AKI AAFP
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Which of the following conditions can lead to prerenal acute kidney injury?

  • Acute tubular necrosis
  • Prolonged hypotension
  • Decreased cardiac output (correct)
  • Kidney stones

    • What mechanism do ACE inhibitors and ARBs use to impair renal perfusion?

  • Increased intraglomerular pressure
  • Constriction of the afferent arteriole
  • Dilation of the efferent arteriole (correct)
  • Relaxation of the colonic vascular supply

    • Which of the following is NOT considered an intrinsic cause of acute kidney injury?

  • Neurogenic bladder (correct)
  • Acute tubular necrosis
  • Acute interstitial nephritis
  • Immune complex-mediated injury

    • Which statement best describes acute tubular necrosis?

    <p>It involves damage to the tubular cells due to ischemic or nephrotoxic reasons.</p> Signup and view all the answers

    Which of the following medications is most likely to contribute to acute interstitial nephritis?

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

    Identify a postrenal cause of acute kidney injury.

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

    What is the primary supportive management for acute kidney injury (AKI)?

    <p>Fluid resuscitation</p> Signup and view all the answers

    Which of the following is a typical symptom of prerenal acute kidney injury?

    <p>Decreased renal perfusion</p> Signup and view all the answers

    What is an essential characteristic of Stage 1 acute kidney injury?

    <p>Increase of 1.5 to twofold from baseline serum creatinine</p> Signup and view all the answers

    Which treatment is indicated for severe hyperkalemia to shift potassium into cells?

    <p>5 to 10 units of regular insulin with dextrose</p> Signup and view all the answers

    What does elevated antistreptolysin O titer typically indicate?

    <p>Poststreptococcal glomerulonephritis</p> Signup and view all the answers

    What is a consequence of a chloride-restrictive strategy for resuscitation in ICU patients?

    <p>Lower incidence of acute kidney injury</p> Signup and view all the answers

    What does an increase in serum creatinine greater than threefold from baseline indicate?

    <p>Stage 3 acute kidney injury</p> Signup and view all the answers

    What is the recommended action regarding the use of diuretics for acute kidney injury in absence of volume overload?

    <p>They have no benefit and should not be used</p> Signup and view all the answers

    Which condition is indicated by increased anion gap and increased osmolar gap?

    <p>Ethylene glycol or methanol poisoning</p> Signup and view all the answers

    Which lab finding may suggest the presence of multiple myeloma?

    <p>Monoclonal spike on serum protein electrophoresis</p> Signup and view all the answers

    What mechanism primarily causes prerenal acute kidney injury?

    <p>Decreased renal perfusion and GFR</p> Signup and view all the answers

    Which of the following is the most common cause of intrinsic acute kidney injury?

    <p>Acute tubular necrosis</p> Signup and view all the answers

    What type of medication is primarily associated with the development of acute interstitial nephritis?

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

    Which of the following conditions is NOT a cause of postrenal acute kidney injury?

    <p>Acute tubular necrosis</p> Signup and view all the answers

    Which of the following conditions can lead to ischemic acute tubular necrosis?

    <p>Severe dehydration</p> Signup and view all the answers

    How do ACE inhibitors contribute to decreased renal perfusion?

    <p>By dilation of the efferent arteriole</p> Signup and view all the answers

    Which statement best describes the nature of postrenal acute kidney injury?

    <p>It is due to obstruction of urinary flow.</p> Signup and view all the answers

    In the context of acute kidney injury, which condition is likely caused by medication side effects?

    <p>Acute interstitial nephritis</p> Signup and view all the answers

    What urine output defines oliguria?

    <p>Less than 400 ml per day</p> Signup and view all the answers

    Which stage of acute kidney injury (AKI) is characterized by an increase of more than threefold from baseline or a serum creatinine level of at least 4.0 mg per dL?

    <p>Stage 3</p> Signup and view all the answers

    What is the consequence of using diuretics in acute kidney injury when there is no volume overload?

    <p>Increases morbidity and mortality</p> Signup and view all the answers

    What abnormal laboratory finding is associated with rhabdomyolysis?

    <p>Elevated creatinine kinase level</p> Signup and view all the answers

    What does the presence of a positive ANA and double stranded DNA antibody indicate?

    <p>Autoimmune disease</p> Signup and view all the answers

    In patients with severe hyperkalemia, what is the recommended intravenous treatment to shift potassium into cells?

    <p>5 to 10 units of regular insulin with dextrose</p> Signup and view all the answers

    What does a chloride-restrictive strategy for resuscitation in ICU patients help to minimize?

    <p>Acute kidney injury</p> Signup and view all the answers

    What elevated titer is typically linked to poststreptococcal glomerulonephritis?

    <p>Elevated antistreptolysin O</p> Signup and view all the answers

    What does serum creatinine levels indicate in relation to acute kidney injury?

    <p>Severity of kidney injury</p> Signup and view all the answers

    Which of the following correctly describes oliguria?

    <p>Urine output less than 400 ml per day</p> Signup and view all the answers

    What is the significance of a chloride-restrictive strategy during resuscitation in ICU patients?

    <p>Decreases incidence of acute kidney injury</p> Signup and view all the answers

    What does Stage 2 acute kidney injury indicate regarding urine output?

    <p>Less than 0.5 mL per kg per hour for more than 12 hours</p> Signup and view all the answers

    In the context of acute kidney injury, which statement about diuretics is accurate?

    <p>They should not be used without volume overload.</p> Signup and view all the answers

    What indicates an acute rise of at least 0.5 mg per dL in the context of Stage 3 AKI?

    <p>An increase &gt; threefold from baseline</p> Signup and view all the answers

    What does elevated levels of creatine kinase typically indicate?

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

    What abnormal laboratory finding is associated with Elevated Uric Acid levels?

    <p>Tumor Lysis Syndrome</p> Signup and view all the answers

    Which of the following is a possible consequence of peripheral vasodilation in the context of prerenal acute kidney injury?

    <p>Decreased glomerular filtration rate</p> Signup and view all the answers

    What is a potential result of acute tubular necrosis due to ischemic causes?

    <p>Irreversible damage leading to chronic kidney disease</p> Signup and view all the answers

    Which of the following medications is most likely to induce acute interstitial nephritis?

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

    What is the primary mechanism that causes decreased renal perfusion in prerenal acute kidney injury related to hypovolemia?

    <p>Decreased blood volume returning to the heart</p> Signup and view all the answers

    Acute kidney injury can be categorized by income location. Which specific area is most affected by acute tubular necrosis?

    <p>Renal tubules</p> Signup and view all the answers

    In the context of postrenal acute kidney injury, which condition is most directly associated with obstruction of urinary flow?

    <p>Neurogenic bladder</p> Signup and view all the answers

    Which of the following is characterized by a hypersensitivity reaction that can lead to acute kidney injury?

    <p>Acute interstitial nephritis</p> Signup and view all the answers

    What is the mechanism by which medications like ACE inhibitors affect renal perfusion?

    <p>Dilation of the efferent arteriole</p> Signup and view all the answers

    What is the urinary output that defines anuria?

    <p>Less than 100 ml per day</p> Signup and view all the answers

    What potentially indicates worsening renal function in the context of chloride levels?

    <p>Excess chloride</p> Signup and view all the answers

    Which stage of acute kidney injury is characterized by a urine output of less than 0.3 mL per kg per hour for 24 hours?

    <p>Stage 3</p> Signup and view all the answers

    What is a consequence of acute kidney injury related to elevated antistreptolysin O titers?

    <p>Poststreptococcal glomerulonephritis</p> Signup and view all the answers

    What parameters are utilized in the diagnosis of acute kidney injury?

    <p>Serum creatinine levels, urine output, and the need for renal replacement therapy</p> Signup and view all the answers

    What is the appropriate action regarding the use of dopamine for acute kidney injury prevention?

    <p>It should not be used.</p> Signup and view all the answers

    What urine output characterizes Stage 1 acute kidney injury according to the criteria provided?

    <p>Increase in serum creatinine by ≥ 0.3 mg per dL</p> Signup and view all the answers

    What is the relationship between diuretics and acute kidney injury when there is no volume overload?

    <p>They have no effect on morbidity or mortality.</p> Signup and view all the answers

    What physiological condition primarily leads to prerenal acute kidney injury?

    <p>Decreased renal perfusion</p> Signup and view all the answers

    Which factor is associated with the intrinsic cause of acute kidney injury?

    <p>Immune complex-mediated injury</p> Signup and view all the answers

    In the context of acute tubular necrosis, which of the following describes its mechanism of injury?

    <p>Ischemic or nephrotoxic damage to tubules</p> Signup and view all the answers

    What is a common drug class reported to lower renal perfusion through the dilation of arterioles?

    <p>ACE inhibitors</p> Signup and view all the answers

    Which of the following is classified as a postrenal cause of acute kidney injury?

    <p>Prostate enlargement</p> Signup and view all the answers

    Which of the following best characterizes acute interstitial nephritis?

    <p>A hypersensitivity reaction to medications</p> Signup and view all the answers

    What is one of the major examples of ischemic causes which can lead to acute tubular necrosis?

    <p>Prolonged periods of hypotension</p> Signup and view all the answers

    Which conditions can lead to postrenal acute kidney injury due to obstructions?

    <p>Neurogenic bladder</p> Signup and view all the answers

    Study Notes

    Etiologies of Acute Kidney Injury (AKI)

    • AKI is classified into three main categories: prerenal, intrinsic, and postrenal causes.

    Prerenal Acute Kidney Injury

    • Results from decreased renal perfusion and glomerular filtration rate (GFR) due to:
      • Intravascular volume depletion (e.g., vomiting, diarrhea)
      • Peripheral vasodilation
      • Decreased arterial pressures
      • Impaired cardiac function
    • Common medications that lower renal perfusion include ACE inhibitors, ARBs, and NSAIDs.
    • ACE inhibitors and ARBs cause reduced intraglomerular pressure through dilation of the efferent arterioles.

    Intrinsic Acute Kidney Injury

    • Injury categorized by location, primarily affecting:
      • Glomerulus
      • Tubule
      • Interstitial or vascular areas
    • Most common cause is acute tubular necrosis (ATN), resulting from ischemic or nephrotoxic damage.

    Acute Tubular Necrosis

    • Defined as damage to tubular cells from prolonged ischemia or nephrotoxicity.
    • Ischemic causes include severe hypotension, hypovolemia, and renal hypoperfusion due to hemorrhage or sepsis.

    Acute Interstitial Nephritis

    • A significant contributor to AKI, often due to hypersensitivity reactions to medications (e.g., antibiotics, NSAIDs).

    Postrenal Causes of Acute Kidney Injury

    • Results from urinary flow obstruction due to conditions like:
      • Neurogenic bladder
      • Retroperitoneal fibrosis
      • Tumor burdens (bladder, prostate, cervical cancer)

    Management of Acute Kidney Injury

    • Supportive care is the primary approach.
    • Resuscitation indicated using isotonic crystalloids such as 0.9% normal saline and lactated Ringer's solution.
    • Excess chloride can indicate worsened renal function and acid-base disturbances.
    • A chloride-restrictive strategy during resuscitation is associated with lower AKI incidence.

    Urine Output Definitions

    • Oliguria: Urine output < 400 mL/day.
    • Anuria: Urine output < 100 mL/day.

    Treatment for Severe Hyperkalemia

    • Administer 5-10 units of regular insulin with 50% dextrose IV to shift potassium into cells.

    Diagnosis of Acute Kidney Injury

    • Based on serum creatinine levels, urine output, and need for renal replacement therapy.

    Recommendations and Considerations

    • Dopamine is not recommended for preventing AKI.
    • Diuretics do not improve outcomes in AKI without volume overload.

    Stages of Acute Kidney Injury

    • Stage 1: Creatinine increase ≥ 0.3 mg/dL or 1.5-2 times baseline; urine output < 0.5 mL/kg/hour for >6 hours.
    • Stage 2: Creatinine increase > 2-3 times baseline; urine output < 0.5 mL/kg/hour for >12 hours.
    • Stage 3: Creatinine increase > 3 times baseline or ≥ 4.0 mg/dL; urine output < 0.3 mL/kg/hour for 24 hours or anuria for 12 hours.

    Clinical Indicators

    • Elevated antistreptolysin O titer suggests poststreptococcal glomerulonephritis.
    • Elevated creatine kinase/myoglobin levels with dipstick positive for blood indicates rhabdomyolysis.
    • Elevated prostate-specific antigen suggests prostate hypertrophy or cancer.
    • Elevated uric acid levels may indicate malignancy or tumor lysis syndrome.
    • Increased anion gap and osmolar gap may indicate ethylene glycol/methanol poisoning.
    • Low complement levels could indicate systemic lupus erythematosus (SLE), endocarditis, or postinfectious glomerulonephritis.
    • Monoclonal spike on serum protein electrophoresis is indicative of multiple myeloma.
    • Positive ANA and double-stranded DNA antibodies suggest autoimmune diseases like SLE.

    Etiologies of Acute Kidney Injury (AKI)

    • AKI is classified into three main categories: prerenal, intrinsic, and postrenal causes.

    Prerenal Acute Kidney Injury

    • Results from decreased renal perfusion and glomerular filtration rate (GFR) due to:
      • Intravascular volume depletion (e.g., vomiting, diarrhea)
      • Peripheral vasodilation
      • Decreased arterial pressures
      • Impaired cardiac function
    • Common medications that lower renal perfusion include ACE inhibitors, ARBs, and NSAIDs.
    • ACE inhibitors and ARBs cause reduced intraglomerular pressure through dilation of the efferent arterioles.

    Intrinsic Acute Kidney Injury

    • Injury categorized by location, primarily affecting:
      • Glomerulus
      • Tubule
      • Interstitial or vascular areas
    • Most common cause is acute tubular necrosis (ATN), resulting from ischemic or nephrotoxic damage.

    Acute Tubular Necrosis

    • Defined as damage to tubular cells from prolonged ischemia or nephrotoxicity.
    • Ischemic causes include severe hypotension, hypovolemia, and renal hypoperfusion due to hemorrhage or sepsis.

    Acute Interstitial Nephritis

    • A significant contributor to AKI, often due to hypersensitivity reactions to medications (e.g., antibiotics, NSAIDs).

    Postrenal Causes of Acute Kidney Injury

    • Results from urinary flow obstruction due to conditions like:
      • Neurogenic bladder
      • Retroperitoneal fibrosis
      • Tumor burdens (bladder, prostate, cervical cancer)

    Management of Acute Kidney Injury

    • Supportive care is the primary approach.
    • Resuscitation indicated using isotonic crystalloids such as 0.9% normal saline and lactated Ringer's solution.
    • Excess chloride can indicate worsened renal function and acid-base disturbances.
    • A chloride-restrictive strategy during resuscitation is associated with lower AKI incidence.

    Urine Output Definitions

    • Oliguria: Urine output < 400 mL/day.
    • Anuria: Urine output < 100 mL/day.

    Treatment for Severe Hyperkalemia

    • Administer 5-10 units of regular insulin with 50% dextrose IV to shift potassium into cells.

    Diagnosis of Acute Kidney Injury

    • Based on serum creatinine levels, urine output, and need for renal replacement therapy.

    Recommendations and Considerations

    • Dopamine is not recommended for preventing AKI.
    • Diuretics do not improve outcomes in AKI without volume overload.

    Stages of Acute Kidney Injury

    • Stage 1: Creatinine increase ≥ 0.3 mg/dL or 1.5-2 times baseline; urine output < 0.5 mL/kg/hour for >6 hours.
    • Stage 2: Creatinine increase > 2-3 times baseline; urine output < 0.5 mL/kg/hour for >12 hours.
    • Stage 3: Creatinine increase > 3 times baseline or ≥ 4.0 mg/dL; urine output < 0.3 mL/kg/hour for 24 hours or anuria for 12 hours.

    Clinical Indicators

    • Elevated antistreptolysin O titer suggests poststreptococcal glomerulonephritis.
    • Elevated creatine kinase/myoglobin levels with dipstick positive for blood indicates rhabdomyolysis.
    • Elevated prostate-specific antigen suggests prostate hypertrophy or cancer.
    • Elevated uric acid levels may indicate malignancy or tumor lysis syndrome.
    • Increased anion gap and osmolar gap may indicate ethylene glycol/methanol poisoning.
    • Low complement levels could indicate systemic lupus erythematosus (SLE), endocarditis, or postinfectious glomerulonephritis.
    • Monoclonal spike on serum protein electrophoresis is indicative of multiple myeloma.
    • Positive ANA and double-stranded DNA antibodies suggest autoimmune diseases like SLE.

    Etiologies of Acute Kidney Injury (AKI)

    • AKI is classified into three main categories: prerenal, intrinsic, and postrenal causes.

    Prerenal Acute Kidney Injury

    • Results from decreased renal perfusion and glomerular filtration rate (GFR) due to:
      • Intravascular volume depletion (e.g., vomiting, diarrhea)
      • Peripheral vasodilation
      • Decreased arterial pressures
      • Impaired cardiac function
    • Common medications that lower renal perfusion include ACE inhibitors, ARBs, and NSAIDs.
    • ACE inhibitors and ARBs cause reduced intraglomerular pressure through dilation of the efferent arterioles.

    Intrinsic Acute Kidney Injury

    • Injury categorized by location, primarily affecting:
      • Glomerulus
      • Tubule
      • Interstitial or vascular areas
    • Most common cause is acute tubular necrosis (ATN), resulting from ischemic or nephrotoxic damage.

    Acute Tubular Necrosis

    • Defined as damage to tubular cells from prolonged ischemia or nephrotoxicity.
    • Ischemic causes include severe hypotension, hypovolemia, and renal hypoperfusion due to hemorrhage or sepsis.

    Acute Interstitial Nephritis

    • A significant contributor to AKI, often due to hypersensitivity reactions to medications (e.g., antibiotics, NSAIDs).

    Postrenal Causes of Acute Kidney Injury

    • Results from urinary flow obstruction due to conditions like:
      • Neurogenic bladder
      • Retroperitoneal fibrosis
      • Tumor burdens (bladder, prostate, cervical cancer)

    Management of Acute Kidney Injury

    • Supportive care is the primary approach.
    • Resuscitation indicated using isotonic crystalloids such as 0.9% normal saline and lactated Ringer's solution.
    • Excess chloride can indicate worsened renal function and acid-base disturbances.
    • A chloride-restrictive strategy during resuscitation is associated with lower AKI incidence.

    Urine Output Definitions

    • Oliguria: Urine output < 400 mL/day.
    • Anuria: Urine output < 100 mL/day.

    Treatment for Severe Hyperkalemia

    • Administer 5-10 units of regular insulin with 50% dextrose IV to shift potassium into cells.

    Diagnosis of Acute Kidney Injury

    • Based on serum creatinine levels, urine output, and need for renal replacement therapy.

    Recommendations and Considerations

    • Dopamine is not recommended for preventing AKI.
    • Diuretics do not improve outcomes in AKI without volume overload.

    Stages of Acute Kidney Injury

    • Stage 1: Creatinine increase ≥ 0.3 mg/dL or 1.5-2 times baseline; urine output < 0.5 mL/kg/hour for >6 hours.
    • Stage 2: Creatinine increase > 2-3 times baseline; urine output < 0.5 mL/kg/hour for >12 hours.
    • Stage 3: Creatinine increase > 3 times baseline or ≥ 4.0 mg/dL; urine output < 0.3 mL/kg/hour for 24 hours or anuria for 12 hours.

    Clinical Indicators

    • Elevated antistreptolysin O titer suggests poststreptococcal glomerulonephritis.
    • Elevated creatine kinase/myoglobin levels with dipstick positive for blood indicates rhabdomyolysis.
    • Elevated prostate-specific antigen suggests prostate hypertrophy or cancer.
    • Elevated uric acid levels may indicate malignancy or tumor lysis syndrome.
    • Increased anion gap and osmolar gap may indicate ethylene glycol/methanol poisoning.
    • Low complement levels could indicate systemic lupus erythematosus (SLE), endocarditis, or postinfectious glomerulonephritis.
    • Monoclonal spike on serum protein electrophoresis is indicative of multiple myeloma.
    • Positive ANA and double-stranded DNA antibodies suggest autoimmune diseases like SLE.

    Etiologies of Acute Kidney Injury (AKI)

    • AKI is classified into three main categories: prerenal, intrinsic, and postrenal causes.

    Prerenal Acute Kidney Injury

    • Results from decreased renal perfusion and glomerular filtration rate (GFR) due to:
      • Intravascular volume depletion (e.g., vomiting, diarrhea)
      • Peripheral vasodilation
      • Decreased arterial pressures
      • Impaired cardiac function
    • Common medications that lower renal perfusion include ACE inhibitors, ARBs, and NSAIDs.
    • ACE inhibitors and ARBs cause reduced intraglomerular pressure through dilation of the efferent arterioles.

    Intrinsic Acute Kidney Injury

    • Injury categorized by location, primarily affecting:
      • Glomerulus
      • Tubule
      • Interstitial or vascular areas
    • Most common cause is acute tubular necrosis (ATN), resulting from ischemic or nephrotoxic damage.

    Acute Tubular Necrosis

    • Defined as damage to tubular cells from prolonged ischemia or nephrotoxicity.
    • Ischemic causes include severe hypotension, hypovolemia, and renal hypoperfusion due to hemorrhage or sepsis.

    Acute Interstitial Nephritis

    • A significant contributor to AKI, often due to hypersensitivity reactions to medications (e.g., antibiotics, NSAIDs).

    Postrenal Causes of Acute Kidney Injury

    • Results from urinary flow obstruction due to conditions like:
      • Neurogenic bladder
      • Retroperitoneal fibrosis
      • Tumor burdens (bladder, prostate, cervical cancer)

    Management of Acute Kidney Injury

    • Supportive care is the primary approach.
    • Resuscitation indicated using isotonic crystalloids such as 0.9% normal saline and lactated Ringer's solution.
    • Excess chloride can indicate worsened renal function and acid-base disturbances.
    • A chloride-restrictive strategy during resuscitation is associated with lower AKI incidence.

    Urine Output Definitions

    • Oliguria: Urine output < 400 mL/day.
    • Anuria: Urine output < 100 mL/day.

    Treatment for Severe Hyperkalemia

    • Administer 5-10 units of regular insulin with 50% dextrose IV to shift potassium into cells.

    Diagnosis of Acute Kidney Injury

    • Based on serum creatinine levels, urine output, and need for renal replacement therapy.

    Recommendations and Considerations

    • Dopamine is not recommended for preventing AKI.
    • Diuretics do not improve outcomes in AKI without volume overload.

    Stages of Acute Kidney Injury

    • Stage 1: Creatinine increase ≥ 0.3 mg/dL or 1.5-2 times baseline; urine output < 0.5 mL/kg/hour for >6 hours.
    • Stage 2: Creatinine increase > 2-3 times baseline; urine output < 0.5 mL/kg/hour for >12 hours.
    • Stage 3: Creatinine increase > 3 times baseline or ≥ 4.0 mg/dL; urine output < 0.3 mL/kg/hour for 24 hours or anuria for 12 hours.

    Clinical Indicators

    • Elevated antistreptolysin O titer suggests poststreptococcal glomerulonephritis.
    • Elevated creatine kinase/myoglobin levels with dipstick positive for blood indicates rhabdomyolysis.
    • Elevated prostate-specific antigen suggests prostate hypertrophy or cancer.
    • Elevated uric acid levels may indicate malignancy or tumor lysis syndrome.
    • Increased anion gap and osmolar gap may indicate ethylene glycol/methanol poisoning.
    • Low complement levels could indicate systemic lupus erythematosus (SLE), endocarditis, or postinfectious glomerulonephritis.
    • Monoclonal spike on serum protein electrophoresis is indicative of multiple myeloma.
    • Positive ANA and double-stranded DNA antibodies suggest autoimmune diseases like SLE.

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    Description

    This quiz explores the etiology of Acute Kidney Injury (AKI), focusing on prerenal, intrinsic, and postrenal causes. Dive into the mechanisms behind decreased renal perfusion and the common medications that contribute to these conditions, such as ACE inhibitors and NSAIDs. Additional attention is given to acute tubular necrosis and its classifications.

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