Renal Final Test
what is AKI? and what defines it?correct answerAcute Kidney Injury
-rapid deteriration in renal function resulting in accumulation of nitrogenous wastes
-less than 3 months
no specific BUN or Potassium
what is Chronic Kidney Disease?correct answer-irreversible loss of renal function that may or may not
lead to End Stage Renal Disease
-more than 3 months
ESRD is what and indications?correct answer-End Stage Renal Disease
-creatine clearance <10ml/min
-need renal replacement therapy to survive
what is Azotemia and what can it lead to?correct answer-elevation of blood urea nitrogen i.e. increased
BUN
-can lead to Uremia clinical symptoms of high Azotemia
Uremia symptoms is what?correct answer-side effect of accumulation of nitrogenous compounds
-Nausea, vomiting, confusion, anorexia seizures
What is Oliguriacorrect answer<500cc/day of urine output
Non-Oliguric is what?correct answer->500cc a day of urine output
Anuric is what?correct answer<100 cc a day of urine out put i.e. there is an obstruction
what test can be used for assessment of Renal Function?correct answer-Serum creatinine
-24 creatinine clearance
-eGFR that takes into account Age, Weight and Sex
what happens to Serum Creatinine in AKI?correct answerthere is a change in Serum Creatinine by >0.3
from the baseline
Where is Creatine made from?correct answer-get in diet 50% and synthesize other half in the Liver
what is abnormal creatinine for men and women?correct answermen> 1.5mg/dl
female>1.2mg/dl
-there needs to be an increase from the base line by 0.3 even if baseline is higher than these values
,What are the Cases when the Serum Creatinine is very low at baseline?correct answer-Cirrhosis of the
liver: failure
-minimal protein intake with severe malnutrition
-Pregnancy increased volume and GFR
-extrems of age/nutrition
The baseline here is <0.6mg/dl
and
what you need to remember about Creatinine level?correct answer-need to look at baseline in
individuals and the underlying medical disease that makes it be elevated and then observe for change
from this
normal 24hr clearance of Creatinine in urine?correct answer-90-120ml/min in urine
what is the standard eGFR that is used?correct answer-the MDRD
Modification of Diet in Renal Disease
For the same creatinine level who has better renal function?correct answerMen
and the younger
what is the normal BUN/Cr ratio?correct answer10-15:1 in normal person in blood
Uremic Syndrome is what?correct answer-have a high BUN
-there is toxic nitrogenous molecules in the body
-leads to:
-Confusion/Disorientation
Nausea/Vomiting
Pericarditis
Asterixes and seizures
what is Asterixes?correct answerthe hand-flapping due to interruption of signals from high NH4+ in
blood
what can elevate BUN in people with normal Renal Function?correct answer-Corticosteroids
-Catabolism
-Increased protein intake
-GI bleeding
thus BUN can't be used independently as marker of kidney function
,What drugs Can elevate serum Creatinine levels?correct answer-Trimethoprim drug that is part of
Bactrim directly competes for secretion with creatinine
What can Cause Rhabdomyolysis? and elevate serum Creatininecorrect answer-Release of creatine from
damaged muscle membranes
-Trauma
-Statins(HMG-CoA reductase inhibitors)
-Seizures
Important to check the CPK: Creatine Phosphokinase levels to help monitor this
what can act as a clue that the kidney function is fine that there is just an elevated level of creatine?
correct answerBUN level is normal
and the BUN to Creatinine ratio is out of whack< 10:1
-Normal urine output >500cc/day
-No obvious hemodynamic or toxic insult
How to tell AKI from CKD?correct answer-look at the radiology of the kidney and the Ultrasound
-normal kidney>11cm or radiograph
-normal kidney has heterogenous Echogenicity i.e. the Cortex looks different then the medulla
-there is a differention between the two areas
-in AKI the kidney is not scarred and normal size and heterogenous Echogenicity
What are the types of AKI subgroups?correct answerpre-renal: inadequate perfusion of kidney
-Renal: specific damage to kidney
-Post renal: obstruction of urinary flow
what are the most common cause of AKI outpatient vs. Inpatient?correct answer-pre-renal Azotemia in
outpatient
-Acute Tubular Necrosis in the inpatient setting
what are the Effectors in Auto-regulation of Kidney?correct answer-Noraephinephrine
Angiotensin II
ADH
, which of the Effectors of Auto-regulation affect the kidney?correct answer- PGE2/I2
-Nitric Oxide and Dopamine
all dilate the afferent arterioles
what is the overall Culprit in Pre-renal Azotemia?correct answer-Decreased Effective Circulating Volume
that is broken up into sub types:
-Absolute, Relative
Impaired cardiac output
Impaired renal auto regulation
what are some causes of Absolute volume depletion?correct answer-Gastrointestinal
-Diarrhea
-Vomiting
hemorrhage
sweating
Renal: diuresis, slat wasting burns
What is 3rd Spacing?correct answerwhen the Fluid volume of the Interstitial space increases i.e. the
Plasma volume is dropping causes:
-Hypoalbuminemia from Liver disease, malnutrition, Nephrotic syndrome
Pancreatitis and Sepsis
What do ACEI, ARBs and NSAIDs due that can put the kidney in danger in volume deletion?correct
answer-they interrupt auto regulation that is impt in volume depletion leads to a right shift in the
autoregulation cure and make person more succeptable to AKI
NSAIDs and kidney?correct answer-block the PGE2 and PGI2 production via cycloxyegenase leading
down the pathway to PGF2a that leads to vasoconstriction
-leads to decrease GFR and RPF by affecting the afferent arterioles
-FF=0.20
what does ACEI/ARB do?correct answer-affects the Efferent arterioles leads to big GFR decrease and
increase in RPF leading to Filtration Fraction less than 0.20
what disease should NSAIDs completely prohibited in?correct answer-CHF, Liver Cirrhosis, Nephrotic
and Renovascular disease i.e. renal artery stenosis bilateral
Importance of ACEI/ARB in CKD?correct answer-they are renal protective agents and preserve renal
function in long run
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