauci-immune glomerulonephritis (C)</p> Signup and view all the answers

    Which type of glomerulonephritis is described as a chronic condition with a low progression rate in the text?

    <p>IgA nephropathy (A)</p> Signup and view all the answers

    Which type of glomerulonephritis is most common 1-6 weeks after a streptococcal infection?

    <p>Infection-related glomerulonephritis (A)</p> Signup and view all the answers

    Which glomerular disease is common in Asian and Northern European populations according to the text?

    <p>IgA nephropathy (A)</p> Signup and view all the answers

    Study Notes

    Acute Kidney Injury (AKI)

    • Defined as an increase in serum creatinine of 0.3mg/dL or more in 48 hours, or serum creatinine at least 1.5 times baseline in the last seven days, or urine output less than 0.5 mg/kg/hr for at least 6 hours (oliguria)
    • Associated with increased mortality independent of the cause of injury
    • Presents with oliguria (less than 500 ml of urine per day in adults), and symptoms that are due to the underlying condition
    • Categorized as pre-renal AKI, post-renal AKI, and intrinsic renal AKI

    Post-Renal AKI

    • Due to an obstruction of urine outflow
    • Etiologies include urinary retention, urethral obstruction, and obstruction from a tumor
    • Can be reversible in the first few days
    • Can be found on ultrasound

    Pre-Renal AKI

    • Due to a drop in glomerular perfusion due to hypotension or hypovolemia
    • Can be caused by NSAIDs, ACEi, and ARBs due to hypotension
    • Characterized by a fractional excretion of sodium (FENa) usually less than 1 percent and fractional excretion of urea (FEUrea) usually greater than 35 percent

    Intrinsic Renal AKI

    • Commonly due to glomerular disease, specifically rapidly progressive glomerulonephritis
    • Can also be caused by acute tubular necrosis, acute interstitial nephritis, and tubular obstruction from crystals

    Acute Tubular Necrosis (ATN)

    • Death of the kidney tubules due to either ischemia or nephrotoxins
    • Nephrotoxins that can cause ATN include iodinated contrast
    • Lab findings include FENa greater than 2 percent and FEUrea greater than 35 percent
    • Characterized by the presence of "muddy brown pigmented, coarse granular casts" in the urine sediment
    • Managed with supportive care and preserving volume status while the tubules regenerate

    Acute Interstitial Nephritis

    • Caused by hypersensitivity to a medication, autoimmune causes, infectious causes, infiltrative disease, and toxins
    • May present with peripheral eosinophilia, pruritic rash, and/or fever
    • Usually diagnosed presumptively and treated by withdrawing the offending medication

    Prevention of AKI

    • Maintain adequate volume and blood pressure
    • Minimize exposure to ionic contrast
    • Hold ACEi's/ARB's and diuretics on the day of major procedures
    • Avoid NSAID's in high-risk patients
    • Use caution with nephrotoxic drugs in general

    Glomerular Disease

    • Characterized by proteinuria (specifically albuminuria)
    • Red blood cell casts and/or dysmorphic red blood cells are often present in urine microscopy due to damaged glomerulus
    • Hallmark findings include tea-colored urine due to large amounts of hematuria
    • Nephrotic syndrome presents with hypoalbuminemia, edema, hyperlipidemia, lipiduria
    • Nephritic syndrome presents with hematuria with dysmorphic red blood cells, hypertension, and azotemia
    • Rapidly progressive glomerulonephritis (RPGN) is a nephrologic emergency that can result in advanced CKD or end-stage kidney disease in weeks to months
    • Hallmark finding associated with RPGN is "glomerular crescents" on biopsy

    Nephrology

    • A medical subspecialty dealing with renal disorders and diseases
    • Focuses on maintaining the normal function of kidneys or restoring their function when damaged
    • Nephrologists diagnose and treat kidney diseases, electrolyte disorders, glomerular disease, renal transplantation, dialysis, hypertension, diabetes, and other related conditions.

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    Description

    Test your knowledge on the criteria used to define acute kidney injury (AKI) and the risk factors associated with it. Learn about the key indicators such as serum creatinine levels and urine output that signify AKI.

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