R&R EXAM 4

acute kidney injury (AKI)

OLIGURIA, normal/LARGE kidneys, REVERSIBLE decrease in kidney function that occurs over hours to days.

severe CKD

patient presents with fatigue, confusion, UREMIA, LOSS of APPETITE, and abnormal skin pigmentation what is the most likely diagnosis?

nephritic syndrome

which glomerular disease is LUPUS most commonly associated with?

microalbuminuria

screening for early-stage diabetic nephropathy

proteinuria

major clue that indicates GLOMERULAR (nephritic/nephrotic) disease

pre-renal, renal, post-renal

types of ACUTE KIDNEY INJURY

acute interstitial nephritis

condition where spaces between the kidney tubules become inflamed, type of RENAL AKI

pre-renal AKI

what can hepatorenal syndrome lead to?

pyelonephritis

A bacterial infection of the kidney and renal pelvis, often resulting from a urinary tract infection.

low urine Na and high Urine osm

indicators of pre-renal AKI

chronic kidney disease (CKD)

typically presents with fatigue, ANEMIA, SMALL kidneys

oliguria

DECREASED URINE OUTPUT, <500 ml/day, can indicate ACUTE KIDNEY INJURY

pre-renal

a type of acute kidney injury (AKI) caused by REDUCED BLOOD FLOW to the kidneys

renal

a type of acute kidney injury (AKI) resulting from DIRECT DAMAGE to the KIDNEYS

vascular, glomerular, tubular (ATN), nephritic/interstitial (AIN)

types of RENAL AKI

post-renal AKI

A type of acute kidney injury (AKI) caused by OBSTRUCTION of urine flow AFTER it passes through the kidneys

hydronephrosis

SWELLING of renal pelvis and kidney due to buildup of urine, indication of POST-RENAL AKI

post-renal AKI

what is HYDRONEPHROSIS an indication of?

pre-renal

what does a BUN/Cr ratio larger than 20:1 suggest

pre-renal AKI

what does an INCREASED BUN suggest

fractional excretion of Na (FENa)

percentage of Na secreted in the urine, accounts for abstraction of water by ADH

pre-renal AKI

low urine Na (FENa < 1%) suggests?

pre-renal AKI

what is HIGH URINE OSM an indication of?

acute tubular necrosis

most common cause of hospital acquired AKI

white coat hypertension

a condition where a patient's blood pressure is elevated in a clinical setting but normal in other settings

primary

most common type of hypertension

secondary

type of hypertension more prevalent in younger individuals

weight loss, exercise, low sodium ect.

non-pharmecutical methods of decrease blood pressure

ACEI

best first choice medication for younger pts with hypertension

systolic 130-139 or diastolic 80-89

parameters of stage 1 hypertension

systolic ≥ 140 or diastolic ≥ 90

parameters of stage 2 hypertension

causes glomerular damage that worsens hypertension

how does diabetes affect hypertension?

moderately (1 to 2 carpules)

can local anesthetic be used in patients with hypertension?

delay elective care

a patient presents with BP >180/110 what should be done?

emergency medical attention

a patient presents with BP >180/120 what should be done?

rhabdomyolysis

type of ACUTE TUBULAR NECROSIS (ATN) where muscle tissue breaks down and releases substances into the bloodstream, potentially causing kidney damage

edema, hyperkalemia, acidosis, accumulation of medications and uremic toxins

major complications of AKI

acute tubular necrosis/ATN (renal AKI)

presence of muddy brown casts in urine indicates?

chronic kidney disease (CKD)

urine output >500ml/24hrs ( or normal) is associated with?

chronic kidney disease

IRREVERSIBLE, leads to end stage renal disease (ESRD)

end stage renal disease (ESRD)

GFR <15mL/min indicates?

renal insufficiency

MILD renal disease with diminishing GFR

azotemia

WORSENING renal function, BUN build up resulting in LOW GRF and ELEVATED Cr

Uremia

SEVERE renal dysfunction, kidneys UNABLE to filter toxic nitrogenous wastes, kidney failure that REQUIRES intervention

lifestyle, BP, RAAS, glycemic control, lipid control, SGLT2 inhibitor

interventions for CHRONIC KIDNEY DISEASE (CKD)

diabetes, hypertension, and glomeronephritis

most common causes of chronic kidney disease (CKD)

nephrOtic syndrome

DAMAGE to glomerulus (podocytes) leading to significant proteinuria (>3.5 g)

nephrItic syndrome

INFLAMMATION at glomerulus leading to HEMATURIA (RBC casts) and moderate PROTEINURIA (1-3g)

proteinuria, hypoalbuminemia, edema, hyperlipidemia, lipiduria

clinical features of nephrOtic syndrome

blood in urine (hematuria)

characteristic of nephrItic syndrome

edema, protein malnutrition, CVD, thrombosis, and infection

complications of nephrOtic syndrome

minimal change disease, glomerulosclerosis (FSGS), membranous nephropathy

causes of primary nephrOtic syndrome

focal segmental glomerulosclerosis (FSGS)

most common PRIMARY glomerular disease resulting in ESRD

diabetes, lupus, amyloidosis

SECONDARY causes of nephrOtic syndrome

diabetes

most common SECONDARY glomerular disease resulting in ESRD

hematuria (nephritic syndrome)

what is brown urine an indication of?

post-infectious GN, IgA neuropathy, Progressive GN

primary causes of nephrItic syndrome

post-infectious glomerulonephritis

patient present with dark urine a few weeks after strep throat infection what is likely the cause?

post infectious, IgA, progressive, lupus

immune complex glomeronephritis’s

lupus and ANCA/vasculitis

secondary causes of nephrItis syndrome

lupus

pt presents with fatigue, arthralgia,malar rash, and renal involvement what is the likely diagnosis?

sjogrens

is an autoimmune disorder characterized by dry eyes and dry mouth, can occur alonewith other autoimmune diseases such as lupus

MALT lymphoma

individuals with sjogrens are at increased risk of what?

decrease risk of events (stroke, MI, HF, kidney disease)

What is the main goal of therapy for patients with hypertension?

target patient systolic BP <130

What are evidence-based monitoring parameter goals for patients with hypertension?

ACEI, CCB (calcium channel blocker), a1 blockers, ARBs, hydralazine

Which classes of agents work by decreasing systemic vascular resistance?

thiazide, loop diuretics, K-sparing diuretics

Which classes of agents work by decreasing intravascular volume and thus stroke volume?

ACEI, ARB, CCB (DHP), thiazide

first line therapies for HYPERTENSION

thiazides

inhibit Na-K pump, cause Na and K excretion

ACEIs

block angiotensin II FORMATION, cause VASODILATION and H2O excretion

ARBs

block angiotensin RECEPTOR, cause VASODIALTION and H2O excretion

CCBs(calcium channel blockers)

block calcium channels in smooth muscle, VASODILATION

lisinopril

example of ACEI

losartan

example of ARB

amlodipine

example of CCB

hypokalemia and hyperglycemia

ADRs of THIAZIDES

COUGH, hypotension, hyperkalemia, edema

ADRs of ACEIs

hypotension, hyperkalemia, edema

ADRs of ARBs

edema and constipation

ADRs of CCBs

systolic >180

at what BP should EXt be AVOIDED

epinephrine may worsen hypertension

consideration of epinephrine containing anesthetic with hypertension patients

NSAIDs

increases risk of AKI with antihypertensive agents (diuretics and RAAS)

chronic sustained injury leads to destruction of kidney and replacement with fibrous tissue

HOW does chronic kidney disease progress over time?

compensatory hyperfiltration

what causes the progression of CHRONIC KIDNEY DISEASE

albuminuria

presence of albumin in urine

slowing progression

treatment strategy for CKD

ang II antagonists (ARBs)

first line therapy in HYPERTENSION management in CKD

ang II antagonist and SGLT2 inhibitor 

medications to slow progression of CKD

aranesp

treatment for ANEMIA in CKD

low K diet, caution with meds, potassium binders

treatment for HYPERKALEMIA in CKD

calcitriol

treatment for high parathyroid hormone and low vitamin D in CKD

diabetes caused nephrotic syndrome

what is Kimmelstiel-Wilson nodules in the kidney and indication of?

rapidly progressive renal failure (RPGN)

subcategory of nephritis with lung involvement (pulmonary renal syndrome), presents with PURPURIC RASH and BLOOD IN URINE

acute interstitial nephritis

often due to DRUG REACTIONS, infections, or autoimmune conditions symptoms such as fever, RASH, and eosinophilia.

IgA nephropathy

most common glomerulonephritis (nephritic syndrome)