Nephrology: Renal Failure and Acute Kidney Injury

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Questions and Answers

What is the primary reason for the change in terminology from 'acute renal failure' to 'acute kidney injury'?

To highlight the role of sepsis as a cause

To distinguish it from chronic kidney disease

To emphasize the importance of dialysis therapy

To reflect the diversity of clinical presentation (correct)

What is the approximate mortality rate of acute kidney injury (AKI)?

20%–30%

40%–50%

50%–60% (correct)

70%–80%

What is the main criterion used by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K-DOQI) guidelines to classify chronic kidney disease (CKD)?

Urine output

Glomerular filtration rate (GFR) (correct)

Presence of protein in the urine

Measuring blood pressure

What is the life expectancy of dialysis patients compared to the age-matched general population?

3–11 years shorter Signup and view all the answers

What is the characteristic of Stage I of kidney disease?

Presence of protein in the urine and a normal GFR of 90 or higher Signup and view all the answers

What is the range of GFR in Stage II of kidney disease?

60–89 Signup and view all the answers

What is the most common cause of chronic kidney disease (CKD)?

All of the above Signup and view all the answers

What is the annual mortality rate for chronic dialysis patients?

20%–25% Signup and view all the answers

What is the GFR range for Stage III kidney disease?

30 to 59 Signup and view all the answers

What is the primary purpose of these Clinical Guidelines?

To evaluate the evidence underlying nutrition support in patients with AKI and CKD Signup and view all the answers

Which of the following is NOT addressed by these Guidelines?

Chronic nutrition care beyond EN or PN Signup and view all the answers

According to the Guidelines, what is the grade of the recommendation for patients with renal disease to undergo formal nutrition assessment?

D Signup and view all the answers

What is the primary reason for the association between low serum albumin concentration and mortality in patients with AKI and CKD?

Inflammation Signup and view all the answers

What is the trend in albumin concentration in Stage V CKD that predicts mortality?

Decrease over 18 months Signup and view all the answers

What is the purpose of evaluating serum protein status together with a marker of inflammation?

To identify patients at high risk for mortality Signup and view all the answers

What is the distinction between protein and energy wasting and cachexia in patients with CKD and AKI?

Protein and energy wasting are common in both CKD and AKI, but cachexia is not Signup and view all the answers

Study Notes

Renal Failure

Renal failure occurs when the kidneys cannot adequately excrete nitrogenous and metabolic wastes, leading to acute or chronic kidney injury.

Acute Kidney Injury (AKI)

AKI has a highly variable spectrum of symptoms and outcomes, ranging from anuria to adequate urine output and from short-term to prolonged renal replacement therapy.
Major causes of AKI include:
- Sepsis
- Trauma
- Hypotension
- Intravenous contrast dye
- Medications
- Pre-existing chronic kidney disease (CKD)
Mortality rate of AKI remains high, around 50-60%.

Chronic Kidney Disease (CKD)

CKD is classified into 5 categories (I-V) based on measured glomerular filtration rate (GFR).
The most common causes of CKD include:
- Diabetes mellitus
- Hypertension
- Glomerular disease
Prognosis of CKD remains bleak, with an annual mortality rate of over 20% and life expectancy 3-11 years shorter than the age-matched general population.

Stages of CKD

Stage I: Presence of protein in the urine and a normal GFR (≥90).
Stage II: Kidney damage and a slight decrease in GFR (60-89).
Stage III: Moderate decrease in GFR (30-59).
Stage IV: Severe decrease in GFR (15-30).
Stage V: End-stage renal disease, requiring dialysis or a kidney transplant, with a GFR of <15.

Nutrition Support

Patients with AKI and CKD should undergo formal nutrition assessment, including evaluation of inflammation, with development of a nutrition care plan.
Low serum albumin concentration is linked to mortality in patients with AKI and Stage V CKD.
Inflammation plays a role in renal disease, and patients with AKI and Stage V CKD have high levels of inflammatory cytokines.

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Description

Learn about the causes and symptoms of renal failure and acute kidney injury, including sepsis, trauma, and medication-related factors.