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What role does the aldosterone system play in relation to blood pressure?
What role does the aldosterone system play in relation to blood pressure?
Which type of drug is known to interfere with afferent arteriolar dilation?
Which type of drug is known to interfere with afferent arteriolar dilation?
What triggers glomerular injury related to immune complexes?
What triggers glomerular injury related to immune complexes?
Which condition is characterized by the deposition of IgA antibodies in the kidneys?
Which condition is characterized by the deposition of IgA antibodies in the kidneys?
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What can result from untreated glomerular damage?
What can result from untreated glomerular damage?
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Which of the following conditions is a complication of systemic lupus erythematosus?
Which of the following conditions is a complication of systemic lupus erythematosus?
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What physiological mechanism is primarily affected by ACE inhibitors?
What physiological mechanism is primarily affected by ACE inhibitors?
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What can lead to a functional acute kidney injury (AKI)?
What can lead to a functional acute kidney injury (AKI)?
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What is the most common cause of intrinsic AKI?
What is the most common cause of intrinsic AKI?
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Which factor is primarily associated with tubular damage in AKI?
Which factor is primarily associated with tubular damage in AKI?
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What percentage of patients may not recover baseline kidney function in acute interstitial nephritis if treatment is delayed?
What percentage of patients may not recover baseline kidney function in acute interstitial nephritis if treatment is delayed?
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Which of the following conditions is associated with renal ischemia?
Which of the following conditions is associated with renal ischemia?
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What is the main consequence of prolonged acute tubular necrosis on the medulla?
What is the main consequence of prolonged acute tubular necrosis on the medulla?
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Which type of AKI accounts for less than 5% of all AKI cases?
Which type of AKI accounts for less than 5% of all AKI cases?
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What is a common cause of bladder outlet obstruction leading to postrenal AKI?
What is a common cause of bladder outlet obstruction leading to postrenal AKI?
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Which nephrotoxin is specifically mentioned as damaging the renal tubules?
Which nephrotoxin is specifically mentioned as damaging the renal tubules?
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What condition can lead to prerenal acute kidney injury (AKI)?
What condition can lead to prerenal acute kidney injury (AKI)?
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Which gender is associated with a higher incidence of acute kidney injury?
Which gender is associated with a higher incidence of acute kidney injury?
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What is a primary factor contributing to intrinsic acute kidney injury?
What is a primary factor contributing to intrinsic acute kidney injury?
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Which racial group has an increased risk of developing acute kidney injury?
Which racial group has an increased risk of developing acute kidney injury?
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Which of the following conditions increases vulnerability to kidney injury?
Which of the following conditions increases vulnerability to kidney injury?
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What is the impact of chronic kidney disease (CKD) on acute kidney injury development?
What is the impact of chronic kidney disease (CKD) on acute kidney injury development?
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Which medications are mentioned as potentially harmful to kidney function?
Which medications are mentioned as potentially harmful to kidney function?
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What type of biomarkers are classified as conventional biomarkers?
What type of biomarkers are classified as conventional biomarkers?
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What does a risk score of 0 to 4 points indicate regarding AKI risk?
What does a risk score of 0 to 4 points indicate regarding AKI risk?
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What is the normal range for Blood Urea Nitrogen (BUN) levels?
What is the normal range for Blood Urea Nitrogen (BUN) levels?
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Which vasopressor is commonly used for hemodynamic support in cases of vasodilatory shock?
Which vasopressor is commonly used for hemodynamic support in cases of vasodilatory shock?
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What is the caloric intake goal according to KDIGO guidelines for patients with kidney impairment?
What is the caloric intake goal according to KDIGO guidelines for patients with kidney impairment?
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What should be monitored frequently in cases of severe hypocalcemia?
What should be monitored frequently in cases of severe hypocalcemia?
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What treatment should be considered if AKI leads to blood loss or symptomatic anemia?
What treatment should be considered if AKI leads to blood loss or symptomatic anemia?
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What is the Positive Predictive Value (PPV) of the risk score system for predicting AKI?
What is the Positive Predictive Value (PPV) of the risk score system for predicting AKI?
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What is one primary indication for the use of vasopressors in critically ill patients?
What is one primary indication for the use of vasopressors in critically ill patients?
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What primary factors influence the extent of cellular injury in acute tubular necrosis (ATN)?
What primary factors influence the extent of cellular injury in acute tubular necrosis (ATN)?
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In the context of acute interstitial nephritis (AIN), which of the following primarily triggers the condition?
In the context of acute interstitial nephritis (AIN), which of the following primarily triggers the condition?
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What are the characteristic clinical manifestations of the oliguric phase in acute kidney injury?
What are the characteristic clinical manifestations of the oliguric phase in acute kidney injury?
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Which cellular injury aspect is NOT associated with acute tubular necrosis (ATN)?
Which cellular injury aspect is NOT associated with acute tubular necrosis (ATN)?
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What is a common sign to look out for during the initiation phase of acute kidney injury?
What is a common sign to look out for during the initiation phase of acute kidney injury?
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What characterizes the progression from the initiation phase to the oliguric phase in acute kidney injury?
What characterizes the progression from the initiation phase to the oliguric phase in acute kidney injury?
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Which type of kidney injury is more commonly caused by nephrotoxins?
Which type of kidney injury is more commonly caused by nephrotoxins?
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Which immune response is activated in acute interstitial nephritis?
Which immune response is activated in acute interstitial nephritis?
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What is the immune response in acute interstitial nephritis (AIN) primarily characterized by?
What is the immune response in acute interstitial nephritis (AIN) primarily characterized by?
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During which phase do patients often mistake an increase in diuresis for normal kidney function?
During which phase do patients often mistake an increase in diuresis for normal kidney function?
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What characterizes the recovery phase of kidney function?
What characterizes the recovery phase of kidney function?
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What is a common symptom of acute kidney injury (AKI)?
What is a common symptom of acute kidney injury (AKI)?
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Which condition is specifically referred to as postrenal AKI?
Which condition is specifically referred to as postrenal AKI?
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What triggers the immune response that leads to drug-induced acute interstitial nephritis?
What triggers the immune response that leads to drug-induced acute interstitial nephritis?
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What is usually the timeframe for full recovery from kidney injury?
What is usually the timeframe for full recovery from kidney injury?
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What is a potential consequence of recognizing AKI symptoms late?
What is a potential consequence of recognizing AKI symptoms late?
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Study Notes
Acute Kidney Injury (AKI)
- AKI is a clinical syndrome characterized by an abrupt decrease in kidney function, evidenced by changes in serum creatinine, blood urea nitrogen (BUN), and urine output.
Pathophysiology
- Prerenal AKI: Results from hypoperfusion of the renal parenchyma, with or without systemic hypotension. Causes include: volume depletion (hemorrhage, vomiting, diarrhea, dehydration), reduced effective circulating volume, decreased cardiac output, and systemic vasodilation.
- Intrinsic AKI: Kidney damage from direct injury to kidney structures. This can affect various parts of the kidney, including: vasculature, glomeruli, tubules, and interstitium.
- Postrenal AKI: Obstruction at any level in the urinary collection system. Common causes include bladder outlet obstruction (e.g., benign prostatic hyperplasia, prostate cancer), ureteral obstruction (kidney stones, blood clots), or external compression.
Renal Vasculature Damage
- This is a less common cause of AKI. It can occur from obstruction of large renal vessels.
- Atheroemboli: Usually from vascular procedures (angioplasty, aortic manipulations). Plaques dislodge and travel to the kidneys.
- Thromboemboli: Can originate from mural thrombus (e.g., heart failure, atrial fibrillation). Blood clots travel from the heart to the kidneys.
Smaller Vessels
- Inflammation of renal capillaries can cause microvascular damage leading to ischemia (reduced blood supply) and complications like ischemic acute tubular necrosis (ATN).
Nephrophil Invasion
- Promotion of thrombus formation, tissue infarction, and collagen deposition influences kidney injury.
Hypertension
- Damages renal microvasculature, impairing blood flow and contributing to kidney injury.
Glomerular Damage
- Less frequent cause, often caused by immune complex deposition in glomeruli triggering an inflammatory response. Examples include lupus nephritis and IgA nephropathy.
Tubular Damage (ATN)
- The most common cause of intrinsic AKI, typically due to ATN resulting from renal ischemia or nephrotoxins (drugs like aminoglycosides and contrast dyes). Medullary tubules are particularly vulnerable to ischemic damage.
- Phases of ATN: Initiation (vasoconstriction/ischemia reduces GFR), Extension (increased hypoxia/inflammation), Maintenance (GFR at lowest point, repair begins), and Recovery (tubular regeneration and restoration of function).
Interstitial Damage (AIN)
- Commonly drug-induced or due to infections, autoimmune diseases. It's an immune-mediated reaction causing interstitial inflammation in the tubules and interstitial tissues.
Postrenal AKI
- Represents less than 5% of all AKI cases.
- Any obstruction of urinary collection system results in accumulation of urine upstream, increasing pressure and reducing glomerular filtration rate (GFR).
Risk Factors
- Chronic kidney disease (CKD)
- Diabetes
- Heart and liver diseases
- Albuminuria
- Major surgery
- Acute decompensated heart failure
- Sepsis
- Hypotension
- Medications (e.g., ACE inhibitors, ARBs, aminoglycosides)
- Advanced age
- Male gender
- African American race
Clinical Manifestations
- Reduced urine output (oliguria or anuria)
- Fluid overload (edema)
- Metabolic acidosis
- Electrolyte imbalances
- Uremia-related symptoms (fatigue, nausea, vomiting, confusion, metallic taste, ammonia breath)
Laboratory Evaluation
- Serum creatinine, blood urea nitrogen (BUN), and urine output.
- Advanced biomarkers (TIMP-2, IGFBP7) for early AKI detection.
- Urinalysis and electrolyte measurements to distinguish causes.
Staging
- Three major classification systems for AKI: RIFLE, AKIN, and KDIGO
- KDIGO is extensively used for clinical assessment
- Staging is often based on serum creatinine and urine output.
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Description
This quiz covers the key aspects of Acute Kidney Injury (AKI), including its definitions, types, and underlying causes. Understand the different categories: prerenal, intrinsic, and postrenal AKI, as well as renal vasculature damage. Test your knowledge on how these factors impact kidney function.
