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