Icm Winter 8 Renal

Front 1

SG

Urine Osm

Back 1

SG: weight of soln compared to weight of water. High when urine is conc, low when urine is dilute

OSM: conc of urine, determine by ADH level

Front 2

when is glucose + besides DM

Back 2

1. preggo
2. kids w/fever

Front 3

whats the DEF of ARF (acute renal failure)

Back 3

1. increase of Cr 0.5 or more, or >20% increase above baseline

2. GFR that decreases by 50%

**ARF is common, ppl die bc of it- infections and cardiorespiratory sx

Front 4

when will you see...

1. RBC casts
2. WBC casts
3. Brown Casts

Back 4

1. RBC- glomerulonephtitis

2. WBC- acure interstitial nephritis

3. Acute tubular necrosis

Front 5

what are some causes of PRE RENAL acure renal failure

Back 5

1. Decreased Arteriole Volume: low volume- diarrhea, dehydration, CHF, systemic vasodilation
2. renal vasoconstriction: nsaids, ACEi, ARB, renal A stenosis/vasculitis/embolism/dissection

**when blood flow to kidney drops the kidney cant get rid of waste--- N wast increases and urine production decreases

Front 6

what are hte 3 most common causes of INTRA-RENAL acute renal failure

Back 6

1. ATN from Ischemia
2. ATN from Toxins
3. Acute Interstitial Nephritis- allergic, infectious, drug mediated. classic to see rash, fever and arthralgia

Front 7

what are hte 3 phases of ATN

Back 7

1. initiation
2. maintainance
3. rocovery: LOTS of pee

**no way to speed this process

Front 8

what cause of Acute Renal Failure is commonly associated with a rash, fever, and arthralgias

Back 8

AIN- acute interstitial nephritis

**its commonly caused by: infection, drug allergy, AI
**can have eios in pee

Front 9

how is AIN tx

Back 9

remove the offending drug and treat underlying cause (infectious, drug, AI)

**steroids can help

Front 10

what is a sx of post renal ARF

Back 10

Lots of pee left in the bladder after you go

CAUSE:
Bladder neck obstruction: BPH, neurogenic bladder, anticholinergic meds

Ureteral: BL stones, abnormilaites

Front 11

what are some risk factors for ARF

Back 11

1. DM
2. chronic renal insuffiency
3. heart failure
4. old

Front 12

what ways is ARF managed

Back 12

1. treat underlying condition
2. maintain electrolytes
3. use renal doses for any meds given
4. maximize renal perfusion

Front 13

what is given prophylactically before contrast is used

Back 13

acetylcysteine, decreases ARF

**NaBicarb used to decrease dye induced nephropathy

Front 14

is DA a good tx for ARF

Back 14

nope

Front 15

should diuretics be given in renal failure

Back 15

nope

Front 16

what are the indications for urgent dialysis

Back 16

AEIOU

A: acidosis
E: electrolyte disorder
I: intoxication (methanol, salicylates)
O: overload volume (CHF)
U: uremia (encephalopathy, pericaditis)

Front 17

whats the def of chronic renal failure

Back 17

GFR <60 for at least 3 months

common in dm and htn

Front 18

how do we screen for CKD (Chronic Kidney disease)

Back 18

UA
creat
micro albumin

Front 19

what is GFR in mod CKD, when do you need dialysis

Back 19

MOderate: 30-59

Dialysis: when GFR <30. tend towards acodisos and hyperkalemia

Front 20

is anemia of a concern in CKD

Back 20

ya, R/O other cause before you give EPO

Front 21

how is CKD tx

Back 21

1 control HTN- ACEi, ARB,
2. control lipids
3. treat anemia- give EPO, target Hg 11-12
4. Vit D defect: renal osteodystrophy
5. PTH is high
6. Phos is HIGH, this can promote artherosclerosis

Front 22

what happens to PTH in renal failure (chronic)

Back 22

increasses so PTH kills Ca from bones nad we are vit D deficient adn so we get renal osteodystrophy

**also have high phos levels

**cortical bone is decreased and easily fractured

Front 23

what does ADH do

Back 23

increase water retention, this CONCENTRATES the urine

(primary hormone to regulate Na, more than aldo. excess ADH leads to hyponaturemia)

Front 24

what does Aldosterone do

Back 24

conserves Na, increase water retention --:> increase BP

K is secreted out into the pee

**BLOCKED by spironolactone

Front 25

whats hyponaturemia

sx

Back 25

low Na, usually bc of ADH excess

sx vary- anorexia NV, cerebral edema, restlessness, irritable, coma, convulsion,

Front 26

ok so we have have

hypotonic hyponaturemia
isotonic hyponaturemia
hypertonic hyponaturemia

what are they

Back 26

hypotonic hyponaturemia: MOST COMMON. usually bc of SIADH

isotonic hyponaturemia: lab artifact, bc of high lipids or high protein, seen in MM

hypertonic hyponaturemia: common w/hyperglycemia. tx w/fluids and Na

Front 27

hypotonic hypovolumic hyponaururemia

if its renal loss what will urine Na be

if its extranrenal what is urine Na

Back 27

Renal: Na >20, fractional excretion Na >1. its a mineralcorticoid or diuretic issue

Extrarenal: <10 Na in urine, fractional excretion <1. its diarrhea, not drinking, etc

Front 28

why be slow with correcting hyponaturemia

Back 28

can lead to central pontine myelonisis

**replenish w/normal saline

Front 29

what 3 things cause SIADH

Back 29

1. CNS- stroke, hemorrhage, trauma, psychosis
2. Tumors- small cell lung, duodenal/pancreatic CA, olfactory neuroblastoma
3. drugs: carbamazebine, thiazide, siureics,
4. surgery, pulm dusease, hormones

Front 30

how is SIADH dx

Back 30

Hypotonic low Na
K normal
Na in pee >20
urine osm >200
low serum osm
low serum uric acid

**ADH increases water reabs and excretes Na to con urine and dilute urine

Front 31

what horomen acts to dilute serum osm and increase urine osm

Back 31

ADH

**it increases water reabs and excretes Na

Front 32

how is SIADH tx

Back 32

restrict fluid intake
hypertonic saline

Front 33

what causes hypernaturemia

Back 33

dehydration, its a water deficit relative to Na

*8always hypertonic

Front 34

central DI

what is it

what causes it

Back 34

dont make ADH so you cant conc urine

idiopathic, tranuma to hypothalamus, cancer, anorexia, congenital

Front 35

what is nephrogenic DI

Back 35

when kidney doesnt respond to ADH (ADH causes water retention and urine conc, so in DI you pee lots and its not conc)

**nephrogenic caused by
lithium, hypercalcemia, prego, damage to nephron- ATN

Front 36

how is central DI tx

what about nephrogenic

Back 36

central: desmopressin

neohrogenic: Na restriction, diuretic

Front 37

what is normal K

what causes it to be low

Back 37

3.5-4.5

**common to be low; caused by, diuretics, vomit, diarrhea, laxative, NG tube,

Front 38

when do you get a U wave

Back 38

hypokalemia

NV, mm weakness, cramps

Front 39

what EKG changes are seen in hypokalemia

what about hyperkalemia

Back 39

U wave
flat T

hyperkalemia: peaked T

Front 40

what is pseudohyperkalemia due to

Back 40

traumatic blood draw

Front 41

whats the cause of hyperkalemia

Back 41

acidosis
rhabdomyolysis
Drugs: ACEi, ARB, k sparing diuretics

peaked T waves, sine wave

Front 42

can hyper or hypolakemia make sine waves on EKG

Back 42

hyper

Front 43

when is tx for hyperkalemia give, what is it

Back 43

when there are T waves or sine waves

CaCL- works fast
Gluconate-

Front 44

whats the tx for hyperkalemia

Back 44

1. CaCl: stabalize membrame, use w/peaked T
2. Insulin: get K into the cells
3. B2 agonist: get K into the cells
4. Kayexelate: decrease total K via gut
5. Duiretics: decrease total K