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