Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
49 Cards in this Set
- Front
- Back
|
What are 4 major causes of ARF
|
EG
NSAIDs Idiopathic Lepto |
|
|
What does ARF most commonly result from
|
Acute tubular necrosis
Less often from renal inflammation |
|
|
What fraction of ARF dogs have a condition that predisposes them to ischemia
|
1/3
|
|
|
What is the most common infectious cause of ARF
|
Lepto
|
|
|
What percentage of ARF cases are idiopathic
|
25%
|
|
|
True/False: Renal ischemia is most likely to cause ARF in those patients that already have renal dz
|
True
|
|
|
How do NSAIDs cause ARF
|
Renal Ischemia
|
|
|
What are some extra-renal conditions that can affect USG
|
Drugs
Endocrine Dzs |
|
|
True/False: ARF is a potentially reversible condition
|
True
But it requires aggressive tx initially |
|
|
How are clinical findings different b/t ARF and CRF
|
ARF- less than 1wk inapp, depress, v+; moderately to severely depressed; urine volume often decreased; good body condition; enlarged kidneys that are painful (but can be normal); bone density always normal
CRF- wks-mths inapp, v+, depress; often alert and responsive; PU/PD common; may be thin; kidneys small and irregular (but can be normal); bone density may be decreased |
|
|
Which (ARF or CRF) do you expect to find moderate to severe metabolic acidosis
|
ARF
CRF is mild to moderate |
|
|
Which (ARF or CRF) are you more likely to see casts
|
ARF
|
|
|
What is the K+ like in cases of ARF
|
Normal to increased
Can be decreased in CRF |
|
|
How are BUN and Creat different in ARF than in CRF
|
In ARF, they are initially normal, and then progressively increase
In CRF, they are usually increased, but stable |
|
|
What do patients w/ acute on chronic renal failure typically look like
|
They have features of both ARF and CRF
|
|
|
How might a patient's urine volume help tell b/t ARF and CRF
|
w/ CRF, they are often PU/PD
ARF patients usually show anuria or oliguria |
|
|
How common are oral ulcers in ARF
|
Rare
|
|
|
What three dzs might icterus in a patient w/ ARF suggest
|
Lepto
RMSF DIC |
|
|
Anion gap values >40 are indicative of what
|
EG intoxication
|
|
|
What are the characteristics of proteinuria in cases of ARF
|
Usually mild (UPC<2) and transient
|
|
|
Why is a urine culture indicated in cases of ARF
|
Must R/O UTI
UTI can exacerbate renal dz UTI is rarely the cause of the renal injury, though |
|
|
Why is EU of limited use in renal failure cases
|
Kidneys poorly excrete contrast, and they may not excrete enough to make useful images
|
|
|
How often is renal bx done to dx ARF
|
Rarely
May be good if cannot tell from CRF, though Also good to help dx EG, esp. if has been way too long to use blood as a way to test for exposure |
|
|
True/False: If Lepto is even a remote possibility as the cause of ARF, serum samples should be sent for Lepto titers
|
True
It is a treatable cause of ARF! |
|
|
What are the 4 objectives of tx of ARF
|
1. Minimize additional renal injury
2. Treat for the treatable 3. Promote diuresis if oliguria exists 4. Combat metabolic consequences of uremia |
|
|
What percentage of ARF cases end up w/ CRF
|
60%
|
|
|
How should IV fluids be used initially in tx of ARF
|
Can use LRS or 0.9%NaCl
IV to rehydrate within 6hrs Record BW after rehydrating to establish a "normal" to compare future weights to Even if clinical dehydration is not apparent, assume 3-5%BW in cases of ARF |
|
|
How should maintenance fluid therapy be initiated in ARF
|
AFTER rehydration, supply measured v+/d+/u+ losses and insensible losses (10-20mL/kg/day)
Recalculate this volume q 4-6hrs Use Plasma-Lyte N or Normosol-M as maintenance fluid |
|
|
Why should LRS and 0.9%NaCL not be used as maintenance therapy in ARF
|
They contain too much sodium
|
|
|
What can you use as maintenance fluids for ARF if you do not have Normosol-M or Plasma Lyte-M
|
Alternate LRS and 5% Dextrose
OR Use 0.45%NaCl/2.5% Dextrose *You must add K+ to each of these substitutes |
|
|
True/False: Depending on the severity of renal injury, you may need to provide IV fluids for 1-3 weeks
|
True
|
|
|
True/False: Urine formation means improved renal fxn
|
False
Not necessarily; But, it is easier to avoid edema and maintain electrolytes and acid-base when urine is being made |
|
|
Why is Mannitol indicated if oliguria persists despite correction of dehydration
|
Osmotic diuretic
Urine should start being made w/in 15 minutes w/ the goal of 1-2mL/kg/hr production |
|
|
Why is repetitive dosing of Mannitol dangerous if urine flow does not increase
|
Vascular overload may occur
But, if it works, you can start a CRI or give q 6-8hrs |
|
|
When should loop diuretics like Furosemide be used in ARF
|
When osmotic diuretics have not helped or when patient is volume overloaded
|
|
|
How does DA work for ARF
|
Stimulates urine production by causing dilation of renal vasculature and increasing renal blood flow
But, rarely seems to work |
|
|
What is the tx of choice for EG and salicylate toxicosis
|
Dialysis
But, finances are limiting as are availability, and intense labor |
|
|
When should hyperkalemia be considered L/T
|
When >8mEq/L or signs of cardiotoxicosis occur
Give NaHCO3- or IV insulin w/ dextrose Can give CaGluconate if L/T arrhythmias exist |
|
|
True/False: Hypokalemia can occur in ARF
|
True
It can occur in the recovery phase if there is excessive urinary loss and decreased intake Add KCl to fluids to correct |
|
|
Besides K+, what other electrolyte can be increased in ARF
|
Phosphate- secondary to decreased renal elimination
|
|
|
Why does metabolic acidosis occur in ARF
|
Kidney cannot reabsorb HCO3- and excrete H+
|
|
|
When should NaHCO3- be given
|
When blood pH is < 7.2 or the TCO2 <12 mEq/L
|
|
|
What are two reasons for the v+ seen w/ ARF
|
Uremic toxins' effects on CRTZ and emetic center
GI ulceration from decreased renal elimination of gastrin and subsequent hyperacidity |
|
|
What can be given to help control uremic gastritis
|
H2 blocker
|
|
|
True/False: Anti-Lepto Abx should be given if there is ANY possibility that Lepto could be the cause of the ARF
|
True
Give Doxycycline for 2 weeks Px 70-80% Survival |
|
|
Which ARF cases should have CVP monitored
|
Those w/ heart dz
AND Those w/ persistent oliguria/anuria CVP used to determine if over or under hydrated |
|
|
True/False: BUN, Creat, electrolytes, and anuria/oliguria can be used to predict ARF survival
|
False
|
|
|
What percentage of ARF cases die or are euthanized
|
60-80%
EG has the highest Mt Lepto has the lowest Mt |
|
|
What percent of those that live through a case of ARF have a full recovery
|
40%
60% get CRF |
