Pharmacotherapy Lecture on Acute Tubular Necrosis
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Questions and Answers

What symptom is specifically associated with postrenal acute kidney injury (AKI)?

  • Weight gain
  • Pulmonary oedema
  • Anuria alternating with polyuria (correct)
  • Nausea and vomiting
  • Which physical examination finding suggests systemic venous congestion and volume overload?

  • Cold extremities
  • Rash
  • Tachycardia
  • Jugular venous distention (JVD) (correct)
  • Which of the following signs is NOT typically associated with hypovolaemia?

  • Increased blood pressure (correct)
  • Hypotension
  • Reduced skin turgor
  • Postural hypotension
  • What is a common symptom of intrinsic acute kidney injury due to acute interstitial nephritis?

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

    Which condition can be indicated by the presence of crackles in the lungs during a physical examination?

    <p>Pulmonary oedema</p> Signup and view all the answers

    What could a high blood urea nitrogen (BUN) to serum creatinine (SCr) ratio indicate?

    <p>Prerenal acute kidney injury (AKI)</p> Signup and view all the answers

    In prerenal AKI, what happens to the fractional excretion of sodium (FENa)?

    <p>FENa decreases below 1%</p> Signup and view all the answers

    Which laboratory finding is NOT typically associated with prerenal AKI?

    <p>Brown, muddy granular casts in urine</p> Signup and view all the answers

    Which condition can cause an increase in blood urea nitrogen (BUN) levels besides prerenal AKI?

    <p>Excessive protein intake</p> Signup and view all the answers

    What would a FENa value above 2% indicate?

    <p>Intrinsic renal failure</p> Signup and view all the answers

    What is the reference range for serum creatinine (SCr) levels?

    <p>53 to 106 𝜇mol/L</p> Signup and view all the answers

    Which urinalysis finding is most consistent with allergic interstitial nephritis?

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

    What is a common laboratory test for identifying metabolic acidosis?

    <p>Arterial blood gases</p> Signup and view all the answers

    What is the most common cause of intrinsic acute kidney injury (AKI)?

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

    Which of the following is NOT a typical nephrotoxin that can lead to acute tubular necrosis?

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

    What can happen to prerenal acute kidney injury (AKI) if the underlying cause is not addressed?

    <p>It can progress to acute tubular necrosis</p> Signup and view all the answers

    Which condition is associated with postrenal AKI due to obstruction?

    <p>Benign prostatic hyperplasia (BPH)</p> Signup and view all the answers

    What determines the signs and symptoms of acute kidney injury (AKI)?

    <p>The underlying aetiology</p> Signup and view all the answers

    What can lead to the necrosis of tubular epithelial cells in acute tubular necrosis?

    <p>Nephrotoxins and poor renal blood flow</p> Signup and view all the answers

    Which of the following is a cause of postrenal AKI?

    <p>Urinary tract obstruction</p> Signup and view all the answers

    What consequence does the necrosis of tubular epithelial cells lead to in acute tubular necrosis?

    <p>Blockage of tubules with debris</p> Signup and view all the answers

    What laboratory test is essential for evaluating kidney function in this patient?

    <p>BUN and SCr</p> Signup and view all the answers

    Which medication combination poses the highest risk of acute kidney injury (AKI) in this patient?

    <p>ARB, diuretic, and NSAID</p> Signup and view all the answers

    What history would be most relevant to assess for a risk of prerenal AKI?

    <p>Recent gastroenteritis</p> Signup and view all the answers

    Which additional lab test could help rule out infection in this patient?

    <p>WBC count</p> Signup and view all the answers

    Which question is least likely to provide relevant information for pharmacotherapy assessment?

    <p>What is your favorite food?</p> Signup and view all the answers

    Which symptom is a specific indicator of acute kidney injury (AKI) in this patient?

    <p>Bilateral 2+ pitting edema</p> Signup and view all the answers

    What is a concerning change in this patient's weight relevant to her kidney condition?

    <p>She weighs 70.5 kg, an increase of 2.5 kg</p> Signup and view all the answers

    Which medication in her regimen is primarily used to manage hypertension?

    <p>Losartan/Hydrochlorothiazide</p> Signup and view all the answers

    Which laboratory value would be crucial for further assessing the patient's kidney function?

    <p>Serum creatinine (SCr)</p> Signup and view all the answers

    Which of the following is a condition this patient has that increases her risk for AKI?

    <p>Stage 2 chronic kidney disease</p> Signup and view all the answers

    What symptom might indicate fluid overload in this patient?

    <p>Crackles on auscultation</p> Signup and view all the answers

    Which question is relevant to ask regarding her current pharmacotherapy?

    <p>Have you recently increased your sodium intake?</p> Signup and view all the answers

    What nonspecific symptom is this patient exhibiting that could be associated with AKI?

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

    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.

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