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Questions and Answers
Which condition is classified under intrarenal causes of AKI?
What is a common cause of acute tubular necrosis (ATN)?
Which of the following factors may trigger an inflammatory response in acute tubular necrosis?
What characterizes prerenal conditions related to AKI?
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In what phase of AKI are symptoms typically absent, but renal damage is already occurring?
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Which process contributes to the worsening of tubular injury in AKI?
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What is a significant post-renal condition that can lead to AKI?
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How does reduced blood flow affect the kidneys during AKI?
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Study Notes
AKI (Acute Kidney Injury)
- Characterized by a sudden loss of renal function, often reversible.
- Can be classified into three categories: prerenal, intrarenal, and postrenal.
Prerenal AKI
- Characterized by decreased renal perfusion due to factors like:
- Extremely low blood pressure or blood volume
- Heart dysfunction (e.g., myocardial infarction, heart failure)
- Liver disease with portal hypertension
Intrarenal AKI
- Involves direct damage to the kidney structures.
- Can be further categorized into:
- Vascular disease:
- Reduced blood supply within the kidney (e.g., atherosclerosis, renal vein thrombosis, renal aneurysm, aortic dissection)
- Glomerular disease:
- Conditions like glomerulonephritis and acute interstitial nephritis (often linked to allergic reactions to nephrotoxic medications)
- Tubular and interstitial disease:
- Tubular disorders and toxic injury
- Vascular disease:
Postrenal AKI
- Occurs when urine excretion is interfered with due to:
- Bilateral ureter obstruction (e.g., kidney stones, tumors)
- Bladder obstruction and dysfunction (e.g., benign prostatic hyperplasia, tumors, nerve innervation disruption)
Acute Tubular Necrosis (ATN)
- A common cause of intrarenal AKI.
- Often triggered by ischemia (reduced blood flow) due to decreased renal perfusion and sepsis.
- Exposure to nephrotoxic drugs can also contribute.
- Process involves:
- Nephron injury leading to reduced blood flow and increased vascular permeability.
- Inflammatory response with activation of leukocytes, macrophages, and complement.
- Impaired sodium, water, and other substance transport in the kidney.
- Tubular shedding and obstruction, leading to pressure buildup within the lumen.
- Necrosis in multiple areas of the tubule.
Phases of AKI
- Initial phase: Often asymptomatic, renal damage is occurring, functioning nephrons compensate.
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Oliguric phase: Impaired glomerular filtration leads to solute and water reabsorption, waste products accumulate (uremia).
- Characterized by decreased urine output, electrolyte disturbances, fluid volume excess, azotemia (elevated nitrogenous waste in the blood), and metabolic acidosis.
- Lasts for days to weeks.
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Diuretic phase: Gradual return of renal function, cell regeneration occurs.
- Tubular damage impairs urine concentration, leading to excessive diuresis (increased urine production - up to 5L/day).
- Can lead to dehydration and electrolyte imbalances.
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Recovery phase: Gradual restoration of normal glomerular function and resolution of symptoms.
- Can persist for 3 to 12 months.
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Description
Explore the critical aspects of Acute Kidney Injury (AKI), including its categories: prerenal, intrarenal, and postrenal. Understand the causes, symptoms, and treatment options for each type of AKI. Enhance your knowledge on how these factors influence renal function.
