Internal Disorders II (Kidney)

what 3 causes fall under prerenal AKI?

Low blood volume (hypovolemic) Decreased Cardiac output Hypotension

what drug is most likely associated with risk of kidney disease?

NSAIDs

What finding is indicative of prerenal KI? Oliguria Hydronephrosis on ultrasonogram Hypertension FENa > 3%

Oliguria (urine reabsorbed to maintain blood volume)

what criteria is used to classify AKI?

RIFLE criteria

What is the most common cause of secondary hypertension?

Renal artery stenosis

most common autoimmune causes of 2ary kidney disease?

SLE Wegner`s granulomatosis (Polyangiitis) Vasculitis

type 3 hypersensitivities?

SLE post-streptococcal glomerulonephritis IgA nephropathy Henoch-Schönlein Purpura (IgA vasculitis) Rheumatoid arthritis reactive arthritis

S-Cr test stands for?

Serum creatinine (creatinine in blood?)

WBC casts in urinalysis of AKI patient indicates?

TIN (tubular interstitial nephritis)inflammation or infection (pyelonephritis - ascending UTI due to E. coli) or (interstitial nephritis)

Risk (RIFLE)

-1.5 fold increase in serum creatinine -GFR decrease 25% -<0.5ml/kg for 6 hours

Injury (RIFLE)

-2 fold increase in serum creatinine -GFR decrease 50% -<0.5 ml/kg for 12 hours

Failure (RIFLE)

-3 fold increase in serum creatinine -GFR decrease of 75% -<0.5 ml/kg for 24 hours

polycystic kidney disease

-a genetic disorder causes cystic dilation of collecting tubules. -risk for kidney stones and pyelonephritis. -no treatment needed if asymptomatic

causes of post renal AKI?

-benign prostatic hyperplasia (most common) -nephrolithiasis (kidney stone) -neoplasm causing obstruction -retroperitoneal fibrosis

bacterial endocarditis presentation in kidney?

-focal segmental glomerulonephritis -nephritic syndrome (hematuria)

Alport syndrome

-most common hereditary nephritis. -x-linked defect of type IV collagen that affects eyes, kidneys and cochlea -presents similar to Goodpasture but lacks goodpasture antigen

what excretion function are kidneys associated with?

-selective reabsorption/excretion -excretion of urea, creatinine, uretic acid (BUN) -excretion of drugs, pollutants and toxins

pathophysiology of Berger's disease?

-triggered by mucosal infections (UTI or GI infection) -IgA antibodies form immune complexes in kidney

Granulomatosis with polyangiitis (Wegener)

-vasculitis of small and medium sized vessels. -necrotizing granulomatous inflammation. -RPGN -nephritic syndrome (hematuria)

what are some common pathologies that are known to cause inflammatory glomerulonephritis?

-wegener`s granulomatosis -goodpasture syndrome -SLE

Renal Function Tests are used in order to?

1. Assess kidney function 2. Diagnose kidney disease 3. monitor progression of kidney disorder treatment 4. evaluate patient`s hydration state

what are most common post infectious kidney disease?

1. GABHS 2. UTI 3. GI-tract infection

what are two conditions that present with right-sided colicky pain?

1. acute appendicitis 2. renal colic

top 3 most common cause of CKD?

1. diabetes mellitus 2. hypertension 3. chronic glomerulonephritis

what are risks for kidney disease?

1. diabetes mellitus 1/2 2. Hypertension 3. significant atherosclerosis 4. HF (systolic forward failure) 5. Severe Dehydration 6. hemorrhage/trauma

acute tubular necrosis is damage of epithelium of tubular nephrons and is most commonly caused by?

1. ischemia (hypoxia, MI, hypovolemic shock) 2. Drugs (NSAIDS, iodine, aminoglycosides) 3. Casts (Multiple myeloma, kidney stone, rhabdomy)

what should be differential diagnosis for hematuria?

1. nephritic syndrome 2. infection (cystitis, urethritis, pyelonephritis) 3. malignancy 4. Urolithiasis (kidney stone) 5. hemophilia 6. myoglobinuria

what are red flags for kidney disease?

1. old age 2. DM 3. HTN 4. genetic 5. history of recurrent UTI 6. NSAIDs, antibiotics, immunosuppressants 7. CVD 8. history of stroke, MI, PAD 9. Autoimmune 10. proteinuria/hematuria

what is best test for nephrotic syndrome?

24hr urine collection

how much of kidney function needs to be lost for clinical signs and symptoms?

90% of both kidneys

bacteriuria values

>10^5 organisms/ml in midstream collection

proteinuria values

>150mg protein/day in urine

Henoch-Schonlein Purpura (HSP)

A tetrade of rash, arthralgia, abdominal pain and kidney disease in a child. -IgA vasculitis characterized by palpable purpura. -GABHS is mc trigger.

Type 2 hypersensitivities?

Autoimmune hemolytic anemia good pasture syndrome graves disease immune thrombocytopenia myasthenia gravis

What is the term for elevated BUN & serum creatinine? Acute kidney failure Chronic kidney disease Uremia Azotemia Decreased GFR

Azotemia

A 68-year-old man is admitted to the intensive care unit after open abdominal aortic aneurysm repair. The patient has received 4 units of packed red blood cells during the surgery. During the first 24 hours following the procedure, he has only passed 200 mL of urine. He has congestive heart failure and hypertension. Current medications include atenolol, enalapril, and spironolactone. He appears ill. His temperature is 37.1°C (98.8°F), pulse is 110/min, respirations are 18/min, and blood pressure is 110/78 mm Hg. Examination shows dry mucous membranes and flat neck veins. The remainder of the examination shows no abnormalities. Laboratory studies show a serum creatinine level of 2.0 mg/dL and a BUN of 48 mg/dL. His serum creatinine and BUN on admission were 1.2 mg/dL and 18 mg/dL, respectively. Further evaluation of this patient is most likely to reveal which of the following findings? BUN/serum creatinine ratio 25:1 Proteinuria Decreased urine osmolality Hematuria RBC casts

BUN/serum creatinine ratio 25:1 (Patients with prerenal (AAA=hypovolemic) azotemia typically present with a decreased urine sodium concentration (< 20 mmol/L) and a BUN/serum creatinine ratio > 20:1. This type of AKI is caused by a lack of fluids (e.g., due to decreased perioperative oral intake and intraoperative blood loss) and subsequently reduced renal perfusion, rather than direct damage to the nephrons. The kidneys physiologically respond by reabsorbing large amounts of sodium, which is then followed by water. As a result, the excreted urine contains low amounts of sodium and is concentrated; only a small amount of water is lost.)

Thrombotic Thrombocytopenic Purpura (TTP)

Caused by deficiency of a vWF cleaving metalloprotease that triggers formation of numerous thrombi within small vessels.

Heavy metal nephropathy classical triad

Chronic kidney disease Hypertension Gout

what is amyloidosis?

Deposition of a misfolded protein that can be localized or systemic; if systemic, can be primary (AL deposited due to plasma cell issue) or secondary (AA deposited due to chronic inflammation and overproduction of SAA which becomes AA) can lead to nephrotic syndrome causing proteinuria

Most common systemic causes of nephrotic syndrome?

Diabetes Melitus Lupus Nephropathy Amyloidosis

most common cause of nephrotic syndrome in African Americans?

Focal glomerulosclerosis

Most common primary causes of nephrotic syndrome?

Focal glomerulosclerosis Membranous nephropathy Minimal change disease

A patient experiences acute kidney injury (failure) after a recent episode of scarlet fever. What is the most likely cause of kidney injury in this case?

GABHS

definition of chronic kidney disease (CKD)

GFR <60ml/min or kidney damage for >3months

3 weeks after an episode of GABHS pharynngitis, a nine-year-old male presents with oliguria, BUN-to-serum Cr 15:1, and FENa 2.5%, and urine sediment positive for dysmorphic RBCs with casts. What renal disease is most likely? Hemolytic-uremic syndrome Acute tubular necrosis Tubulointerstitial nephritis Glomerulonephritis

Glomerulonephritis (dysmorphic RBC casts)

what is most common acute kidney injury in children?

HUS (hemolytic-uremic syndrome)

most common presentation of nephrotic syndrome?

Heavy proteinuria (>3.5g/day) Generalized Edema Hyperlipidemia - fatty casts Hypoalbuminemia

most common presentation of nephritic syndrome?

Hematuria RBC casts in urine Hypertension

what is the most common primary glomerulonephritis worldwide?

IgA nephropathy (Berger's Disease) males 20-30year old or children increased serum IgA causes mesangial proliferation

3 weeks after an episode of GABHS pharynngitis, a nine-year-old male presents with oliguria, BUN-to-serum Cr 18:1, and FENa 2.5%, and urine sediment positive for dysmorphic RBCs with casts. What category of renal disease is most likely? Intrinsic AKI Nephrolithiasis Prerenal AKI Postrenal AKI

Intrinsic AKI (dysmorphic RBC=glomerulonephritis which is intrinsic AKI)

erythropoietin is what?

a hormone that induces the formation of RBC

Pathological bone fractures due to CDK is most likely the result of ... Select TWO answers. a. sHPT b. decreased renal erythropoietin production c. azotemia d. nephrosclerosis e. renal metabolic acidosis

a. d.

A 36-year-old African-American man comes to the physician for a 4-week history of swollen legs. He has difficulty putting on socks because of the swelling. Two years ago, he was diagnosed with sleep apnea. He takes no medications. He is 171 cm (5 ft 6 in) tall and weighs 115 kg (253 lb); BMI is 39 kg/m2. His pulse is 91/min and blood pressure is 135/82 mm Hg. Examination shows periorbital and bilateral lower extremity edema. Serum Albumin 3.1 g/dL Total cholesterol 312 mg/dL Urine Blood negative Protein +4 RBC 1-2/hpf (WNL) RBC cast negative Fatty casts numerous A renal biopsy is obtained. Which of the following is most likely to be seen under light microscopy of the patient's renal biopsy specimen? a. Segmental sclerosis of the glomeruli b. Fibrin crescents within the glomerular space c. Diabetic hyaline arteriolosclerosis d. Eosinophilic nodules within the glomeruli e. Diffuse thickening of glomerular capillaries f. Amyloid deposition in the mesangium

a. Segmental sclerosis of the glomeruli (MC nephrotic syndrome cause in African Americans is Focal Segmental Glomerulosclerosis)

what is most common renal AKI cause?

acute tubular necrosis

muddy brown casts are a characteristics of?

acute tubular necrosis (ATN)

A 52-year-old female undergoes IV urography (pyelogram) for diagnosis of suspect kidney stones. The woman has had several episodes of left lower back pain and macroscopic hematuria for two weeks. During the week after the procedure, the patient develops continuously decreasing urine volume. Lab positive for BUN-to-serum Cr 10:1, urine osmolality < 300 mOsm, urine Na 45, FENa 2.5%, and a urine sediment positive for granular casts with brown pigment and epithelial cells. What is the most likely differential diagnosis? Glomerulonephritis Uremia Acute tubular necrosis Tubulointerstitial nephritis

acute tubular necrosis (low osmolality = intrinsic AKI)

when erythropoietin is low due to a kidney disease what is the most likely patient presentation?

anemia

how does appendicitis differ from renal colic pain?

appendicitis presents with nausea, fever, pain at mcburney`s point

what is minimal change disease in adults?

associated with NSAID toxicity or Hodgkin lymphoma fusion of foot processes of podocytes in nephrons good prognosis does not progress to CKD

what is membranous glomerulnephropathy?

associated with nephrotic&nephritic syndrome most common nephrotic cause in whites

systemic lupus erythematosus (SLE)

autoimmune disease that affects connective tissue, skin, and internal organs. -women 30-40 years old -relapsing, remitting symptoms. -ANA and complex mediated inflammation. -butterfly rashes

Which of the following are true? Select all that apply. a. NSAIDs tend to increase blood flow to the kidney. b. CT scans reveal indentations on the curvature of the kidney in those with AN. c. Those with analgesic nephropathy (AN) tend to have enlarged kidneys. d. CT scans reveal papillary calcification in those with AN. e. Prostaglandins cause vasoconstriction of glomerular afferent arterioles. f. NSAIDs tend to decrease GFR.

b. d. f.

why is FENa high in intrinsic AKI?

because Na+ is excreted due to reabsorption impairment.

why is chronic kidney disease the under recognized public health crisis?

because it goes without symptoms and thus known as silent killer

why is urethral obstruction rarely a case of AKI?

because must be bilateral to cause renal failure

why is FENa low in pre-renal AKI?

because sodium is reabsorbed into the blood to maintain blood volume, instead of being excreted.

why is weight gain and edema common in AKI?

because when the water cannot be excreted due to kidney failure, the water accumulates in the body causing weight gain and edema.

terminal hematuria suggests?

bladder, prostate, trigonal area cause

function of ACE inhibitors

block the conversion of angiotensin I to angiotensin II, this causes vasodilation of efferent arteriole.

BUN test stands for?

blood urea nitrogen (urine in blood?)

What kidney-protective drug is recommended in individuals who have acute or chronic kidney disease, hypertension and proteinuria? a. aminoglycocide b. NSAID c. ACE inhibitor d. loop diuretic (furosedmide)

c. ACE inhibitor

systemic lupus erythematosus

chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs.

urolithiasis symptoms?

colicky pain (very severe that comes in bouts) with radiation to groin or genitals

what is the best measure for glomerular filtration rate?

creatinine clearance. increase in plasma creatinine = disease progression

what are most common causes of post renal AKI?

crystal or protein deposition in pelvis/ureter, bladder/urethra mass/kidney stone or infection

what are 3 possible pathophysiological mechanisms that can lead to proteinuria?

damage to glomeruli damage to tubules overproduction of low molecular weight proteins

what is the pathophysiology of prerenal AKI?

decreased blood flow/volume to kidney causes a drop in GFR which then causes a decrease in clearance of metabolites (BUN, Cr, uremic toxins).

glycosuria is most commonly due to?

diabetes mellitus

what are characteristics of primary kidney diseases?

due to decline kidney function, slow progressive. asymptomatic for decades.

why is presentation of intrinsic AKI different from prerenal AKI?

due to impaired reabsorption, the urine will have increased sodium and thus decreased osmolality.

A 40-year-old woman comes to the physician because of a 1-week history of fatigue, dark urine, and a feeling of heaviness in her legs. Two weeks ago, she returned from a vacation to Brazil, where she spent most of her days exploring the city of Rio de Janeiro on foot. She also gained 3 kg (7 lb) during her vacation. She has systemic lupus erythematosus. Her only medication is hydroxychloroquine. Her temperature is 37.5°C (99.5°F), pulse is 78/min, and blood pressure is 162/98 mm Hg. Physical examination shows 2+ pretibial edema bilaterally. Urinalysis shows: Blood 3+ Protein 1+ RBC 6-8/hpf with dysmorphic features RBC casts numerous WBC 8/hpf WBC casts rare Bacteria negative Which of the following is the most likely cause of this patient's leg findings? a. Increased capillary permeability b. Reduced cardiac stroke volume c. Hypoalbuminiemia d. This is nephritic, not nephrotic syndrome. e. Salt retention f. Venous insufficiency

e. Salt retention (This patient presents with features of nephritic syndrome, a condition caused by damage to the glomerular capillary wall (e.g., lupus nephritis secondary to SLE). Subsequent disruption of the glomerular filtration barrier leads to the characteristic nephritic sediment detectable on urinalysis. Another typical feature is salt retention leading to volume expansion, hypertension, and edema, although the underlying mechanism is not fully understood.)

A 6-year-old girl is brought to the physician because of increasing swelling around her eyes for the past 3 days. Her vital signs are within normal limits. Physical examination shows periorbital edema and abdominal distention with shifting dullness. Laboratory studies show a serum albumin of 2 g/dL and a serum cholesterol concentration of 290 mg/dL. Urinalysis shows 4+ proteinuria and fatty casts. Histological examination of a kidney biopsy specimen is most likely to show which of the following findings? a. Effacement of foot processes of podocytes on light microscopy b. Mesangial proliferation on light microscopy c. Granular subepithelial deposits of IgG, IgM, and C3 on immunofluorescence d. Subepithelial dense deposits on electron microscopy e. Normal glomeruli on light microscopy f. Deposits of IgG and C3 at the glomerular basement membrane on immunofluoresence

e. normal glomeruli on light microscopy (minimal change disease in kids presents with normal glomeruli on light microscopy, that's why it's called "Nil`s disease" = nothing disease)

what are signs and symptoms for patients with kidney disease?

edema (periorbital, peripheral) HTN Nausea Hematuria Lower back pain (costovertebral)

azotemia

elevated BUN or S-Cr

heavy exercise can lead to hematuria. T/F

false, can lead to hemoglobinuria

SLE presents with nephritic syndrome only. T/F

false, can present with nephritic or nephrotic syndrome.

Uremia (urine in blood) is most common cause of death for AKI patient. T/F

false, infection is most common cause of death. followed by cardiorespiratory complications.

NSAIDS only have intrinsic renal effects. T/F

false, pre-renal as well because it interrupts the blood flow.

autosomal dominant polycystic kidney disease (ADPCKD)is more deadly then autosomal recessive (ARPCKD). T/F

false, recessive is more deadly.

A 6-year-old boy is brought to the physician because of increasing swelling around his eyes for the past 3 days. During this period, he has had frothy light yellow urine. He had a sore throat 12 days ago. He appears tired. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 105/65 mm Hg. Examination shows periorbital edema and pitting edema of the lower extremities. Cardiopulmonary examination shows no abnormalities. Which of the following findings on urinalysis is most likely associated with this patient's condition? Muddy brown casts RBC casts Hyaline casts WBC casts Fatty casts Waxy casts

fatty casts (nephrotic syndrome)

proteinuria causes?

fever, intense exercise, dehydration or multiple myeloma or glomerulonephritis

what is FENa?

fractional excretion of sodium! this is an important measure, because it will show the percentage of sodium filtered vs fraction of sodium excreted in urine.

RBC casts in urinalysis of AKI patient indicates?

glomerular disease (intrinsic AKI)

GFR test stands for?

glomerular filtration rate test (is creatinine cleared?)

microscopic hematuria is due to what origin?

glomerular origin

most common primary kidney diseases?

glomerulonephritis pyelonephritis cystic kidney diseae

what are three types of intrinsic AKI?

glomerulonephritis (failure of filtration) acute tubular necrosis (failure of reabsorption) Tubulointerstitial disorder (failure of reabsorption)

presentation of nephritic syndrome?

gross hematuria Coca Cola colored urine

most common glomerular causes of intrinsic AKI is due to what type of reaction?

hypersensitivity reactions

common lab findings in prerenal AKI?

in prerenal AKI kidney`s have ability for reabsorption, thus oliguria because Na+ and water are reabsorbed to preserve blood volume. increased BUN to serum Cr ratio (>20:1)

synthesis of renin leads to?

increase of angiotensin II and aldosterone

why do we see proteinuria with glomerular damage?

increased permeability of glomerular filtration barrier causing more protein to be excreted as urine

causes of tubulointerstitial nephritis?

inflammation of tubules or interstitium. ascending UTI (pyelonephritis, E. coli) drugs (allergy, antibiotics, diuretics, anti seizure drugs)

persistent flank pain is more common with?

inflammatory disease (pyelonephritis)

What is the most likely cause of AKI if the BUN/Cr ratio is less than 10:1?

intrarenal, because renal damage causes decreased urea reabsorption

a positive dipstick urinalysis for proteins suggests what type of AKI?

intrinsic AKI (glomerulus affected)

inflammatory glomerulonephritis is most commonly rapidly progressive and what should be done as far as lab testing?

lab tests should be ordered regularly & biopsy needed.

what is a complication of untreated prerenal AKI?

less and less blood flow to kidneys can cause ischemia and thus acute tubular necrosis (ATN).

why do we see proteinuria with tubular damage?

less proteins can be reabsorbed into the blood stream and thus more proteins are in urine

function of aldosterone is to

maintain BP by retention of Na+ and H2O

painless hematuria is most commonly due to?

malignancy of bladder or kidney

most common cause of nephrotic syndrome in white patients?

membranous nephropathy

what is the most common cause of nephrotic syndrome in children?

minimal change disease

Most common cause of nephrotic syndrome in kids?

minimal change disease (nil`s disease)

conditions that cause nephrotic syndrome?

minimal change nephropathy focal segmental glomerulosclerosis membranous nephropathy diabetic neuropathy amyloidosis SLE

what is the prognosis for AKI?

more than 80% of AKI patients have complete recovery.

what is diabetic nephropathy?

most common cause of CKD atherosclerosis can cause renal stenosis hypertension treatment is done with ACE inhibitors

What is minimal change disease in kids?

most common nephrotic syndrome in children periorbital edema normal glomeruli seen in children (nil`s disease) triggered by viral infection or allergy

uremia symptoms

nasea fatigue vomiting anorexia muscle cramps anxiety, depression visual disturbance increased thirst

Dorothy presents at the nephrology ward presenting with hemoptysis and oliguria.. Findings: peripheral/periorbital edema, cola colored urine, HTN, oliguria. Dorothy shows signs of ________ syndrome. The most likely ddx is ________.

nephritic / goodpasture syndrome

Timmy presents at the nephrology ward 2 weeks after a throat infection. Findings: peripheral/periorbital edema, cola-colored urine, HTN, oliguria. Timmy shows sign of ________ syndrome. The most likely DDX is ___________.

nephritic / post-streptococcal GN

presentation of goodpasture?

nephritic syndrome skin pallor, fever, arthralgia hemoptysis = life threatening rapidly progressive glomerulonephritis (RPGN)

glomerulonephritis is associated with which type of syndrome?

nephritic syndrome (RBC casts)

Gregory, 55-year-old Hispanic male, presents at the nephrology ward. He has hypoalbuminemia, hyperlipidemia, and frothy urine with fatty casts. 24 hour urine collection shows massive proteiuria (> 3.5 g protein lost in urine/24 hr). Gregory shows signs of _______ syndrome. The most likely ddx is ________.

nephrotic / focal segmental glomerular nephropathy (FSGN)

Brian, 10 years old and stung by a bee, presents at the nephrology ward . He also has hypoalbuminemia, hyperlipidemia, and frothy urine with fatty casts. 24 hour urine collection shows massive proteiuria (> 3.5 g protein lost in urine/24 hr). Brian shows signs of _______ syndrome. The most likely ddx is _______.

nephrotic / minimal change disease

fatty casts in urinalysis indicate?

nephrotic syndrome

what is the least common cause of AKI?

postrenal AKI

why type of acute kidney injury is the most common?

prerenal

what are the three possible types of acute kidney injury (AKI)?

prerenal, renal and postrenal

acute tubular necrosis is due to

prolonged ischemia from pre-renal AKI

what do NSAIDS inhibit?

prostaglandin: cyclooxygenase

foamy urine appearance can be caused by what?

proteinuria

what is most common patient presentation for glomerulonephritis?

proteinuria hematuria because filtration doesn't work so it stays in the blood.

what are most common signs of nephrotic syndrome? and why?

proteinuria (increased filtration and lack of absorption) hypoalbuminemia (loss of protein in urine) edema (due to increased reabsorption of water) hyperlipidemia

why can NSAIDs cause AKI?

reduce the production of prostaglandin which can cause decreased GFR due to constriction of afferent arteriole.

what aspects of regulation do Kidneys need to do?

regulate fluid homeostasis balance ions/electrolytes maintain acid/base balance

myoglobinuria is most commonly due to?

rhabdomyolysis (muscle breakdown)

How is post-streptococcal glomerulonephritis diagnosed?

s-Anti-streptolysin-O (ASO) antibody detection

What is focal segmental glomerulosclerosis?

sclerosis of segments of some glomeruli mc in African American males with previous UTI associated with Hodgkin lymphoma proteinuria can lead to nephritic syndrome collapse of mesangial cells poor prognosis leads to CKD within 10years

hemoglobinuria is most commonly due to?

severe intravascular hemolysis

what endocrine functions are kidneys involved in?

synthesis of renin, erythropoietin, prostanoids

What is the most common cause of intrinsic acute kidney injury? Rhabdomyolysis Glomerulonephritis Ascending UTI Unmanaged prerenal AKI

unmanaged prerenal AKI which causes acute tubular necrosis (ATN)

classic physical finding for uremia?

uremic frost, hyperpigmentation

initial hematuria suggests?

urethral cause

hematuria is most commonly due to?

urethral damage

bacteriuria is most commonly due to?

urinary tract infection

micturition

urination (amount, appearance, discomfort?)

uremia

urine in the blood. (end stage renal failure)

macroscopic hematuria is due to what origin?

urologic origin

Wegener's granulomatosis

vasculitis of the lung and kidney, Autoimmune

sepsis causes vasodilation or vasoconstriction?

vasodilation (prerenal cause of AKI)

what aspects of metabolism/catabolism are kidneys involved in?

vitamin D metabolism hormone catabolism (insulin, PTH, calcitonin)

uremia is what?

when urine accumulates in blood

Is prerenal AKI reversible?

yes if blood flow to kidneys is restored.

what population most likely affected by goodpasture syndrome?

young, white, male smoker.

most common secondary kidney diseases that are not autoimmune?

DM HTN HF Atherosclerosis (renal artery disease)

Goodpasture syndrome

Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody. (Type 2 hypersensitivity)

what is the most common cause of glomerular AKI?

GABHS (post-streptococcal glomerulonephritis)

pyelonephritis test?

Murphy's punch

An individual presents with oliguria and azotemia due to severe narrowing of the kidney's main arteries due to atherosclerosis. The name of the disease is?

Renal Artery Stenosis

what is most common intrinsic AKI?

acute tubular necrosis (ATN)

The function of angiotensin II is to ________.

constrict arterioles (increase peripheral vasculature resistance) and increase BP

what are most common causes of renal AKI?

glomerulonephritis (progressive) vascular disorder interstitial disorder acute tubular necrosis

what are some lab values that could be abnormal in patients with kidney disease?

hematuria proteinuria increased BUN or creatinine

what increases urine specific gravity?

large molecules such as glucose or radio contrast media.

a few hyaline casts on urinalysis with AKI symptoms means?

most likely prerenal AKI (blood flow issues with normal functioning kidneys)

what are signs/symptoms for AKI?

oliguria, anuria weight gain and edema (ankle/periorbital) azotemia (azot=nitrogen) elevated serum creatinine

An individual presents with oliguria and azotemia due to severe narrowing of the kidney's main arteries due to atherosclerosis. The name of the disease is ____________-. This disease causes ____________ AKI. (prerenal, intrinsic, post renal)

renal artery stenosis / prerenal AKI