Renal Failure and Acute Kidney Injury
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Questions and Answers

What is the best way to define GFR?

Inulin is the best way to define GFR.

What are the two main categories of kidney failure?

The two main categories of kidney failure are acute kidney injury (AKI) and chronic kidney disease (CKD).

Which of the following is a characteristic of prerenal injury?

  • Obstruction of urine outflow from the kidney
  • Marked decrease in renal blood flow (correct)
  • Damage to the structures within the kidney

    • What is the primary cause of acute tubular necrosis?

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

    The kidneys receive 10-15% of the cardiac output.

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

    What are the three phases of acute tubular necrosis?

    <p>The three phases of acute tubular necrosis are the initiating phase, the maintenance phase, and the recovery phase.</p> Signup and view all the answers

    What is another term for end-stage kidney failure?

    <p>Uremia describes end-stage kidney failure, where 90% of nephrons are lost.</p> Signup and view all the answers

    Hypertension is a common complication of chronic kidney disease.

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

    What is the main treatment strategy for slowing the progression of chronic kidney disease?

    <p>The main treatment strategy for slowing the progression of chronic kidney disease is to control blood pressure using anti-hypertensive medications.</p> Signup and view all the answers

    What is the purpose of dialysis in the treatment of kidney failure?

    <p>To remove potassium and waste products from the blood</p> Signup and view all the answers

    Which of the following is NOT a sign or symptom of uremia?

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

    What percentage of cardiac output do the kidneys typically receive?

    <p>20-25%</p> Signup and view all the answers

    What is a key characteristic of prerenal injury?

    <p>Decrease in renal blood flow</p> Signup and view all the answers

    What is a typical BUN to creatinine ratio in prerenal failure?

    <p>15:1 to 20:1</p> Signup and view all the answers

    Which of the following drugs is known to exacerbate hypoperfusion in prerenal injury?

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

    Which condition can cause impaired renal perfusion leading to prerenal injury?

    <p>Cardiogenic shock</p> Signup and view all the answers

    How do tubular epithelial cells respond to ischemia in acute kidney injury?

    <p>Aggravate interstitial inflammation</p> Signup and view all the answers

    What happens to the filtration rate in acute kidney injury within three months?

    <p>Drops significantly</p> Signup and view all the answers

    What is a common cause of decreased vascular volume leading to prerenal injury?

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

    What is a common result of intrinsic injury in acute kidney injury?

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

    Which substance accumulation can lead to intratubular obstruction in the kidneys?

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

    What is the GFR when uremia develops in stage 5 of chronic kidney disease?

    <p>Less than 15 ml/min/1.73m2</p> Signup and view all the answers

    What percentage of nephrons are lost during the renal insufficiency stage of chronic kidney disease?

    <p>30-80%</p> Signup and view all the answers

    What causes nephrotoxicity related to intrinsic injury?

    <p>Direct tubular cell damage</p> Signup and view all the answers

    Which condition is directly associated with the final stages of chronic kidney disease?

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

    Which of the following is a potential cause of intrinsic injury leading to acute kidney injury?

    <p>Nephrotoxic drugs</p> Signup and view all the answers

    What is a common symptom experienced as chronic kidney disease progresses to uremia?

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

    Which of the following is NOT indicative of intrinsic injury in the kidneys?

    <p>Normal levels of renal markers</p> Signup and view all the answers

    What type of drug is most likely to cause damage to the proximal convoluted tubule (PCT)?

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

    What happens to serum creatinine levels as renal reserve decreases?

    <p>They remain normal or high</p> Signup and view all the answers

    How do nephrotoxic drugs primarily affect the kidneys?

    <p>By causing direct tubular damage</p> Signup and view all the answers

    What term describes the early stage of chronic kidney disease characterized by partly lost nephron function but often asymptomatic?

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

    What is a consequence of the thickening of the filtration barrier in advanced chronic kidney disease?

    <p>Impaired waste removal</p> Signup and view all the answers

    Which of the following disorders is an example of intrinsic injury in the kidneys?

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

    What does azotemia refer to in the context of kidney disease?

    <p>Elevated blood urea nitrogen levels</p> Signup and view all the answers

    What is a common consequence of retention of potassium during the maintenance phase of acute tubular necrosis?

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

    What typically marks the recovery phase of acute kidney injury?

    <p>Increased urine output and decreased serum creatinine</p> Signup and view all the answers

    Which condition is often associated with postrenal injury due to obstruction?

    <p>Prostatic hyperplasia</p> Signup and view all the answers

    What is a critical aspect of diagnosing acute kidney injury?

    <p>Assessing urine output and serum creatinine levels</p> Signup and view all the answers

    What must be addressed to help prevent the progression of acute kidney injury?

    <p>Identifying and correcting the underlying cause</p> Signup and view all the answers

    How do remaining nephrons in chronic kidney disease (CKD) adapt?

    <p>They hypertrophy</p> Signup and view all the answers

    What is a potential complication that can worsen acute tubular necrosis?

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

    What happens to the glomerular filtration rate (GFR) during the maintenance phase of acute kidney injury?

    <p>It markedly decreases</p> Signup and view all the answers

    What occurs in the early stages of chronic kidney disease concerning urine production?

    <p>Large volumes of concentrated urine are produced.</p> Signup and view all the answers

    What condition is characterized by the retention of water, electrolytes, and wastes in later stages of chronic kidney disease?

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

    Which of the following treatments focuses on adjusting dietary intake based on kidney function in chronic kidney disease?

    <p>Dietary management</p> Signup and view all the answers

    What is a common effect of high blood pressure on kidney function?

    <p>Increased proteinuria</p> Signup and view all the answers

    Which endocrine dysfunction occurs in chronic kidney disease leading to anemia?

    <p>Reduced production of erythropoietin (EPO)</p> Signup and view all the answers

    What is a main goal of utilizing anti-hypertensive medications in chronic kidney disease treatment?

    <p>To slow the progression of kidney damage</p> Signup and view all the answers

    What must be managed in dietary management during the later stages of chronic kidney disease?

    <p>Fluid intake restriction and electrolyte management</p> Signup and view all the answers

    What occurs as a result of impaired renin-synthesis capacities in chronic kidney disease?

    <p>Metabolic acidosis</p> Signup and view all the answers

    What type of solution is used in dialysis to manage solute movement in patients with kidney disease?

    <p>Hypotonic solution</p> Signup and view all the answers

    What is a likely consequence of chronic kidney disease on bone health?

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

    What condition arises from hyperphosphatemia and hypocalcemia in chronic kidney disease?

    <p>Secondary hyperparathyroidism</p> Signup and view all the answers

    What hematological disorder is commonly associated with chronic kidney disease?

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

    What is a primary reason for fluid retention in patients with chronic kidney disease?

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

    What skin condition may result from phosphate crystallization in chronic kidney disease?

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

    Which of the following statements about drug metabolism in chronic kidney disease is correct?

    <p>Nephrotoxic drugs can accumulate due to impaired renal excretion.</p> Signup and view all the answers

    How is chronic kidney disease diagnosed?

    <p>Based on progressive decrease in GFR</p> Signup and view all the answers

    Study Notes

    Renal Failure

    • Renal failure encompasses acute and chronic kidney disease.
    • Acute kidney injury (AKI) is a sudden decline in kidney function.
    • Chronic kidney disease (CKD) is a progressive decline in kidney function.

    Acute Kidney Injury

    • Prerenal Injury:
      • Reduced blood flow to the kidneys, often due to decreased vascular volume from hypovolemia (e.g., hemorrhage, dehydration), distributional shock or medication use.
      • Impaired perfusion is a key factor.
      • Heart failure and cardiogenic shock may also cause impaired perfusion.
      • Also includes impairment of renal compensation mechanisms due to medications.
      • Prerenal injury: Characterized by a marked decrease in renal blood flow.
      • Manifestations: A sharp decrease in urine output due to a decline in glomerular filtration rate (GFR). A disproportionate increase in blood urea nitrogen (BUN) compared to serum creatinine. A normal BUN to creatinine ratio is 10:1. Prerenal failure has a BUN to creatinine ratio of 15:1 to 20:1.
      • Vasoactive compounds: Contributing to glomerular hypoperfusion. ACE inhibitors and blockers reduce renin's effect on renal perfusion. NSAIDs exacerbate hypoperfusion by preventing blood vessel dilation.
      • Vasoactive compounds: Drugs and mediators that cause vasoconstriction also cause hypoperfusion
    • Intrinsic Injury:
      • Damage to structures within the kidneys.
      • Causes include: Prerenal injury leading to ischemia. Nephrotoxic drugs, tubular obstruction, and infection.
      • Acute glomerulonephritis: Inflammation of the glomerulus.
      • Pyelonephritis: Inflammation of the kidney; often caused by sepsis.
      • Nephrotoxicity: Related to glomerulonephritis (ischemia, direct tubular damage, or intratubular obstruction) and toxicity (more common due to the kidney's rich blood supply and ability to concentrate toxins).
        • Nephrotoxic damage is often caused by drugs (antimicrobials like aminoglycosides, chemotherapeutics, and radiocontrast agents) that cause direct tubular and endothelial cell toxicity, via DNA damage.
    • Postrenal Injury:
      • Obstruction of urine outflow from the kidneys.
      • Obstruction may occur in the ureters, bladder, or urethra.
      • Obstruction causes reflux of urine into the renal pelvis, impairing kidney function.
      • Common causes include prostatic hyperplasia and prostate cancer, kidney stones, trauma, and extrarenal tumors.
      • This type of injury is often treatable.
    • Phases of Acute Tubular Necrosis:
      • Initiation: Kidney damage.
      • Maintenance: Decline in GFR and retention of toxic metabolites.
      • Recovery: Recovery starts with increasing urine output, with serum creatinine, potassium, and BUN gradually lowering.

    Diagnosis and Treatment of Acute Kidney Injury

    • Early detection is key due to high morbidity and mortality.
    • Defining AKI as a sudden drop in glomerular filtration rate (GFR) and a rise in serum creatinine within 3 months.
    • Monitor urine output, urine osmolarity, and sodium levels.
    • Blood tests to monitor BUN, creatinine, metabolic acidosis, and hyperkalemia.
    • Identifying and correcting the cause is important.
    • Adequate caloric intake is necessary to prevent protein use for energy.
    • Prevent or treat infections.
    • Dialysis may be necessary if fluid volume and electrolyte levels cannot be maintained.

    Chronic Kidney Disease

    • Progressive loss of kidney function.
    • Categorized by stages:
      • Decreased renal reserve
      • Renal insufficiency.
      • Uremia (Stage 5). A severe loss of kidney function, where 90% of nephrons are lost, GFR is below 15 ml/min/1.73m², and water, electrolytes, and wastes are retained, affecting all body systems. Oliguria (or anuria) often develops in stage 5. Kidney replacement therapy (dialysis or transplant) is required.
    • Damage to nephrons and resulting fibrosis.
    • Damage and loss of nephrons contribute to GFR reduction.
    • Compensatory hypertrophy of remaining nephrons.
    • Fibrotic tissue development.
    • Signs and symptoms: -Uremic encephalopathy
      • suppressed immune system
      • pruritus (itching)
      • Impaired drug/drug metabolite excretion
      • electrolyte imbalances (hyperkalemia, hypernatremia, hypocalcemia, etc)
      • hematological disorders (anemia, coagulopathies)
      • heart failure
      • hypertension (mostly multifactorial).
    • Diagnosis: Progressive decline in GFR over 3+ months accompanied by albuminuria.
      • Osmotic diuresis (early stages).
      • Azotemia, hyponatremia, and uremia (later stages), often with fluid, electrolyte, and waste retention.

    Chronic Kidney Disease Treatment

    • Strategies to consider:
      • Slowing the progression of kidney disease:
        • Controlling blood pressure using antihypertensive medications.
        • Reducing or quitting tobacco smoking.
      • Dialysis and transplantation.
      • Dietary management:
        • Controlling electrolytes.
        • Restrictions on protein and fluid intake.

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    Related Documents

    Renal Failure Lecture Notes PDF

    Description

    This quiz covers the concepts of renal failure, including both acute and chronic kidney disease. It delves into acute kidney injury (AKI), particularly focusing on prerenal injury, its causes, manifestations, and the physiological effects on kidney function. Prepare to test your understanding of these critical medical topics.

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