Acute Intrinsic Renal Failure

Front 1

AIRF is a Syndrome. T/F

Back 1

True

Front 2

It is an __________ ____________ in function.

Back 2

Abrupt Decline

Front 3

Recent _____________ of Azotemia

Back 3

ONSET

Front 4

T/F. It is a recognition of Azotemia

Back 4

False

Front 5

Describe AIRF

Back 5

Inability to Regulate Volume and Composition (electrolyte and acid base) of Body Fluids

Front 6

Two Subdivisions of Acute Intrinsic Failure

Back 6

Nephritis & Nephrosis

Front 7

What is characteristic of Pre-Renal Azotemia?

Back 7

Physiologic Oliguria

Front 8

What type of lesions are seen in severe, prolonged renal hypofusion?

Back 8

Primary

Front 9

What type of lesions are these?

Back 9

Ischemic Necrosis

Front 10

Common Causes of AIRF

Back 10

Nephrotoxic nephrosis
Nephritis
Ischemic nephrosis

Front 11

Potential Causes

Back 11

Dehydration
Trauma
Anesthesia
Sepsis
Hyperthermia (heat stroke)
Hemolysis
Ace inhibitors
Shock
Hemorrhage
Surgery
Burns
Hypothermia
Myoglobinuria
NSAIDSystemic

Front 12

Potential Nephrotoxins

Back 12

Ethylene Glycol

Front 13

What anti-microbials are nephrotoxic?

Back 13

Aminoglycosides
Amphotericin
Cephaloridine
Sulfonamides
Tetracyclines

Front 14

What cancer therapies are nephrotoxic?

Back 14

Cisplatin

Front 15

How does Hypercalcemia and Causes affect the kidney?

Back 15

Cholecalciferol-containing rodenticides

Calcipotriene

Humoral hypercalcemia of malignancy

Front 16

What heavy metals are toxic?

Back 16

arsenic

Lead

Front 17

Nephrotoxins for Horses?

Back 17

Rhabdomyolysis
Red Maple Leaf

Front 18

Nephrotoxins for Cats?

Back 18

Easter Lily

Front 19

Nephrotoxins for Cows?

Back 19

Acorns/Oak Bud

Front 20

Nephrotoxins for Dogs?

Back 20

Raisins/Grapes

Melamine-cyanuric acid contaminated food

Front 21

What does exposure to a nephrotoxin cause?

Back 21

tubular injury

Front 22

What is the spectrum of injury?

Back 22

Degeneration (nephrosis) to Acute tubular necrosis (ATN)

Front 23

Why is it important to believe clinical signs over just clinical pathology?

Back 23

Could have minimal to no light microscopic lesions but STILL develop severe renal excretory failure

Front 24

What is the Maintanence phase of AIRF?

Back 24

Sudden INCREASE in serum creatinine concentration that persists DESPITE correction of all pre-renal factors

Front 25

What pre-renal factors are corrected?

Back 25

Restoration of EC Volume and Cardiac Output

Front 26

True/False. Oliguria, Normal Urine Output, and Polyuria do NOT occur in AIRF.

Back 26

False

ALL can occur depending on severity of insult

Specific Cause

Phase of AIRF

Front 27

How long does the maintainence phase take before restoration?

Back 27

1-3 week course

Front 28

T/F. Removal of the inciting cause at this point will NOT result in immediate return of normal renal function

Back 28

TRUE

Front 29

What does the maintainence phase signify?

Back 29

Critical amount of lethal tubular cell injury

Front 30

What is the maintainence phase characterized by>?

Back 30

Severe decrease in renal Blood flow and GFR

Front 31

If renal blood flow goes back to normal, what happens to GFR?

Back 31

Stays LOW

Front 32

True/False. Conversion from Oliguria to Polyuria may occur.

Back 32

True

Front 33

Recovery Phase of AIRF.

Back 33

Return of normal BUN & Creatinine = POSSIBLE

Complete recovery = may not be possible (greatest injury)

Partial improvement = Chronic Renal Failure

BUN & serum creatinine may return to normal but decreased GFR may persist

Urinary concentrating defect may persist

Front 34

How many tests can be definitive for?

Back 34

No Single Test is Definitive

Front 35

Important Diagnostic Steps.

Back 35

History

PE

U/A

CBC

Chem

Renal Size

Renal Biopsy

Front 36

What are two rule outs?

Back 36

Azotemia and Isosthenuria

Front 37

What to look for in the history?

Back 37

Absence of longstanding PU/PD

Potential for renal ischemia or nephrotoxin exposure

Oliguria

Polyuria

Front 38

What are non-specific signs?

Back 38

Anorexia

Vomit

Diarrhea

Front 39

What is particularly inportant in the CBC?

Back 39

PCV!

Front 40

When should you do your CBC, Chem, U/A

Back 40

When the patient is "Healthy"--> Pre-Tx

Front 41

On physical exam, signs of UREMIA are More or Less Severe than Signs of Pre-Renal Azotemia?

Back 41

MORE

Front 42

True/False. Uremia signs may be Similar to CRF

Back 42

True

Front 43

True/False. Uremia mucus membranes (in regard to anemia) are similar to anemic signs in CRF

Back 43

False

Uremia: Absence of pallor to mucous membranes
CRF: Non-Regenerative

Front 44

Hypothermia= ______________

Back 44

Nephrosis

Front 45

Hyperthermia= ____________________

Back 45

Nephritis

Front 46

List Physical Exam Findings

Back 46

Dehydration is common before fluids

Overhydration may occur after fluids

Bradycardia / Arrhythmia if markedly hyperkalemic

Normal to large kidneys

Bladder: Normal-sized to small

No evidence of lower urinary tract obstruction

Front 47

What is a possible consequence of Overhydration?

Back 47

Edema/Ascites

Front 48

On a hemogram of AIRF, when can you see anemia?

Back 48

NOT early on

--> more common with CRF

Total protein = normal to elevated (hydration)
May decrease during iatrogenic overhydration
+/-thrombocytopenia (Lepto)
Inflammatory /

Front 49

If there is sudden blood loss, what type of response would be seen and when?

Back 49

mild/moderate regenerative EARLY

Front 50

On a hemogram of AIRF, what do Total Protein values look like with Hydration?

Back 50

normal to elevated

Front 51

When would these values for TP possibly decrease?

Back 51

iatrogenic overhydration

Front 52

You may or may not see thrombocytopenia due to Lepto. True/False.

Back 52

True

Front 53

What type of leukogram would be seen with AIRF?

Back 53

Inflammatory / stress leukogram

Front 54

On a U/A for AIRF, is the concentration dilute or concentrated? and WHEN?

Back 54

DILUTE very early

Front 55

Often, the range for USG in AIRF is __________ to ___________.

Back 55

1.007-1.017

Front 56

T/F. USG is only low with oliguric AIRF and not with non-oliguric AIRF.

Back 56

False.

BOTH

Front 57

Will a low USG differentiate AIRF from CRF?

Back 57

NO!

Front 58

What types of -URIA's are seen with AIRF?

Back 58

Hematuria

Proteinuria

Glucosuria

Front 59

What is different about Glucosuria in this case?

Back 59

Can be seen with a normal blood glucose

Front 60

What does this indicate?

Back 60

Renal Tubular Injury