Snapshot A 56-year-old man presents with lower abdominal pain. His symptoms have progressively worsened over the course of the day. Medical history is significant for benign prostatic hyperplasia on tamsulosin. His blood pressure is 144/106 mmHg (normally, his blood pressure is 120/80 mmHg). On physical examination he has bladder distension. Laboratory testing is significant for a creatinine of 2.4 mg/dL (last serum creatinine was 0.7 mg/dL.) (Post-renal acute kidney injury likely secondary to benign prostatic hyperplasia) Introduction Clinical definition acute reduction in glomerular filtration rate (GFR) recall that GFR represents the sum of the filtration rates of nephrons therefore, GFR reflects functioning renal mass Epidemiology risk factors hypertension chronic kidney disease dehydration and volume depletion diabetes chronic liver or lung disease Etiology prerenal causes decreased renal perfusion (e.g., hemorrhage, congestive heart failure, and diuretic use) intrarenal causes acute tubular necrosis ischemia and toxic causes interstitial nephritis glomerulonephritis vasculitis hemolytic uremic syndrome postrenal causes urinary flow obstruction (e.g., benign prostatic hyperplasia and nephrolithiasis) Pathogenesis based upcome etiology (look at etiology) Prognosis lower rates of recovery in patients > 65 years of age increased risk of end-stage renal disease, chronic kidney disease, and mortality Presentation Symptoms may be asymptomatic oliguria anuria polyuria confusion Physical exam hypertension edema decreased urine output Imaging Renal ultrasound indication initial imaging study for assessing acute kidney injury can assess for renal size and hydronephrosis to assess for postrenal obstruction Studies Labs increase in serum creatinine by ≥ 0.3 mg/dL within 48 hours blood urea nitrogen (BUN):creatinine ratio urinalysis dipstick to assess for protein, glucose, leukocyte esterase, hemoglobin and myoglobin, and specific gravity microscopy for example red dysmorphic cells suggests a glomerular etiology (e.g., glomerulonephritis) muddy brown casts suggests tubular necrosis white blood cell casts suggest pyelonephritis or acute interstitial nephritis fractional excretion of Na+ (FeNa+) if patient is on diuretics use FeUrea urine osmolality and Na+ Studies To Assess For Prerenal, Intrarenal, and Postrenal Acute Kidney Injury (AKI)StudiesPrerenal AKIIntrarenal AKIPostrenal AKIUrine osmolality (mOsm/kg)> 500< 350< 350FeNa+< 1%> 2%< 1% in mild cases> 2% in severe casesUrine Na+(mEq/L)< 20> 40> 40Serum BUN/Cr> 20:1< 15:1Variable Differential Acute gastrointestinal bleeding Rhabdomyolysis Medication-induced impairment of creatinine secretion cimetidine trimethoprim pyrimethamine Treatment Treatment is dependent on the etiology of AKI and its consequences for example a patient who is hyperkalemic and not responding to medical treatment should be dialyzed a patient with a history of excessive fluid loss (e.g., diarrhea and vomiting) should be given intravenous fluid Complications Hyperkalemia Metabolic acidosis Uremic encephalopathy and platelet dysfunction Anemia Chronic kidney disease
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.RL.13.27) A previously healthy 9-year-old, Caucasian girl presents to your office with severe abdominal pain. Her mother also mentions that she has been urinating significantly less lately. History from the mother reveals that the girl suffers from acne vulgaris, mild scoliosis, and had a bout of diarrhea 3 days ago after a family barbecue. Lab work is done and is notable for a platelet count of 97,000 with a normal PT and PTT. The young girl appears dehydrated, yet her serum electrolyte levels are normal. What is the most likely etiology of this girl's urinary symptoms? QID: 100981 Type & Select Correct Answer 1 Hypothalamic dysfucntion 4% (4/110) 2 Surreptitious laxative use 6% (7/110) 3 Toxic shock syndrome 3% (3/110) 4 Shiga toxin production from Shigella 17% (19/110) 5 Shiga-like toxin production from EHEC 65% (72/110) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (M1.RL.12.71) A 49-year-old female with a history of alcoholism was found lying unconscious on a bench at a local park and rushed to the emergency department. Upon arrival, the patient regained consciousness and complained of intense bilateral flank pain and a recent decrease in urination. Urine microscopy demonstrated abundant square crystals of calcium oxalate that looked like “folded envelopes." Which of the following findings is most likely to be seen in this patient: QID: 101025 Type & Select Correct Answer 1 Metabolic alkalosis 18% (17/96) 2 Anion gap metabolic acidosis 65% (62/96) 3 Non-anion gap metabolic acidosis 11% (11/96) 4 Respiratory acidosis 4% (4/96) 5 Respiratory alkalosis 0% (0/96) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic
All Videos (2) Login to View Community Videos Login to View Community Videos Acute Renal Failure Keshav Mudgal Renal - Acute Kidney Injury D 8/20/2015 135 views 5.0 (2) Login to View Community Videos Login to View Community Videos Acute Renal Failure Renal - Acute Kidney Injury E 2/14/2015 82 views 0.0 (0) Renal | Acute Kidney Injury Renal - Acute Kidney Injury Listen Now 15:34 min 11/7/2021 85 plays 5.0 (1)