Renal Failure and Acute Kidney Injury Overview

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Questions and Answers

Which of the following is a post-renal cause of acute kidney injury?

Renal artery occlusion

Kidney stones (correct)

Lupus nephritis

Diabetes Mellitus

What is the primary laboratory finding indicating chronic kidney disease?

Decreased urinary sodium excretion

Persistently elevated creatinine (correct)

Normal urine osmolality

Low BUN levels

What physical exam finding is often associated with hypertension as a risk factor for chronic kidney disease?

Palpable abdominal masses

Edema in the lower extremities (correct)

Increased jugular venous pressure

Frothy urine

Which treatment option is typically recommended for pre-renal acute kidney injury?

Fluid hydration Signup and view all the answers

In chronic kidney disease, which laboratory finding is suggestive of dyslipidemia?

Increased protein in urine Signup and view all the answers

Which imaging study might be indicated for assessing underlying conditions in acute kidney disease?

CT scan of the abdomen Signup and view all the answers

Which of the following statements is true regarding the pathophysiology of chronic kidney disease?

It leads to progressive loss of kidney function over months to years. Signup and view all the answers

Which of the following factors increases the risk of developing renal conditions?

Obesity Signup and view all the answers

What commonly associated pathogen is frequently linked to xanthogranulomatous pyelonephritis?

Proteus mirabilis Signup and view all the answers

Which imaging method is most likely to show a non-functioning kidney with renal enlargement in xanthogranulomatous pyelonephritis?

CT scan Signup and view all the answers

What is the typical surgical intervention for severe xanthogranulomatous pyelonephritis due to significant renal destruction?

Nephrectomy Signup and view all the answers

Which condition is characterized by a sudden decline in kidney function within hours to 7 days?

Acute Kidney Injury Signup and view all the answers

Which electrolyte imbalance is commonly associated with acute kidney injury?

Hyperkalemia Signup and view all the answers

What is a common risk factor for the development of xanthogranulomatous pyelonephritis?

Chronic urinary tract obstruction Signup and view all the answers

What is the primary pathophysiological consequence of phosphate retention in renal osteodystrophy?

Hypocalcemia due to decreased calcium absorption Signup and view all the answers

What is one of the consequences of renal failure related to electrolyte balance?

Metabolic acidosis Signup and view all the answers

What sign might indicate a significant renal malfunction in a patient with acute kidney injury?

Oliguria Signup and view all the answers

Which imaging study is most commonly used to assess kidney size and rule out obstruction?

Ultrasound Signup and view all the answers

At what GFR level should dialysis be considered for initiation?

15 mL/min Signup and view all the answers

What is the primary reason urinalysis may be conducted in patients with suspected kidney disease?

To check for proteinuria and hematuria Signup and view all the answers

Which condition is NOT indicated for dialysis according to the AEIOU criteria?

Kidney stones Signup and view all the answers

What is a common consequence of secondary hyperparathyroidism in renal osteodystrophy?

Bone pain and fractures Signup and view all the answers

What dietary modifications are recommended for patients undergoing treatment for chronic kidney disease?

Low protein, low potassium, low phosphorus Signup and view all the answers

Which of the following substances is commonly dialyzed in cases of intoxication?

Aspirin Signup and view all the answers

Study Notes

Renal Failure Overview

Renal failure is characterized by decreased kidney filtration, leading to waste product retention and electrolyte imbalances.
Consequences include accumulation of urea and creatinine, electrolyte disturbances like hyperkalemia and metabolic acidosis.

Acute Kidney Injury (AKI)

AKI is a sudden decline in kidney function over hours to 7 days, marked by elevated creatinine and reduced urine output.
Symptoms include oliguria, anuria, fluid overload, and electrolyte imbalances.
Causes are categorized into pre-renal, renal (intrinsic).
Pre-renal:
- Hypovolemia from dehydration, blood loss, or diuretics.
- Decreased cardiac output from heart failure or cardiogenic shock.
- Vasodilation due to sepsis or anaphylaxis.
- Renal artery stenosis.
- Systemic hypotension.
Renal (Intrinsic):
- Acute tubular necrosis caused by ischemia or nephrotoxins.
- Acute interstitial nephritis triggered by allergic reactions or infections.

Diagnostic Methods

Blood tests: serum creatinine and BUN for kidney function; CBC for anemia; electrolyte panel for hyperkalemia and acidosis.
Urinalysis: proteinuria and hematuria.
Imaging studies: Ultrasound or CT scan for assessing kidney size, structure, and obstruction.
GFR Calculation: Estimated using serum creatinine, age, sex, and race.

Treatment of AKI

Address the underlying cause: Hydration for pre-renal AKI, cessation of nephrotoxins.
Supportive care: Diuretics, electrolyte management.

Chronic Kidney Disease (CKD)

CKD involves chronic kidney dysfunction lasting over 3 months, characterized by progressive decline in kidney function.
Most common causes are diabetes mellitus and hypertension.
Laboratory findings:
- Elevated BUN (>20 mg/dL suggests kidney dysfunction).
- Elevated creatinine (>1.2 mg/dL in women, >1.4 mg/dL in men, indicates kidney impairment).
- Stages based on GFR:
 - Stage 1: GFR > 90 mL/min (normal kidney function).
 - Stage 2: GFR 60-89 mL/min (mild reduction).
 - Stage 3: GFR 30-59 mL/min (moderate reduction).
 - Stage 4: GFR 15-29 mL/min (severe reduction, approaching dialysis).
 - Stage 5: GFR <15 mL/min (end-stage renal disease).

Complications of CKD

Anemia: Loss of EPO leading to normocytic anemia.
Dyslipidemia: Increased triglycerides due to protein loss in urine and impaired clearance of chylomicrons and VLDL.

Treatment of CKD

Manage underlying causes: Tight blood sugar control in diabetes, control of blood pressure using ACE inhibitors or ARBs.
Supportive care: Dietary modifications (low protein, low potassium, low phosphorus), management of complications (e.g., erythropoietin-stimulating agents for anemia).
Dialysis: Initiated when GFR falls below 15 mL/min or when symptoms like fluid overload or severe electrolyte imbalance arise.
Kidney transplant: Considered for eligible patients with end-stage renal disease.

Dialysis

Dialysis is a medical procedure that removes waste products and excess fluid from the blood when kidneys are not functioning adequately.
Indications for dialysis (ΑΕΙΟU):
- Acidemia: Metabolic acidosis not controlled by medications.
- Electrolytes: Severe hyperkalemia posing a risk to cardiac function.
- Intoxication: Poisoning or overdose from dialyzable substances.
- Overload of fluid: Fluid overload leading to CHF or pulmonary edema.
- Uremic Symptoms: Symptoms of uremia like nausea, vomiting, confusion, and pericarditis.
Dialyzable substances include salicylates, lithium, isopropyl alcohol, magnesium laxatives, and ethylene glycol.

Renal Osteodystrophy

Phosphate retention decreases calcium levels in plasma, causing hypocalcemia.
Lack of active vitamin D reduces gut calcium absorption, also leading to hypocalcemia.
Both pathways stimulate parathyroid hormone (PTH) secretion, resulting in secondary or tertiary hyperparathyroidism
Symptoms/Manifestations: Bone pain, fractures, osteitis fibrosa cystica (bone disease due to high PTH), brown tumors.

Xanthogranulomatous Pyelonephritis

A chronic kidney infection characterized by renal parenchyma destruction and the presence of lipid-laden macrophages (foam cells) within the kidney.
Frequently confused with renal tumors due to its appearance.
Common pathogens: Proteus mirabilis, other organisms can also be involved.
Risk factors: Chronic urinary tract obstruction (stones or tumors), diabetes mellitus.
Signs & Symptoms: Flank pain, fever, weight loss, hematuria, fluctuating renal function.
Diagnostic methods:
- CT scan: Shows a non-functioning kidney with enlargement, heterogeneous mass, and possible obstruction.
- Ultrasound: May reveal a hydronephrotic kidney with changes suggestive of chronic infection.
Treatment: Surgical intervention, nephrectomy is typically necessary due to significant renal destruction and complications.

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Description

This quiz provides a comprehensive overview of renal failure and acute kidney injury (AKI). It covers the mechanisms, symptoms, causes, and consequences associated with these conditions. Test your understanding of how kidney function is compromised and the implications for health.