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Questions and Answers
What symptom is specifically associated with postrenal acute kidney injury (AKI)?
Which physical examination finding suggests systemic venous congestion and volume overload?
Which of the following signs is NOT typically associated with hypovolaemia?
What is a common symptom of intrinsic acute kidney injury due to acute interstitial nephritis?
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Which condition can be indicated by the presence of crackles in the lungs during a physical examination?
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What could a high blood urea nitrogen (BUN) to serum creatinine (SCr) ratio indicate?
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In prerenal AKI, what happens to the fractional excretion of sodium (FENa)?
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Which laboratory finding is NOT typically associated with prerenal AKI?
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Which condition can cause an increase in blood urea nitrogen (BUN) levels besides prerenal AKI?
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What would a FENa value above 2% indicate?
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What is the reference range for serum creatinine (SCr) levels?
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Which urinalysis finding is most consistent with allergic interstitial nephritis?
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What is a common laboratory test for identifying metabolic acidosis?
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What is the most common cause of intrinsic acute kidney injury (AKI)?
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Which of the following is NOT a typical nephrotoxin that can lead to acute tubular necrosis?
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What can happen to prerenal acute kidney injury (AKI) if the underlying cause is not addressed?
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Which condition is associated with postrenal AKI due to obstruction?
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What determines the signs and symptoms of acute kidney injury (AKI)?
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What can lead to the necrosis of tubular epithelial cells in acute tubular necrosis?
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Which of the following is a cause of postrenal AKI?
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What consequence does the necrosis of tubular epithelial cells lead to in acute tubular necrosis?
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What laboratory test is essential for evaluating kidney function in this patient?
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Which medication combination poses the highest risk of acute kidney injury (AKI) in this patient?
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What history would be most relevant to assess for a risk of prerenal AKI?
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Which additional lab test could help rule out infection in this patient?
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Which question is least likely to provide relevant information for pharmacotherapy assessment?
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Which symptom is a specific indicator of acute kidney injury (AKI) in this patient?
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What is a concerning change in this patient's weight relevant to her kidney condition?
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Which medication in her regimen is primarily used to manage hypertension?
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Which laboratory value would be crucial for further assessing the patient's kidney function?
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Which of the following is a condition this patient has that increases her risk for AKI?
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What symptom might indicate fluid overload in this patient?
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Which question is relevant to ask regarding her current pharmacotherapy?
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What nonspecific symptom is this patient exhibiting that could be associated with AKI?
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Study Notes
Acute Tubular Necrosis (ATN)
- Acute Tubular Necrosis (ATN) is the primary cause of intrinsic acute kidney injury (AKI).
- ATN involves necrosis of tubular epithelial cells due to nephrotoxins (e.g., aminoglycosides, contrast media) and conditions like sepsis and ischaemia.
- Damage leads to tubular blockage by debris, increasing tubular pressure and hindering the elimination of sodium, water, and metabolic waste.
- If untreated, prerenal AKI may progress to ATN.
Postrenal Acute Kidney Injury
- Postrenal AKI results from obstruction of urinary outflow, affecting the ureters, urinary bladder, or urethra.
- Common causes include benign prostatic hyperplasia (BPH), pelvic tumors, and kidney stones (nephrolithiasis).
Clinical Presentation & Diagnosis of AKI
- Signs and symptoms of AKI vary based on underlying causes and can include:
- Weight gain or loss (prerenal)
- Gastrointestinal symptoms like nausea, vomiting, and diarrhea
- Fatigue and shortness of breath
- Pruritus and edema
- Anuria with alternating polyuria (postrenal)
- Colicky abdominal pain radiating to the groin (postrenal)
- Electrolyte disturbances
- Signs of hypovolaemia: tachycardia, hypotension, postural hypotension, dry skin, sunken eyes, collapsed peripheral veins, and cold extremities.
Physical Examination Findings
- Increased blood pressure and peripheral edema may be observed.
- Changes in mental status, jugular venous distention, and pulmonary edema can indicate severity.
- Physical indicators include crackles in the lungs and asterixis (involuntary jerking).
- Hypotension or orthostatic hypotension might present in prerenal AKI, along with rashes from intrinsic causes.
AKI Staging System
- Based on serum creatinine changes as per South African Renal Society (SARS) guidelines from 2015.
- BUN-to-creatinine ratio > 10:1 can suggest prerenal AKI due to increased urea reabsorption at lower urine flow rates.
- FENa (fractional excretion of sodium) differentiates AKI types; < 1% indicates prerenal AKI due to enhanced sodium reabsorption.
Laboratory Tests
- Full blood count (FBC) may show elevated white blood cell count indicative of infection.
- Arterial blood gases can reveal metabolic acidosis.
- Urea & Electrolytes (U & E):
- Elevated serum creatinine (SCr) reference range: 53 to 106 µmol/L.
- Elevated BUN (reference range: 2.9 to 8.9 mmol/L).
- Hyperkalaemia might be present.
- Urinalysis findings:
- Different appearances can indicate specific underlying conditions, such as brown muddy casts for intrinsic ATN or eosinophiluria for acute interstitial nephritis.
Case Study Findings
- Example patient is a 65-year-old woman with stage 2 chronic kidney disease and presenting symptoms including nausea, vomiting, and weight gain due to edema.
- Her blood pressure is elevated at 170/94 mmHg, and crackles are observed on auscultation.
- Medications include losartan, hydrochlorothiazide, ibuprofen, and others, which may contribute to AKI risk.
Questions for Further Assessment
- Signs and symptoms of AKI:
- Bilateral pitting edema, weight gain, elevated blood pressure, crackles, and general weakness suggest AKI.
- Risk factors for developing AKI include age, history of diabetes and chronic kidney disease, and medication use (especially NSAIDs).
- Additional laboratory information needed includes comprehensive blood chemistry tests (BUN, SCr, bicarbonate, potassium), WBC count, previous lab results to assess baseline kidney function, urinalysis, and results related to glucose management.
- Key pharmacotherapy questions include duration and dosages of ibuprofen and other medications, adherence to prescriptions, and use of additional medications.
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Description
This quiz focuses on kidney-related conditions, particularly Acute Tubular Necrosis (ATN), a common cause of intrinsic acute kidney injury (AKI). It examines the nephrotoxic agents responsible for ATN and the implications for treatment in pharmacy practice.
