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29 Cards in this Set

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Dx:
Rapid onet of oliguria w/ increasing BUN and creatinine; often occurs in hospitalized patients
Acute Renal Failure
ARF class:
weight loss or gain, poor skin turgor, edema/ascites, renal artery bruit
Pre-renal ARF
ARF class:
weight gain, obtundation, hypotension to HTN, JVD, evidence of muscle trauma, infection, contaminated IV lines
Intrinsic ARF
ARF class:
weight gain, enlarged prostate, pelvic mass, bladder distension
Post-renal ARF
Etiology of pre-renal ARF
(4 and example of each)
1. Hypovolemia
(including hemorrhage and GI loss)
2. Third-spacing
(including nephrotic syndrome, burns and cirrhosis)
3. Low cardiac Output
(including CHF and shock)
4. Renal hypoperfusion
(including renal artery stenosis, NSAIDs + ACEi)
Etiology of Intrinsic ARF
(5)
1. Hyperviscosity
(multiple myeloma)
2. Acute Tubular Necrosis
(due to: meds or rhabdomyolysis)
3. Glomerular injury
(Nephrotic syndrome, vasculitis, GN)
4. Acute Interstitial Nephritis
5. Renovascular infarction
HAGAR
Etiology of Post-renal ARF
(3)
1. Urinary tract obstruction

2. enlarged prostate

3. bladder dysfunction
Define:

Oliguria
Urine output < 400 mL/day
Indications for Dialysis:
(5)
AEIOU:

Acidosis
Electrolyte abnormalities
Ingestions
Overload
Uremic symptoms (pericarditis, encephalopathy)
Pre-renal amounts for:
1. BUN/creatinine ratio
2. Fe-Na
3. Urine Na
4. Urine Osmolality
5. Urine specific gravity
1. > 20
2. < 1%
3. < 20
4. > 500
5. > 1.020
Intrinsic renal (ARF)amounts for:
1. BUN/creatinine ratio
2. Fe-Na
3. Urine Na
4. Urine Osmolality
5. Urine specific gravity
1. < 20
2. > 1%
3. > 40
4. < 350
5. = 1.010
What (2) Dx test and results point to a post-renal ARF problem?
Fe-Ne > 4%

Urine Na > 40
Equation for Fractional Excretion of Sodium (Fe-Na)
Fe-Na = (urine Na/plasma Na) / (U-creatinine/P-creatinine) x 100%
MCC of intrinsic ARF
Tubulointerstitial diseases
(ATN and AIN)
Dx:
Acute damage of renal tubules due to ischemic or toxic insult
Acute Tubular Necrosis
Etiology of Ischemic (4) and Toxic (4) causes of ATN
Ischemic:
Shock;
Trauma;
Sepsis;
Hypoxia

Toxic:
Rhabdomyolysis;
Aminoglycosides;
IV contrast;
Tumor lysis
IS TSH a TRAIT
(3) Dx findings for ATN
Muddy-brown granular casts;

High urine sodium;

Fe-Na > 1%
Tx for ATN
(4)
- NS for volume replacement;

- IV diuretic in early stages;

- match I and O

- manage electolyte disturbance
Dx:
Inflammation of the renal parenchyma
Acute Interstitial Nephritis
(3) basic classes of etiologies of AIN
Systemic diseases;

Systemic infections;

Medications
(3) systemic diseases that causes AIN
Sarcoidosis;

Sjogren syndrome;

Lymphoma
(4) systemic infections (bugs) that cause AIN
Syphilis;

Toxoplasmosis;

CMV;

EBV
C SET
(3) medication classes that can cause AIN
Beta-blockers;

Diuretics;

NSAIDs
How do NSAIDs cause AIN?
inhibit prostaglandin synthesis, which decreases GFR and start renal failure in pt w/ underlying renal problems
Dx findings of allergic AIN
(3)
WBCs;

Eosinophils;

White (or red) cell casts
Tx of allergic AIN?
(2)
1. stop offending agent

2. Steroids
initial microscopic finding in ATN
blebbing of the PTC and loss of brush boarder
microscopic finding of ischemic (2) ATN versus toxic
Ischemic:
BM damage;
skipped areas of damage

Toxic:
no BM damage;
Uniform damage w/ sparing of DT
Lab:
Oxalate crystal formation in kidney
Ethylene glycol ATN