Sample Lesson – Pre-Renal vs. Intra-Renal vs. Post-Renal AKI


Next Step: Make Cards on the Automatic Key Concepts, and Vignettes

Remember, the more you automatically know what each sentence means on your test, the better you will do. There are 4 stages in making interpretation more automatic:

  • Stage 1: Unable to Make Pathophysiologic Chronologies in Either Timed or Untimed setting
  • Stage 2: Basic Pathophysiologic Chronologies, but with Significant Gaps
  • Stage 3: Detailed Pathophysiologic Chronology Without Time, but Unable to Consistently Generate PC During Timed Setting
  • Stage 4: Consistent Pathophysiologic Chronologies in Timed Setting

My goal with these vignettes is to help you reach Stage 4. How do you do so?

  • With the Automatic Key Concept cards, you can master the underlying information to move past Stages 1 + 2.
  • Then, with the Vignette/Pathophysiologic Chronology cards, you can teach yourself to make these connections on your exam.

Summary of key concepts:

Automatic Key Concepts:

Copy + paste these into your cards, to make these key concepts more automatic.

 

“Pre-renal” kidney injury – what is the mechanism? How could this lead to kidney failure?

Less blood getting to the kidneys to be filtered

 

“Intra-renal” kidney injury – what is the mechanism? How could this lead to kidney failure?

Problems with the filtration mechanism itself

 

“Post-renal” kidney injury – what is the mechanism? How could this lead to kidney failure?

Problems with back-up of urine → high Bowman’s space pressure

 

Pre-renal AKI – use the mechanism to explain what the creatinine levels would be

Kidney failure is defined as decreased GFR below a certain threshold. Recall: creatinine is constantly made as a breakdown product of muscle creatine. 

Pre-renal AKI: blood (which contains creatinine) is shunted away from kidneys to vital organs like the brain/heart. 

When substances like creatinine can’t be filtered → accumulate in blood → serum creatinine ↑

 

Intra-renal AKI – how is it related to pre-renal AKI? Why?

Often occurs in prolonged pre-renal AKI. Renal blood flow ↓ → ischemia to proximal tubular cells → sloughing into lumen of proximal tubule → blocking of proximal tubule

 

Intra-renal AKI – use the mechanism to explain what the creatinine levels would be

Kidney failure is defined as decreased GFR below a certain threshold. Recall: creatinine is constantly made as a breakdown product of muscle creatine. 

Intra-renal AKI: there is a problem with filtration originating within the kidneys, often because of blockage of the proximal tubule. 

When substances like creatinine can’t be filtered → accumulate in blood → serum creatinine ↑

 

Post-renal AKI – use the mechanism to explain what the creatinine levels would be

Post-renal AKI: there is a problem with filtration because of a blockage after the kidneys (e.g., ureters). 

When substances like creatinine can’t be filtered → accumulate in blood → serum creatinine ↑​​

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