Acute Kidney Injury Quiz
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Questions and Answers

What is the primary definition of acute kidney injury (AKI)?

  • Chronic loss of kidney functions over time
  • Abrupt loss of kidney functions (correct)
  • Sustained increase in kidney performance
  • Gradual decline in kidney functions

    • Which of the following is NOT a typical effect of acute kidney injury?

  • Electrolyte disturbances
  • Waste product retention
  • Increased kidney filtration rate (correct)
  • Volume status changes

    • Which biomarker is commonly used to detect acute kidney injury?

  • Blood urea nitrogen (BUN)
  • Serum creatinine (SCr) (correct)
  • Urine output measurement
  • Plasma sodium levels

    • What does the RIFLE classification for acute kidney injury include?

    <p>Risk, Injury, Failure, Loss, End-stage</p> Signup and view all the answers

    What is the purpose of the AKIN criteria?

    <p>To standardize definitions and severity of AKI</p> Signup and view all the answers

    What happens to serum creatinine levels following the onset of acute kidney injury?

    <p>They increase but often lag behind the onset of injury</p> Signup and view all the answers

    Which classification specifically aims to improve global outcomes related to kidney diseases?

    <p>KDIGO</p> Signup and view all the answers

    In the context of acute kidney injury, what does the 'Injury' stage of the RIFLE classification signify?

    <p>Significant but reversible kidney damage</p> Signup and view all the answers

    What is the primary fluid of choice for intravascular volume expansion?

    <p>Isotonic crystalloids</p> Signup and view all the answers

    Which type of solution has been associated with adverse effects and should be avoided?

    <p>Hydroxyethylstarch</p> Signup and view all the answers

    What volume of total body water is generally present in an adult?

    <p>40 L</p> Signup and view all the answers

    How do colloid solutions primarily function in managing fluid status?

    <p>Increase intravascular oncotic pressure</p> Signup and view all the answers

    Which of the following is a common effect of acute kidney injury (AKI)?

    <p>Volume overload</p> Signup and view all the answers

    What is the recommended type of diuretics for treating volume overload in AKI?

    <p>Loop diuretics</p> Signup and view all the answers

    What is the role of diuretics in the management of acute kidney injury?

    <p>They facilitate fluid management</p> Signup and view all the answers

    What percentage of body weight approximately corresponds to total body water volume in an adult?

    <p>60%</p> Signup and view all the answers

    Which of the following colloids might be utilized for large fluid volume patients?

    <p>Gelatins</p> Signup and view all the answers

    What should be monitored to ensure proper kidney function in patients with pre-renal AKI?

    <p>Fluid status and blood pressure</p> Signup and view all the answers

    What defines a significant increase in serum creatinine (SCr) according to KDIGO guidelines?

    <p>0.3 mg/dL increase within 48 hours</p> Signup and view all the answers

    Which of the following is NOT a type of Acute Kidney Injury (AKI)?

    <p>Peri-renal</p> Signup and view all the answers

    What is a common condition that increases the risk of developing AKI in patients?

    <p>Hypertension</p> Signup and view all the answers

    Which of the following is a key indicator of pre-renal AKI?

    <p>Hypo-perfusion to the kidney</p> Signup and view all the answers

    What does a 50% increase in SCr indicate within the last 7 days?

    <p>Risk of Acute Kidney Injury</p> Signup and view all the answers

    Which factor does NOT contribute to the risk of AKI in the elderly?

    <p>Lower protein levels in urine</p> Signup and view all the answers

    What condition is characterized by excess protein in urine?

    <p>Proteinuria</p> Signup and view all the answers

    Which of the following severely increases AKI risk post-operation?

    <p>Blood loss during major surgery</p> Signup and view all the answers

    Which situation describes a post-renal cause of AKI?

    <p>Obstruction of urinary outflow</p> Signup and view all the answers

    What can a sudden drop in urinary output indicate?

    <p>Possible Acute Kidney Injury</p> Signup and view all the answers

    What is one reason early initiation of RRT is preferred?

    <p>It reduces 90-day mortality.</p> Signup and view all the answers

    Which condition is most commonly associated with the initiation of RRT?

    <p>Volume overload and solute imbalances.</p> Signup and view all the answers

    What is a characteristic of Continuous Therapies compared to Intermittent Hemodialysis?

    <p>They provide treatment 24/7.</p> Signup and view all the answers

    What advantage does CRRT have over traditional intermittent RRT?

    <p>Better control of volume and solute removal.</p> Signup and view all the answers

    How does molecular weight affect the dialysis process?

    <p>Smaller molecules pass through the dialysis membrane more easily.</p> Signup and view all the answers

    Which of the following drugs is likely to be poorly dialyzable?

    <p>Highly protein-bound drugs.</p> Signup and view all the answers

    What effect do higher dialysate flow rates have during dialysis?

    <p>They enhance dialysis clearance when drug levels are low.</p> Signup and view all the answers

    What is the primary purpose of comprehensive lab testing in acute kidney injury?

    <p>To monitor kidney function and guide treatment</p> Signup and view all the answers

    Which of the following factors should be identified when gathering medical history for acute kidney injury assessment?

    <p>Fluid losses and comorbidities</p> Signup and view all the answers

    What is the main function of renal ultrasonography in the clinical workup of acute kidney injury?

    <p>To assess the size, shape, and structure of the kidneys</p> Signup and view all the answers

    Which laboratory study is used to assess urine composition in patients with acute kidney injury?

    <p>Urinalysis</p> Signup and view all the answers

    What should be the focus of therapy for acute kidney injury?

    <p>Treating underlying causes of the injury</p> Signup and view all the answers

    Which type of imaging study is helpful in diagnosing renal artery stenosis?

    <p>Renal Doppler ultrasonography</p> Signup and view all the answers

    Which of the following is a critical element to assess during a physical examination for kidney issues?

    <p>Vital signs and volume status</p> Signup and view all the answers

    What should be avoided in patients with acute kidney injury to prevent further damage to the kidneys?

    <p>Nephrotoxins</p> Signup and view all the answers

    What does a complete blood count measure in the context of kidney injury assessment?

    <p>Red and white blood cell counts</p> Signup and view all the answers

    Why is it important to consider previous lab results when assessing a patient for acute kidney injury?

    <p>To identify trends in kidney function over time</p> Signup and view all the answers

    Study Notes

    Acute Kidney Injury (AKI) Overview

    • AKI is the abrupt loss of kidney function
    • Effects include waste product retention, electrolyte imbalances, and changes in fluid balance
    • Detection involves changes in biomarkers like serum creatinine (SCr), typically lagging 48-72 hours behind the onset of injury

    Learning Outcomes

    • Distinguish different types of acute kidney injury
    • Apply various therapeutic strategies for AKI treatment
    • Demonstrate understanding of renal replacement therapy (RRT)

    AKI Classification Systems

    • RIFLE: Risk, Injury, Failure, Loss, End-stage
    • AKIN: Acute Kidney Injury Network
    • KDIGO: Kidney Disease Improving Global Outcomes

    RIFLE Classification

    • Criteria are based on serum creatinine and urine output changes
    • Stages include Risk, Injury, Failure, Loss, and End-stage
    • Purpose: Standardize definition and severity of AKI

    AKIN Criteria

    • SCr increase: 0.3 mg/dL over baseline within 48 hours
    • Percentage increase: 50% or more increase in SCr within 7 days
    • Urine output: Less than 0.5 mL/kg/hour for more than 6 hours

    KDIGO Guidelines

    • SCr increase: 0.3 mg/dL within 48 hours
    • Percentage increase: 50% increase in SCr within the previous 7 days

    Risk Factors for AKI

    • Age: Increased risk with advanced age
    • Comorbidities (HTN, Diabetes): Presence of other health conditions
    • Proteinuria: Excess protein in the urine
    • Major Surgery: Increased post-operative risk
    • Dehydration
    • High Blood Pressure
    • Infections
    • Medications
    • Various factors like obstructions etc

    Types of AKI

    • Pre-renal: Hypo-perfusion to the kidney
    • Intrinsic: Damage directly to the kidney
    • Post-renal: Obstruction of urinary outflow

    Pre-Renal Causes of Decreased Perfusion

    • Fluid Loss: Inadequate intake, vomiting, diarrhea, fever
    • Blood Loss: Trauma resulting in massive hemorrhage
    • Systemic Conditions: Sepsis, heart failure, liver cirrhosis

    Medications Affecting Kidney Blood Flow

    • Efferent Arteriole: Drugs causing vasodilation (ACEI)
    • Prostaglandin Inhibition: Drugs inhibiting vasodilatory prostaglandin synthesis
    • Afferent Arteriole: Drugs causing vasoconstriction

    Intrinsic AKI Causes:

    • Acute tubular injury: Damage to kidney tubules
    • Tubulointerstitial injury: Inflammation of kidney tissue
    • Glomerulonephritis: Inflammation of kidney filtering units

    Glomerular Causes of Intrinsic AKI

    • Autoimmune disorders: Immune system attacking kidney tissue
    • Oncology drugs: Certain cancer treatments affecting glomeruli
    • Specific medications: Interferon, pamidronate, gemcitabine, VEGF inhibitors

    Tubular Causes of Intrinsic AKI: Part 1

    • Antimicrobials: Certain antibiotics can damage kidney tubules
    • Nephrotoxic drugs: Various medications with kidney-damaging effects
    • Acute tubular necrosis: Caused by ischemia (lack of blood supply) or exposure to nephrotoxins (toxins)
    • Contrast media

    Tubular Causes of Intrinsic AKI: Part 2

    • Aminoglycoside-associated ATN: Occurs in a significant portion of adults and infants
    • Amphotericin B: Can cause AKI in a substantial percentage of cases
    • Vancomycin nephrotoxicity: Ongoing debate about its role
    • Contrast-induced nephrotoxicity: Occurs in a varying percentage of patients

    Vascular/Thrombotic Causes of Intrinsic AKI

    • Vasculitis: Inflammation of blood vessels
    • Malignant hypertension: Severe high blood pressure
    • Thrombotic disorders: Blood clotting issues affecting the kidneys

    Interstitial Causes of Intrinsic AKI

    • Infections: Pyelonephritis, renal tuberculosis, fungal nephritis
    • Medications: Antibiotics, NSAIDs, diuretics
    • Immune disorders: Various autoimmune conditions affecting the kidney interstitium

    Post-Renal AKI: Obstruction Causes

    • Nephrolithiasis: Kidney stones obstructing urine flow
    • Benign Prostatic Hypertrophy: Enlarged prostate compressing the urethra
    • Surgical Complications: Post-operative issues leading to obstruction

    Post-Renal Obstruction Causes

    • Kidney stones: Obstruction by calculi
    • Prostatic Hypertrophy: Enlarged prostate blocking urine flow
    • Retroperitoneal Fibrosis: Scarring around kidneys and ureters

    Drug-Induced Crystalluria

    • Mechanism: Low solubility drugs crystallize in urine, forming crystals
    • Effect: Crystals obstruct the collecting system
    • Risk Factors: High drug doses, dehydration, acidic urine

    Common Causes of AKI (Summary)

    • Pre-renal: Hypovolemia, decreased cardiac output, decreased peripheral vascular resistance
    • Intra-renal: Nephrotoxic injury, contrast dye, crush injury, interstitial nephritis, allergies, infections, acute glomerularnephritis, malignant hypertension
    • Post-renal: Benign prostatic hypertrophy, bladder cancer, calculi formation, spinal cord disease

    Clinical Workup

    • Comprehensive evaluation: History, physical examination, and diagnostic tests
    • History details: Fluid losses, previous lab results, comorbidities, and medication history
    • Physical Exam: Assess vital signs, volume status, and signs of underlying conditions

    Laboratory Studies

    • Serum Chemistry: Analyze blood samples to assess electrolytes and metabolic status
    • Urinalysis: Evaluate urine composition and sediment to identify potential issues
    • Complete Blood Count: Measure red and white blood cell counts to detect abnormalities

    Radiographic Studies

    • Include: Renal ultrasonography, Renal Doppler Ultrasonography, Renal Biopsy
    • Renal Ultrasonography: Evaluates kidney size, shape, and structure
    • Renal Doppler Ultrasonography: Assesses blood flow to kidneys, helpful in diagnosing renal artery stenosis
    • Renal Biopsy: Obtaining a kidney tissue sample for microscopic examination

    Therapy for Acute Kidney Injury (AKI)

    • Treat the underlying cause
    • Discontinue nephrotoxins
    • Ensure proper perfusion (monitor fluid status and blood pressure)

    Fluid Replacement

    • Crystalloids vs. Colloids: Crystalloids are more commonly used for resuscitation in pre-renal AKI
    • Colloid solutions: increase intravascular oncotic pressure and shift fluid into the bloodstream

    The KDIGO Guideline

    • Isotonic crystalloids are the fluid of choice for volume expansion
    • Avoid Hydroxyethylstarch due to adverse effects
    • Colloids may still play a role in some cases, particularly larger fluid volumes

    Diuretics

    • Manage fluid overload in AKI
    • Facilitates fluid management
    • Potential renoprotective effects
    • Recommended for treating volume overload and hyperkalemia

    Vasopressors

    • Maintain adequate mean arterial pressure (MAP) for organ perfusion
    • Often necessary when fluid resuscitation alone is insufficient
    • Potential risk for further kidney damage

    Renal Replacement Therapy (RRT)

    • Indications: Anuria, acute fluid overload, severe hyperkalemia, metabolic acidosis, elevated BUN
    • Prevalence: Required in a percentage of critically ill patients with AKI
    • Optimization: Factors to consider include timing, modality, dose, and clearance
    • Timing and initiation: Early initiation is often beneficial
    • Modalities: Intermittent hemodialysis (IHD), Continuous therapies, Hybrid therapies

    CRRT Advantages (Continuous Renal Replacement Therapy)

    • Improved hemodynamic stability
    • Reduced downtime for other procedures

    Drug Dosing in Dialysis (Important Considerations)

    • Molecular weight, protein binding, volume of distribution, dialysis flow rates

    Common Dialyzable Drugs

    • Important to monitor drug levels for proper dosing
    • Important consideration for patient care

    Case Study Introduction

    • 75-year-old male
    • Decreased urine output
    • Right hemi-colectomy 4 hours prior
    • Vital signs: HR 116 BPM, BP 90/60 mmHg

    Patient Medical History

    • Hypertension
    • Type 2 Diabetes Mellitus
    • Gout
    • Medications: Lisinopril, Diclofenac, Allopurinol, Spironolactone

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    Acute Kidney Injury Part 1 PDF

    Description

    Test your knowledge on acute kidney injury (AKI), its definitions, classifications like RIFLE and AKIN, and the biomarkers used for detection. This quiz will challenge your understanding of the impact of AKI and its global significance in kidney disease management.

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