Intern Year: Tintinalli- Section 10-Ch 91-Acute Renal Failure

Front 1

describe the general process in pre-renal, intrinsic, and post renal failure

Back 1

pre: decreased perfusion

intrinsic: pathologic changes within the kidney

post: obstruction to urinary outflow

Front 2

most common cause of intrinsic renal failure?

Back 2

ischemic ARF

traditionally known as acute tubular necrosis and now called acute kidney injury

Front 3

what type of renal failure does this describe:

thirst, orthostatic light-headedness, and decreasing urine output

Back 3

Pre-renal

Front 4

cardiac arrest, severe sepsis, or other causes of systemic hypotension lead to?

Back 4

Ischemic acute kidney injury

Front 5

flank pain and hematuria likely is what kind of nephropathy?

Back 5

crystal induced

aka nephrolithiasis

papillary necrosis can present this way too

Front 6

rhabdomyolisis (myalgais, recent coma, seizures, recreational intoxication, excessive exercise) and hemolysis (recent blood transfusion) can have what type of ARF?

Back 6

pigment induced

Front 7

darkening urine and edema with or without constitutional symptoms such as fever, malaise and rash should raise suspicion for?

Back 7

acute glomerulonephritis

preceded by pharyngitis or cutaneous infection

Front 8

fever, arthralgia, and rash are common with what?

Back 8

acute interstitial nephritis

Front 9

Cough, dyspnea, hemopytsis can raise the suspicion for what renal syndromes?

Back 9

Goodpasture

or

Wegener

Front 10

what GFR typically indicates kidney failure?

Back 10

<15

Front 11

give a dd of prerenal failure

Back 11

Hypovolemia (GI, diruetics, burns)

Hypotension (septic, hemorrhage, decreased CO)

Renal artery and small vessel dz (embolism, thrombosis)

Front 12

Significant permanent loss of renal function occurs over the course of how many days in the setting of complete obstruction?

**

Back 12

10-14 days

the risk of permanent RF increases significantly if obstruction is complicated by UTI

Front 13

Most common cause of in-hospital ARF?

**

Back 13

Radiocontrast-induced nephropathy

IV contrast

Front 14

elevated uric acid levels causes crystal induced nephropathy...this can be caused by medications including?

Back 14

acyclovir, sulfonamides, indinavir, triamterene

Front 15

ARF in the setting of ACE inhibitor initiation should prompt consideration of?

Back 15

bilateral renal artery stenosis

maintenance of GFR is depended on postglomerular arteriole vasoconstriction

Front 16

how do NSAIDs lead to ARF?

Back 16

decreased prostaglandins

results in decreased GFR and renal blood flow

Front 17

what class of abx can cause direct tubular toxicity?

Back 17

Aminoglycosides

Front 18

In patients with no renal function (GFR=0) serum Cr levels increase how?

Back 18

1--3 mg/dL a day

Front 19

In the setting of prerenal failure, the serum ratio of BUN to Cr is?

Back 19

typically >20

Front 20

what renal lab can be increased in the setting of protein loading, GI bleed, or trauma?

Back 20

BUN

Front 21

FeNA=?

Back 21

UNa/PNa / UCr/Pcr

u=urine
P=plasma

Front 22

Give the urine osmolality and FeNa% for the following:

Prerenal azotemia

Back 22

Osmol >500

FeNa < 1%

Front 23

Give the urine osmolality and FeNa% for the following:

Renal azotemia (tubular injury, ischemia, nephrotoxins)

Back 23

Osmol < 350

FeNa >1%

Front 24

Give the urine osmolality and FeNa% for the following:

Postrenal azotemia

Back 24

Osmol >500

FeNa >1%

Front 25

Osmol >500

FeNa >1%

general cause of ARF?

Back 25

Post renal

Front 26

Osmol >500

FeNa < 1%

general cause of ARF?

Back 26

Pre renal

Front 27

Osmol < 350

FeNa >1%

general cause of ARF?

Back 27

intrinsic renal failure

Front 28

in intermittent or partial obstruction, hydronephrosis may NOT be present and it may even be ABSENT in complete obstruction in the setting of what problem?

Back 28

retroperitoneal fibrosis

Front 29

Test of choice for urologic imaging in the setting of ARF?

Back 29

Renal US

has 90% sensitivity and specificity for detecting hydronophrosis due to mechanical obstruction

Front 30

Indications for emergent dialysis?

Back 30

AEIOU

Acidosis (resistant to NaHCO3)

Electrolytes (hyper K>6.5, Na <115 or >165)

Ingestion/Intox (lithium, aspirin, mehanol, ethylene glycol, theophylline)

Overload

Uremia (pericarditis, encephalopathy, asterixis, seizure, bleeding)

Front 31

Radiocontrast induced nephropathy begins to be significant concern when GFR is ?

Back 31

<60

CKD 3

Front 32

Gadolinium based contrast for MRI should not be given if GFR is < __?__

due to the risk of what?

Back 32

<30

CKD 4

risk of nephrogenic systemic fibrosis