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A comprehensive overview of acute kidney injury (aki) and chronic kidney disease (ckd), covering key definitions, classifications, risk factors, complications, and management strategies. It includes a series of questions and answers that test understanding of the material, making it a valuable resource for students and healthcare professionals.
Typology: Exams
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what is known as rapid deterioration in renal function resulting in the accumulation of nitrogenous waste (BUN Azotemia) that develops in days to weeks and less than 3 months? acute renal failure or AKI what is the inability of the kidney to regulate electrolyte, acid base, and or water homeostasis, it is often reversable, and the most common causes are associated with intrarenal injury caused by renal hypoperfusion or nephrotoxins? AKI what are the three different types of AKI? prerenal intrarenal postrenal what type of AKI is this: sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness? prerenal what type of AKI is this: direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply? intrarenal what type of AKI is this: sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury? postrenal
what type of AKI is this: o Leads to an overall decrease in renal perfusion o Hypoperfusion to kidneys (dehydration, shock, trauma, decreased cardiac output, renal vascular disease, renal vasoconstriction (anything that impairs flow to kidneys) o NSAIDs can also cause? prerenal what does dehydration, shock, trauma, decreased cardiac output, renal vascular disease, renal vasoconstriction (anything that impairs flow to kidneys) cause? hypoperfusion to kidneys in prerenal AKI what drugs reduce renal plasma flow by decreasing prostaglandins? NSAIDS what type of AKI is this: o Anything that effects the renal paronychia itself o Drugs like NSAIDs, vancoymycin, gentamycin o Interstitial nephritis cause inflammatory process in kidney and prevents vasodilation o Prerenal state that was unresolved o Contrast o Rhabdo o Interstitial nephritis, tubular obstruction o Glomerular nephritis o Immune mediated phenomenon such as acute bacterial infections? intrarenal what drugs can cause intrarenal AKI? NSAIDS vancomycin
gentamycin what type of AKI is this: o Obstruction o Urethra obstructions, bladder obstructions, BPH, tumors, prostate cancer o Bladder cancer o Metastatic disease? postrenal what type of drugs are renal protectant, but if someone has kidney injury or failure it prevents blood flow to the kidneys so they can be damaging (need to discontinue if this happens) and worsen the renal or kidney injury? ACE inhibitors should you stop ACE inhibitors in kidney disease stage 4 when we are trying to preserve every possible nephron and prevent the patient from going into complete renal failure? yes what are the definitions for AKI based on? creatinine level urine output what is the most preferred definition for criteria of AKI and it stands for kidney disease improving global outcomes? KDIGO does KDIGO for AKI use GFR? no, it only uses creatinine and urine output before diagnosing AKI, does the clinician need to evaluate volume status or exclude that there is an obstruction? yes
what is this the diagnostic criteria for: -increase in serum creatinine of >0.3 mg/dl within 48 hours or >50% within 7 days OR -urine output of <0.5 ml/kg/hour for >6 hours? KDIGO how many stages of KDIGO for AKI are there? stage 1 stage 2 stage 3 what stage of KDIGO is this for AKI: -increase in serum creatinine of >0.3 mg/dl or 1.5 to 1.9 times baseline OR -urine output of <0.5 mg/kg/hour for 6 to 12 hours? stage 1 (risk) what stage of KDIGO is this for AKI: -increase in serum creatinine to 2 to 2.9 times baseline OR
-urine output of <0.5 ml/kg/hour for 12 to 24 hours? stage 2 (injury) what stage of KDIGO is this for AKI: -increase in serum creatinine to >3 times baseline OR -increase in serum creatinine of >0.3 mg/dl to >4 mg/dl OR -urine output of <0.3 ml/kg hour for >24 hours or anuria for >12 hours OR -initiation of kidney replacement therapy? stage 3 (failure) does KDIGO provide both diagnostic and staging criteria? yes in patients <18 years, is stage 3 AKI also defined by KDIGO as a decrease in estimated glomerular filtration rate (eGFR) to <35 ml/min/1.73 m? yes what stage of KDIGO for AKI will there be kidney replacement therapy otherwise known as dialysis? stage 3
is the use of urine output alone insufficient to define AKI? yes what are risk factors for AKI? -any problem causing decreased blood flow to the kidneys -anaphylactic shock caused by drug or transfusion reactions -ingestion of nephrotoxin substances -malignancy -sepsis -cardiac arrest -aneurysm -liver cirrhosis what are these risk factors for: -any problem causing decreased blood flow to the kidneys -anaphylactic shock caused by drug or transfusion reactions -ingestion of nephrotoxin substances -malignancy -sepsis -cardiac arrest -aneurysm -liver cirrhosis? AKI are the most common symptoms of AKI secondary to the accumulation of toxic metabolites? yes
what are these signs and symptoms of: -Fatigue -Malaise -Nausea -Vomiting -Pruritus (from uremia that is forming) -Mental status changes -Oliguria or anuria -Fluid overload resulting in dyspnea and orthopnea? AKI for AKI, should you question a patient about history of drug use, surgery, trauma, or infection as possible sources of renal insult that you can hopefully reverse? yes what are some signs and symptoms of AKI? -Fatigue -Malaise -Nausea -Vomiting -Pruritus (from uremia that is forming) -Mental status changes -Oliguria or anuria -Fluid overload resulting in dyspnea and orthopnea what are these objective signs of:
-Orthostatic vital signs, skin turgor, and distention of jugular veins should be assessed to obtain information about patient's fluid balance -Fluid depletion may mean prerenal etiology -Fluid overload suggests a greater degree of renal impairment -Severe proteinuria may lead to generalized edema -Abdominal bruits can suggest renovascular disease -Orthostatic hypotension? AKI what are some things to look at when diagnosing AKI? -elevated BUN and serum creatinine -monitor serum electrolyte levels -presence of RBCs in urinalysis -WBCs -eosinophiluria -urinary sodium values 20-40 meq/L what are these examples of: -elevated BUN and serum creatinine -monitor serum electrolyte levels -presence of RBCs in urinalysis -WBCs -eosinophiluria -urinary sodium values 20-40 meq/L? things to look at when diagnosing AKI can life threatening abnormalities develop secondary due to renal disease with electrolytes? yes
what does presence of RBCs in urinalysis likely suggest regarding AKI? a vascular or glomerular lesion what is when there is presence of eosinophils in the urine, it is highly indicative of allergic interstitial nephritis (AIN) and it is usually due to renal toxic drugs? eosinophiluria what is the urinary sodium level like in prerenal disease for AKI? <20 mEq/L what do urinary sodium values typically greater than 40 mEq/L indicate? acute tubular necrosis what are the diagnostic tests done for AKI? -renal ultrasound -CT scan (no contrast!) -retrograde pyelogram -cystoscopy -renal biopsy what are these diagnostic tests for: -renal ultrasound -CT scan (no contrast!) -retrograde pyelogram -cystoscopy -renal biopsy? AKI what is this the management for: -morbidity and mortality
-determine reason for underlying renal failure -remove offending agent for post renal failure -temporary dialysis? AKI what is the management for AKI? -morbidity and mortality -determine reason for underlying renal failure -remove offending agent for post renal failure -temporary dialysis can you go into cardiac arrest with AKI from hyperkalemia, GI bleed, or infection? yes is the main goal for AKI to keep the patient alive and determine the underlying cause of AKI? yes what drugs do we want to put patients with AKI on for fluid overload? diuretics do we need to monitor an AKI patient closely day to day? yes do we need to monitor EKG changes in patients with AKI? yes what can happen from uremia with AKI? encephalopathy do patients with AKI develop respiratory acidosis or respiratory alkalosis? respiratory acidosis for AKI, if it is a prerenal cause what do we do? expand intravascular fluid volume by giving fluids
for AKI, if it is a intrarenal cause what do we do? maintain perfusion (stop nephrotoxic drug like aminoglycoside) and hemodialysis for AKI, if it is a postrenal cause what do we do? remove cancer, stone, tumor, or catheter what type of kidney disease is this: ● An irreversible loss of renal function (nephron number) that may or may not lead to End Stage Renal Disease (ESRD) ● Kidney damage or decreased kidney function for 3 or more months ● Duration of kidney failure > 3 months? chronic kidney disease (CKD) for CKD, do we need to be able to do a risk assessment and identify patients who are at risk for CKD? yes is CKD usually asymptomatic in early stages? yes what is this an example of? continuum of development of the progression and complications of CKD what are some risk factors for CKD? -genetics -sociodemographic predisposition -presence of diseases (diabetes, HTN) what are these examples of for CKD: -genetics -sociodemographic predisposition
-presence of diseases (diabetes, HTN)? risk factors what are some complications of CKD? -decreased GFR -albuminuria -cardiovascular disease what are these examples of for CKD: -decreased GFR -albuminuria -cardiovascular disease? complications what is this an example of for CKD: normal increased risk damage decreased GFR kidney failure death? continuum of development of the progression and complications of CKD does GFR decline in the worse kidney issues? yes what type of kidney disease does this urinary pattern suggest:
hematuria with dysmorphic red blood cells, red blood cell casts, varying degrees of albuminuria? proliferative glomerulonephritis what type of kidney disease does this urinary pattern suggest: heavy albuminuria with minimal or absent hematuria? nonproliferative glomerulopathy what type of kidney disease does this urinary pattern suggest: multiple granular and epithelial cell casts with free epithelial cells? acute tubular necrosis in a patient with underlying AKI what type of kidney disease does this urinary pattern suggest: abnormal kidney function with normal dipstick and sediment containing few cells, no casts, and no or minimal proteinuria? -prerenal acute AKI due to either volume contraction or an effective decrease in circulating volume -hypercalcemia -light chain cast nephropathy in multiple myeloma -tumor lysis syndrome -vascular disease that produces glomerular ischemia but not infarction -urinary tract obstruction what is a confirmative and diagnostic test for kidney issues? urinalysis what are the different GFR stages for CKD (6)? G G
G3a G3b G G what are these examples of for CKD: G G G3a G3b G G5? GFR stages for SKD what are the different albuminuria stages for CKD (3)? A A A what are these examples of for CKD: A A A3? albuminuria stages what GFR stage for CKD is this:
normal or high GFR: >90? G what GFR stage for CKD is this: mildly decreased GFR: 60 to 89? G what GFR stage for CKD is this: mildly to moderately decreased GFR: 45 to 59? G3a what GFR stage for CKD is this: moderately to severely decreased GFR: 30 to 44? G3b what GFR stage for CKD is this: severely decreased GFR: 15 to 29? G what GFR stage for CKD is this:
kidney failure (add D if treated by dialysis) GFR: <15? G what is the GFR for CKD G1? > what is the GFR for CKD G2? 60 to 89 what is the GFR for CKD G3a? 45 to 59 what is the GFR for CKD G3b? 30 to 44 what is the GFR for CKD G4? 15 to 29 what is the GFR for CKD G5? < what albuminuria stage for CKD is this AER: normal to mildly increased (may be subdivided for risk prediction) AER: <30 mg/day? A what albuminuria stage for CKD is this AER: moderately increased AER: 30 to 300 mg/day? A
what albuminuria stage for CKD is this AER: severely increased (may be subdivided into nephrotic and nonnephrotic for differential diagnosis, management, and risk prediction) AER: >300 mg/day? A what is the AER for CKD albuminuria stage A1? <30 mg/day what is the AER for CKD albuminuria stage A2? 30 to 300 mg/day what is the AER for CKD albuminuria stage A3? >300 mg/day what does AER stand for? albumin excretion rate is albumin assessed as a marker of kidney damage, reflects increase in glomerular permeability and macro molecules, tells you about endothelial dysfunction? yes wha tare some disorders and diseases we see in clinical practice that end up causing endothelial dysfunction? hypertension diabetes mellitus hypercholesteremia smoking obesity what is one of the first tests you order and do to identify CKD? urinalysis
if someone has a normal GFR, but has albuminuria is that a red flag? yes what do casts indicate in urine? presence of glomerular? what is defined based on the process of either kidney damage or decreased kidney function for 3 or more months, irrespective of cause? CKD what is a normal GFR? 125 ml/min what is a GFR <15 ml/min defined as? kidney failure what are these criteria for: -duration of >3 months, based on documentation or inference -GFR rate <60 ml/min/1.73 m -kidney damage, as defined by structural abnormalities or functional abnormalities other than decreased GFR? CKD what criteria for CKD is this: glomerular diseases -diabetes, autoimmune diseases, systemic infections, drugs, neoplasia vascular diseases -atherosclerosis, hypertension, ischemia, vasculitis, thrombotic microangiopathy
tubulointerstitial diseases -UTI, stones, obstruction, drug toxicity cystic disease -polycystic kidney disease? pathologic abnormalities what are some pathologic abnormalities for criteria for CKD? glomerular diseases -diabetes, autoimmune diseases, systemic infections, drugs, neoplasia vascular diseases -atherosclerosis, hypertension, ischemia, vasculitis, thrombotic microangiopathy tubulointerstitial diseases -UTI, stones, obstruction, drug toxicity cystic disease -polycystic kidney disease what criteria for CKD is this: chronic allograft nephropathy -non specific findings of tubular atrophy, interstitial fibrosis, vascular and glomerular sclerosis rejection
drug toxicity -calcineurin inhibitors BK virus nephropathy recurrent disease -glomerular disease, oxalosis, fabry disease? history of kidney transplantation what are some history of kidney transplantation in addition to pathologic abnormalities observed in native kidneys, for CKD? chronic allograft nephropathy -non specific findings of tubular atrophy, interstitial fibrosis, vascular and glomerular sclerosis rejection drug toxicity -calcineurin inhibitors BK virus nephropathy recurrent disease -glomerular disease, oxalosis, fabry disease what criteria for CKD is this: a marker of kidney damage (increased glomerular permeability, urine albumin to creatinine ratio (ACR)
30 mg/g)
-the normal ACR is <10 mg/g -urine ACR categories 10-29, 30-300, and >300 are termed mildly increased, moderately increased, and severely increased -urine ACR >2200 mg/g is accompanied by symptoms and signs of nephrotic syndrome -threshold value corresponds approx to urine dipstick values of trace or 1+, depending on urine concentration -high urine ACR can be confirmed by urine albumin excretion in a timed urine collection? albuminuria what are these signs and symotoms of: -urine ACR >2200 mg/g -low serum albumin -edema -high serum cholesterol? nephrotic syndrome what are signs and symptoms of nephrotic syndrome? low serum albumin edema high serum cholesterol what criteria for CKD is this: -RBC casts in proliferative glomerulonephritis -WBC casts in pyelonephritis or interstitial nephritis
-oval fat bodies or fatty casts in diseases w proteinuria -granular casts and renal tubular epithelial cells in many parenchymal diseases (non specific)? urine sediment abnormalities as markers of kidney damage what are the urine sediment abnormalities as markers of kidney damage for CKD? -RBC casts in proliferative glomerulonephritis -WBC casts in pyelonephritis or interstitial nephritis -oval fat bodies or fatty casts in diseases w proteinuria -granular casts and renal tubular epithelial cells in many parenchymal diseases (non specific) what are WBC casts in? pyelonephritis or interstitial nephritis what are RBC casts in? proliferative glomerulonephritis what criteria for CKD is this: -polycystic kidneys -hydronephrosis due to obstruction -cortical scarring due to infarcts, pyelonephritis, or vesicoureteral reflux -renal masses or enlarged kidneys due to infiltrative diseases -renal artery stenosis -small and echogenic kidneys (common in later stages of CKD due to many parenchymal diseases)? imaging abnormalities as markers of kidney damage (US, CT, MRI, isotope scans, angiography) what are the imaging abnormalities as markers of kidney damage (US, CT, MRI, isotope scans, angiography) for CKD? -polycystic kidneys -hydronephrosis due to obstruction
-cortical scarring due to infarcts, pyelonephritis, or vesicoureteral reflux -renal masses or enlarged kidneys due to infiltrative diseases -renal artery stenosis -small and echogenic kidneys (common in later stages of CKD due to many parenchymal diseases) what is this an example of? staging of patients who meet the definition of CKD what stage of CKD is the most important because it identifies high risk and this is where they will be referred to nephrology? stage 3 how many stages of kidney failure are there for the GFR? 5 are individuals asymptomatic with CKD until later stages, usually stage 4? yes for CKD, are systemic changes not picked up until the changes are more than 20% of normal? yes what is known as an irreversible loss of renal function (nephron number) that may or may not lead to End Stage Renal Disease (ESRD) and Duration of kidney failure > 3 months? CKD what is known as an irreversible renal failure of a magnitude that requires renal replacement theory, GFR and creatinine clearance <10-15 cc/min? end stage renal disease (ESRD) if someone has diabetes, what number would it be for creatinine clearance of 10-15 cc/min for ESRD? 15 what two diseases cause about 70% of ESRD? diabetes mellitus hypertension
what are these causes of: diabetes mellitus hypertension glomerulonephritis cystic disease other urological diseases? CKD what are some causes of CKD? diabetes mellitus hypertension glomerulonephritis cystic disease other urological diseases what are the risk factors for CKD? • Analgesic abuse •Cigarette smoking •Collagen vascular disease (Wegner's disease) •AIDS-related nephropathies •Cirrhosis •Multiple myeloma •Hereditary renal disease: Polycystic kidney disease (PKD) and Alport syndrome what are these risk factors for:
•Cigarette smoking •Collagen vascular disease (Wegner's disease) •AIDS-related nephropathies •Cirrhosis •Multiple myeloma •Hereditary renal disease: Polycystic kidney disease (PKD) and Alport syndrome? CKD what is a risk factor for CKD and it is glamulomatous inflammation of small and medium blood vessels, it causes a vasculitis, it causes damage to various organs in the body, they present with respiratory symptoms, can have nose ulcerations, persistent runny nose, sinus pain, and it is very rare and can progress to renal failure? collagen vascular disease (wegner's disease) do symptoms for CKD generally not appear until there is a significant decline in GFR to usually a stage 4 or 10-15% left of renal function? yes what are these signs and symptoms of: early signs -anorexia, lassitude, fatiguability, weakness uremic symptoms dermatologic -severe pruritis, deposits of phosphorous on skin GI -anorexia, nausea, vomiting, hiccups