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39 Cards in this Set

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What are the essentials of diagnosis for acute renal failure?
Increase in BUN (azotemia) or serum creatinine
Oliguria
What are the general signs and symptoms of acute renal failure?
azotemia which may lead to n/v, malaise, altered sensorium
arrhythmias with hyperkalemia
rales on pulmonary exam with hypervolemia
abdomnal pain/ileus
platelet dysfunction therefore bleeding
asterixis and confusion
What are the signs and symptoms occur with prerenal renal failure?
increased thirst
decreased urinary output
orthostatic hypotension (hypovolemic)
What is the most common cause of acute renal failure?
Prerenal
- dehydration, diuresis, hemorrhage, decreased CO, pancreatitis, burns, decreased perfusion
What are the intrinsic causes of acute renal failure?
ATN (MC)
NSAIDS
aminoglycosides
What are the lab findings associated with acute renal failure?
elevated BUN/creatinine
hyperkalemia
EKG: peaked T waves, QRS widening
Anemia
Hyperphosphatemia
Hypocalcemia
Leukocytosis or leukopenia
A patient has acute renal failure and track marks. What do you suspect?
Endocarditis
A patient has acute renal failure and hearing loss. What do you suspect?
history of NSAIDS
A patient has acute renal failure and leg pain. What do you suspect?
rhabdomyolysis
A patient has acute renal failure and muddy casts in his urine. What do you suspect?
ATN
True or False: Acute renal failure is a benign disease.
False: It has a 31% mortality rate in patients.
How do you treat acute renal failure?
Fluid management: hypovolemia potentiates and exacerbates all forms of ARF
Urinary catheter in case of postrenal cause
Renal replacement therapy
Intermittent hemodialysis
Mannitol (with rhabdo)
Vasodilators
Diuretics (nonoliguric ARF)
True or False: Reversal of hypovolemia by rapid fluid infusion often is sufficient to treat many forms of acute renal failure.
True
What do you need to be aware of befor initiating fluid in acute renal failure?
ATN
What are the indications for dialysis in treating acute renal failure?
volume overload
hyperkalemia
acid/base disorders
symptomatic uremia
uremia (BUN>100)
dialyzable intoxications (aspirin, lithium)
What is the most common cause of intrinsic ARF?
ATN
How do you differentiate ATN from ARF?
urine
ATN:
- urine brown with muddy casts
- SG <1.012
- osmolality <500
- sodium >40
- Plasma BUN/Cr ratio <10-15
What can cause ATN?
insult or injury to the kidney
- ischemia, prolonged hypotension, sepsis, dehydration
How do you treat ATN?
Avoid fluid overload and hyperkalemia
Loop diuretics
What defines chronic renal failure?
progressive azotemia over months to years
What is diagnostic of chronic renal failure?
bilateral small kidneys on ultrasound
What are the signs and symptoms of CRF?
signs and symptoms of uremia in end-stage
hypertension
bilateral small kidneys on ultrasound
What are complication of CRF?
hyperkalemia
acid-base disorders
hypertension
pericarditis
CHF
anemia
uremic encephalopathy
How do you treat chronic renal failure?
dietary management
dialysis
kidney transplantation
What are the signs and symptoms of glomerulonephritis?
edema typically periorbital and scrotal and hypertension due to volume overload
How do you treat glomerulonephritis?
aggressive reduction of blood pressure and fluid overload
salt and water restriction
diuretic therapy
possible dialysis
corticosteroids
What are the classifications of glomerulonephritis?
acute postinfectious
IgA nephropathy
rapid progressive glomerulonephritis
What are the causes of post-infectious glomerulonephritis?
Group A Beta hemolytic strep (strep. pyogenes)
Staph. aureus, CMV, fungal
What are the signs and symptoms of postinfectious glomerulonephritis?
onset within 1-3 weeks after infection
oliguric, edematous, hypertension
What do you see on labs with postinfectious glomerulonephritis?
cola-colored urine, RBCs, proteinuria
How do you treat postinfectious glomerulonephritis?
Supportive
Antibiotics
Diuresis
What are the essentials of diagnosis for nephrotic syndrome?
urine protein >3.5 per 24 hours
hypoalbuminemia (albumin <3g/dL)
peripheral edema
coffee colored urine
elevated lipids
risk of thrombotic events
What differentiates nephrotic syndrome for nephritic syndrome?
Nephrotic: excessive urine protein, no hypertension, increased damage
Nephritic: hypertension, less proteinuria
What is the hallmark of nephrotic syndrome?
peripheral edema
What are the signs and symptoms of nephrotic syndrome?
peripheral edema, dyspnea, abdominal fullness, ascites
How do you manage nephrotic syndrome?
manage protein loss and edema
statins for hyperlipidemia
coumadin for hypercoagulable state
sodium restriction
diuretics
What are the signs and symptoms of polycytic kidney disease?
high blood pressure
back or side pain
abdominal pain
increased size of abdomen
blood in urine
kidney stones
kidney failure
kidney infections
headache
What are the signs and symptoms of renal cell carcinoma?
gross or microscopic hematuria
flack pain or mass in some patients
systemic symptoms such as fever, weight loss may be prominent
solid renal mass on imaging
A 45 year old obese woman is complaining of dark urine. She has smoked for 20 years. Urinalysis shows hematuria. What is the cause?
cancer until proven otherwise