Renal Final Test Quiz with well answered questions

what is AKI? and what defines it? Acute 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? -irreversible loss of renal function that may or may not lead to End Stage Renal Disease -more than 3 months 00:02 01:08 ESRD is what and indications? -End Stage Renal Disease -creatine clearance 10ml/min -need renal replacement therapy to survive what is Azotemia and what can it lead to? -elevation of blood urea nitrogen i.e. increased BUN -can lead to Uremia clinical symptoms of high Azotemia Uremia symptoms is what? -side effect of accumulation of nitrogenous compounds -Nausea, vomiting, confusion, anorexia seizures What is Oliguria 500cc/day of urine output Non-Oliguric is what? -500cc a day of urine output Anuric is what? 100 cc a day of urine out put i.e. there is an obstruction what test can be used for assessment of Renal Function? -Serum creatinine -24 creatinine clearance -eGFR that takes into account Age, Weight and Sex what happens to Serum Creatinine in AKI? there is a change in Serum Creatinine by 0.3 from the baseline Where is Creatine made from? -get in diet 50% and synthesize other half in the Liver what is abnormal creatinine for men and women? men 1.5mg/dl female1.2mg/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? -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? -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? -90-120ml/min in urine what is the standard eGFR that is used? -the MDRD Modification of Diet in Renal Disease For the same creatinine level who has better renal function? Men and the younger what is the normal BUN/Cr ratio? 10-15:1 in normal person in blood Uremic Syndrome is what? -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? the hand-flapping due to interruption of signals from high NH4+ in blood what can elevate BUN in people with normal Renal Function? -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? -Trimethoprim drug that is part of Bactrim directly competes for secretion with creatinine -Cimetidine: H2 antagonist increase serum creatinine What can Cause Rhabdomyolysis? and elevate serum Creatinine -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? BUN 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? -look at the radiology of the kidney and the Ultrasound -normal kidney11cm 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