Notes in Renal Patho (AKI, ESRD, Transplant)

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Published	10/05/2023	AKI = {{c1::Acute Kidney Injury}}*defined as one of the following: - an increase in {{c6::serum creatinine}} by {{c3::0.3}} mg/dL in 48 hour…
Published	10/05/2023	AKD = {{c1::Acute Kidney Disease}}*AKD and {{c3::AKI}} are often used interchangeably but technically {{c3::AKI}} < 1 week, AKD < {{c2::3}} mont…
Published	10/05/2023	epidemiology of AKI- very {{c1::common}}: incidence is 5% of patients that present to hospital, 20% of patient in the ICU- very {{c2::costly}}: leads …
Published	10/05/2023	Rule of PEES for AKI Evaluation• P{{c1::re-renal}}: Is the issue before the kidneys?*aka. {{c1::prerenal}} {{c2::azotemia}} • P{{c1::arenchymal R…
Published	10/05/2023	Prerenal AKI = Prerenal {{c1::Azotemia}}- most common cause of AKI (30-50% of cases)- more of a {{c2::functional}} impairment without true damage…
Published	10/05/2023	The medications {{c2::lisinopril}} and {{c3::ibuprofen}} pre-disposes a patient to develop an AKI → {{c2::Lisinopril}} (an {{c4::ACE}} inhibitor)&nbsp…
Published	10/10/2023	Kidney Autoregulation- kidney attempts to maintain {{c2::hydrostatic pressure (PGC)}} in the glomerulus to preserve {{c1::glomerular filtration r…
Published	10/05/2023	volume {{c1::depletion}}, congestive heart failure, cirrhosis, and sepsis can all lead to reduced effective arterial blood volume (EAVB) → potential p…
Published	10/05/2023	{{c2::Pre-renal}} AKI = glomerulus is not getting adequate blood flow to keep glomerular pressure adequate for filtration, aka. a state of low {{c3::e…
Published	10/05/2023	Causes of pre-renal AKI- HF → decreased effective {{c5::cardiac output}} either due to poor filling ({{c6::diastolic}} failure) or low ejection fracti…
Published	10/05/2023	prolonged pre-renal state → {{c5::stresses}} kidney tissue by increasing {{c2::osmolality}} of medulla, tubule transport, and {{c3::ATP/energy}} utili…
Published	10/05/2023	{{c1:: Parenchymal (intrinsic)}} AKI Causes:*different diseases affect different parts of nephron- {{c2::Vascular}}: thrombosis, vasculitis- {{c3…
Published	10/05/2023	Renal Vein Thrombosis- usually due to {{c1::hypercoagulable}} state, such as in {{c2::nephrotic}} syndrome (specifically the loss of coagulation inhib…
Published	10/05/2023	Acute Atheroembolic Renal Disease1st type is acute: develops a few days after the inciting event and is due to a massive {{c12::embolization}}2…
Published	10/05/2023	Post Renal (Obstruction) AKI Causes*{{c1::urinary tract}} obstruction that can happen at any point from {{c2::renal pelvis}} to {{c2::urethra}}→ more …
Published	10/05/2023	natural history AKI/AKD- {{c1::pre}}-renal and {{c1::post}}-renal causes typically recover {{c2::fully}} if found and appropriately treated*typically …
Published	10/05/2023	stepwise clinical eval for AKIhistory/physical- {{c9::timeline}}: When did kidney function become abnormal and what were the preceding events?- {{c10:…
Published	10/05/2023	CASE:- history of BPH suggests {{c1::post-renal}} AKI*next step: imaging
Published	10/05/2023	CASE:- coca-cola urine = hematuria → suggests kidney damage → suggests {{c1::renal/parenchymal}} AKIhypertension can also indicate kidney damagerece…
Published	10/05/2023	CASE:- ACE-inhibitor and ibuprofen usage suggests {{c1::pre-renal}} AKI*next step: medication change
Published	10/05/2023	{{c1::Urine Output}} Aids Differential for AKI{{c6::Normal Urine Output (UOP)}}: 800-2000ml/day*assumes average fluid intake of 2L/day {{c2::Poly…
Published	10/05/2023	urine composition- assume average osmolar intake: approximately {{c1::600}} mosm/day - average urinary {{c2::concentrating}} ability: 50-1200 mosm/L*c…
Published	10/05/2023	Markers of Kidney Function*all {{c1::rise::rise/fall}} in AKI {{c9::Blood Urea Nitrogen}} (BUN) - {{c2::freely}} filtered and {{c2::freely}} reab…
Published	10/05/2023	Relationship between creatinine and GFR*have an {{c1::exponential}} or {{c1::logarthrmic}} relationship- at lower levels of {{c2::creatinine}}, a smal…
Published	10/05/2023	functional unit of kidney = {{c1::nephron}} ~1,000,000 per kidney composed of a {{c4::glomerulus}} + {{c4::tubule}} + {{c4::blood vessels}} → r…
Published	10/05/2023	renal vasculature pathway- {{c4::renal artery}} → afferent arteriole → {{c3::glomerular}} capillaries → efferent arteriole → {{c2::peri…
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Published	10/05/2023	tubules- hollow cylinders surrounded by a {{c3::single}} layer of cells → inner surface = {{c1::luminal}} or {{c1::apical}} → outer surface = {{c…
Published	10/05/2023	role of renal tubules- proximal nephron: {{c2::bulk}} reabsorption of {{c6::water}} and {{c8::solutes}} (Na, Cl, HCO3, {{c3::glucose}}) - loop of Henl…
Published	10/05/2023	{{c1::urea}} is filtered and reabsorbed {{c2::creatinine}} is filtered and secreted*used as the most clinically accurate marker of kidney funtion…
Published	10/05/2023	{{c5::hypertension}} (HTN), {{c6::diabetes}} (DM), and glomerulo{{c4::nephritis}} are some common causes of {{c1::end-stage renal disease (ESRD)}…
Published	10/10/2023	in CKD and ESRD, kindey has impaired ability to excrete solutes... leads to:→ high {{c2::BUN}} (elevated urea)→ high serum {{c2::creatinine}} → high {…
Published	10/05/2023	hyper{{c2::kalemia}} often occurs in individuals with End-Stage Renal Disease (ESRD) due to impaired kidney function to remove excess {{c1::potas…
Published	10/05/2023	decreased renal tubular {{c1::secretion}} of potassium contributes to development of hyperkalemia in chronic kidney disease (CKD)
Published	10/05/2023	{{c1::parathyroid hormone (PTH)}} is often elevated in individuals with End-Stage Renal Disease (ESRD) because impaired kidney function to regulate {{…
Published	10/05/2023	{{c2::anemia}} often occur in individuals with End-Stage Renal Disease (ESRD) due to reduced production of {{c1::erythropoietin}} → decreased RBC prod…
Published	10/05/2023	common signs and symptoms of chronic renal failure are {{c2::fatigue}}/{{c2::weakness}} and {{c1::pale}} skin→ also decreased appetite, reduced {{c3::…
Published	10/05/2023	indications of dialysis*AEIOU {{c1::mnemonic}}A - {{c2::acid/base}} disturbances (severe metabolic {{c7::acidosis}}, pH <7.15)E - {{c3::electrolyte…
Published	10/05/2023	Scenario: A 65-year-old patient with a history of chronic kidney disease (CKD) presents with severe fluid retention, elevated potassium levels, and de…
Published	10/05/2023	In the context of Acute Kidney Injury (AKI), dialysis typically indicated when there is severe fluid {{c2::overload}}, {{c3::electrolyte}} imbalances,…
Published	10/05/2023	dialysis comes in two types- {{c1::hemo}}dialysis ({{c1::H}}D):→ uses access points→ go to center, dialysis machine pulls blood and filters it, then p…
Published	10/05/2023	kidney transplant- required for more severe cases of CKD*prior kidneys are left
Published	10/05/2023	CASE: Mr. KD is a 56yo man with long-standing type 2 diabetes mellitus and hypertension.  He has progressive CKD, with current eGFR 14 ml/min/1.7…
Published	10/05/2023	End-Stage Kidney Disease (ESKD/ESRD) has multi-{{c1::system}} effects:*review image below:
Published	10/05/2023	renal replacement therapy options:- {{c9::dialysis}} can do ~{{c1::10-15::range}}% of what a normal kidney does- {{c2::transplant}} can do {…
Published	10/05/2023	{{c2::Kidney Transplant}}: The process of taking a kidney from a person and placing it into the patient with failing or failed kidneys {{c1::Transpla…
Published	10/05/2023	Types of transplant based on {{c1::donor}}-type- transplant from same individual → {{c2::autograft}}- transplant from identical twins → {{c3::syngenei…
Published	10/05/2023	Deceased donor kidney transplant- transplant where donated kidney comes from individuals who are {{c1::brain dead}}*make up almost {{c2::2/3}} of…
Published	10/05/2023	first successful living donor transplant:- Ronald Herrick donated to Richard Herrick ({{c1::monozygotic}} (identical) twins)
Published	10/10/2023	Process of Kidney Transplantation1. {{c1::recipient evaluation}} (indications and contradictions) 2. living kidney donation  3. transplant surge…
Published	10/05/2023	Stage {{c2::5}} CKD is eGFR < {{c1::15::#}} ml/min/1.73m2
Published	10/05/2023	{{c2::Hemodialysis}} is the most {{c3::expensive}} renal replacement modality
Published	10/05/2023	Economic Benefit Of Transplant*over time, transplant is cheaper than dialysisAnnual expenses for ESRD patients: → {{c1::HD}}: $95,000 → {{c1::PD}}: $7…
Published	10/05/2023	Recipient evaluation for KDWho can get a transplant ({{c1::indications}}):  • {{c4::end-stage renal disease}} ({{c9::dialysis}} dependent) • GFR …
Published	10/05/2023	Living kidney donation- about 6000 living kidney donations per year in the US- usual age range of donors: 35-49 years- results in loss of total nephro…
Published	10/05/2023	Barriers to kidney transplantation- early attempts to transplant tissues failed due to {{c1::rejection}}: destruction of transplantation of tissu…
Published	10/05/2023	pretransplant tests1. {{c2::ABO}} blood typing 2. {{c1::HLA}} or {{c1::tissue}} typing 3. {{c2::Crossmatch}}
Published	10/05/2023	Kidney Transplant Surgery- transplanted kidney is placed in the right or left {{c2::iliac fossa}} - donor {{c4::renal}} artery/vein are hooked up to …
Published	10/05/2023	ABO Blood group compatibility- Type {{c1::A}} has A antigen (a {{c7::carbohydrate}} moiety) on surface of RBCs and on {{c8::vascular endothelium}} → …
Published	10/05/2023	Human Leukocyte Antigen (HLA) molecules- encoded by human {{c3::major histocompatibility complex (MHC)}} genes- are groups of proteins present on all …
Published	10/05/2023	HLA typing or Tissue typing- identification of HLA {{c7::antigens}} expressed on {{c1::leukocytes}} of donor and recipient → goal is to find the best …
Published	10/05/2023	urinalysis - {{c1::specific gravity}} is a marker of urinary {{c2::concentration}} and {{c2::ADH}} activity*in volume depletion → conserve everyt…
Published	10/05/2023	Urine Electrolytes- urine {{c1::sodium}} and {{c2::potassium}} are markers of {{c3::aldosterone}} activity  → low urine {{c1::sodium}} (<20 me…
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Published	10/05/2023	Question: - the fractional excretion of sodium is {{c2::0.5}}% → {{c1::pre-renal}} AKI
Published	10/05/2023	Imaging of Kidneysimple/plain film {{c3::X-ray}} (KUB)- rarely helpful because lacks details, indicated by calcifications/stones*{{c4::Kidney, Ureter,…
Published	10/05/2023	Kidney {{c1::biopsy}} whenever diagnosis unclear with lab studies and imagine *especially if suspecting {{c2::glomerular}} disorder→ evaluate his…
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Published	10/05/2023	{{c1::ultrasound}} is most common and most important imaging for AKI but {{c1::CT}} for stones
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Published	10/05/2023	Management of AKI*essentially prevent from further injury - investigate and treat the underlying cause if possible- optimize {{c1::volume}} statu…
Published	10/05/2023	Question:→ most likely {{c2::parenchymal}} AKI→ best next step in management: {{c1::kidney biopsy}}
Published	10/05/2023	signs and symptoms of chronic renal failure (CRF) / chronic kidney disease (CKD)- weakness/fatigue- {{c5::confusion::neurological effect}}- increase i…
Published	10/05/2023	hemodialysis access methods{{c2::central venous catheters (CVC)}}: inserted into IJ→ pros: work immediately (no maturation wait time), low failure rat…
Published	10/05/2023	Anti-HLA antibodies-  immune system produces HLA antibodies against foreign invader (e.g organ transplant) with repeated and …
Published	10/05/2023	Crossmatch- tests whether the recipient has pre-existing {{c6::antibodies}} to potential donor- process: mix recipient {{c1::serum}} with donor {…
Published	10/05/2023	Factors which allow transplant1. ABO blood group compatibility 2. HLA matching – HLA-A, HLA-B and HLA-DR matching is {{c2::desirable}} but n…
Published	10/05/2023	Immunosuppression- prevents {{c2::recognition}} of non-self by blocking {{c1::lymphocyte}} activation and/proliferation *typically multiple agent…
Published	10/05/2023	History of Kidney Transplantation:
Published	10/05/2023	{{c1::kidney paired donation (KPD)}}: exchange of kidney transplant between two donor-recipient pairs *useful for when living donor and intended …
Published	10/05/2023	Kidney transplant chains ({{c1::Domino}} chain)first 16-patient domino chain performed at John's Hopkins in 2009 longest multi-center chain – …
Published	10/05/2023	Donor and recipient are carefully matched based on their {{c4::blood}} group, {{c3::tissue}} typing, and {{c2::crossmatching}} prior to transplantatio…
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