Ipapburke Gu Test 1- Acute Renal Failure

Front 1

Essentials of diagnosis for acute renal failure

Back 1

Sudden increase in BUN or serum creatinine, oliguria often associated, S/S depend on cause, decreased urine output often

Front 2

MC symptom of acute renal failure

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decreased urine output

Front 3

Another name for Acute Renal Failure

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Acute Kidney Injury

Front 4

This is a condition in which GFR is reduced, causing increased metabolites in blood normally cleared by kidney

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Acute Renal Failure

Front 5

What is the urine volume usually in ARF?

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under 400 m/d---> oliguria

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Anuria

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no urine output at all

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If renal concentrating mechanisms are impaired, what would happen to the urine output in ARF?

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may be normal or even high (called high output or nonoliguric renal failure)

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Convenient marker for ARF

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serum creatinine

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What will be the typical increase in serum creatinine concentration in renal failure?

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1-1.5 mg/dl day increase

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What are the symptoms in ARF due to?

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azotemia (increased urea and BUN levels)

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What are some of the symptoms that azotemia can cause?

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nausea/vomiting, malaise, and altered mental status

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What may happen with hyperkalemia in ARF?

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hypertension and arrhythmias

Front 13

3 categories of ARF

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prerenal azotemia, postrenal azotemia, intrinsic renal disease

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MC cause of ARF

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prerenal azotemia

Front 15

What is the cause of prerenal azotemia?

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renal hypoperfusion

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What can result from prerenal azotemia if hypoperfusion persists?

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ischemia will result and cause intrinsic renal failure

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What will happen if prerenal azotemia is reversed?

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if appropriate blood flow is restored, permanent damage will not occur to the renal parenchymal

Front 18

3 reasons for decreased renal perfusion

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decrease in intravascular volume, change in vascular resistance, low cardiac output

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Causes of volume depletion

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hemorrhage, GI losses, dehydration, excessive diuresis, pancreatitis, burns, trauma, and peritonitis

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Reasons for changes in vascular resistance

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sepsis, anaphylaxis, anesthesia, afterload reducing drugs

Front 21

MC specific cause of prerenal azotemia

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dehydration due to renal or extrarenal fluid losses…from diarrhea, vomiting, excessive diuretics

Front 22

Patients in ARF due to dehydration can complain of what (4)

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thirst, dizziness, fluid loss/weight loss

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What can the exam in prerenal azotemia reveal?

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decreased skin turgor, collapsed neck veins, dry mucous membranes, orthostatic hypotension and pulse

Front 24

BUN: Creatinine Ration in prerenal azotemia

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> 20:1

Front 25

Urine osmolality in prerenal azotemia- elevated or decreased ******?

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elevated

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What can be found in the urinary sediment in prerenal azotemia?

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benign or hyaline casts

Front 27

Urinary sodium in prerenal azotemia *****?

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<20 (body's response so it can save water)

Front 28

Most accurate screening test to differentiate between prerenal and ZTN

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FE Na (%)

Front 29

RFI (Renal Failure Index) in prerenal azotemia

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< 1%

Front 30

Do you treat prerenal azotemia (ARF) as an outpatient or inpatient?

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ADMIT them

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Benchmarks of therapy for ARF with prerenal azotemia

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euvolemia, attention to serum potassium, and avoidance of nephrotoxic drugs

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Least common cause of prerenal azotemia

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postrenal azotemia

Front 33

Why is it important to detect postrenal azotemia?

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because it is reversible

Front 34

Explain fluid challenge in ARF due to prerenal azotemia.

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If they respond to fluids by beginning to increase urine output (of good quality), they had prerenal azotemia

Front 35

When does postrenal azotemia occur?

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when urinary flow from both kidneys or a single functioning kidney is obstructed

Front 36

Why is the decreased GFR in postrenal azotemia?

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each nephron has an elevated intraluminal pressure

Front 37

Specific causes of postrenal azotemia

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urethral obstruction, bladder dysfunction or obstruction, and obstruction of both ureters or renal pelvises (MC: BPH)

Front 38

MC cause of postrenal azotemia in men

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BPH

Front 39

Patients taking these drugs are at risk for postrenal azotemia

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anticholinergics

Front 40

What imaging is used to identify an obstruction?

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US

Front 41

What might the exam on postrenal azotemia reveal?

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enlarged prostate, distended bladder, or mass palpable with pelvic exam

Front 42

Urine output in postrenal azotemia

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may be an uric or polyuric

Front 43

BUN: Creatinine Ration in postrenal azotemia

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> 20:1 (but can vary)

Front 44

What will possibly be found in urinary sediment in postrenal azotemia?

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normal, or red cells, white cells, or crystals

Front 45

What is the U Na in postrenal azotemia?

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variable, but usually greater than 20

Front 46

What is the FE Na in postrenal azotemia?

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variable, usually >1

Front 47

What is RFI in postrenal azotemia?

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usually >1%

Front 48

What will clench the diagnosis in postrenal azotemia?

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It won't be the labs, but rather the history, because the labs are variable

Front 50

Tx for postrenal azotemia

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relieve the obstruction ASAP (if caught within a few days can be reversible)

Front 51

If there is no urine output at all, think pre or post renal azotemia?

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postrenal azotemia

Front 52

When do you consider intrinsic renal disease?

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After pre and post renal azotemic causes have been excluded

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Where are the sites of injury in intrinsic renal disease?

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tubules, interstitium, vasculature, and glomeruli

Front 54

Three conditions that are considered intrinsic renal disease

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ATN, acute interstitial nephritis, and acute glomerulonephritis

Front 55

Essentials of diagnosis for ATN

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acute renal insufficiency, clinical scenario consistent with diagnosis, and urine sediment with pigmented granular casts and renal tubular epithelial cells

Front 56

Presentation of patient with ATN

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generalized swelling, N/V, oliguria, decreased LOC, uremic tongue, anorexia, GI bleed, muscle weakness, twitching

Front 57

Two major causes of ATN

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ischemia and nephrotoxin exposure

Front 58

MC cause of intrinsic ARF

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ARF due to tubular damage or ATN

Front 59

What often precedes ATN?

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prerenal azotemia

Front 60

Settings that might cause ischemia or hypotension/hypoxia that leads to ATN

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dehydration, shock, sepsis, major surgery, trauma

Front 61

Are exogenous or endogenous nephrotoxin exposures more common in ATN?

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exogenous

Front 62

Examples of exogenous nephrotoxins

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aminoglycosides, Vancomycin, cephalosporins, radiographic contrast media, cyclosporin, antineoplastics, heavy metals like lead and mercury

Front 63

Examples of endogenous nephrotoxins

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heme containing products (myoglobin and hemoglobin), uric acid, and paraproteins (Bence Jones)

Front 64

Describe urine in ATN

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brown with proteinuira and low pH

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Urine osmolality in ATN

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low (<400 is severe impairment)

Front 66

Muddy brown granular cats

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ATN (may also have renal tubular epithelial cells and tubular casts in urine)

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BUN: Creatinine Ratio in ATN

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< 20: 1

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U Na in ATN

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>20

Front 69

FE NA in ATN

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> 1-2

Front 70

RFI in ATN

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> 1%

Front 71

Why do you do CBC in ATN?

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check for anemia

Front 72

These electrolyte abnormalities are common in ATN

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hyperkalemia and hyperphosphatemia

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TX for ATN

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ICU, avoid volume overload with diuretics, protein restriction, phosphate binding agent, dialysis if indicated

Front 74

Indications for dialysis in renal failure

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hyperkalemia, volume overload that doesn't respond to diuretic, worsening acidosis, uremic complications like encephalopathy, pericarditis, and seizures

Front 75

Three phases of clinical course of ATN

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initial injury, maintenance, and recovery

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Maintenance phase is either ________ or __________ (urine output).

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oliguric or nonoliguric

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Does nonuliguric or oliguric ATN have better outcome?

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nonoliguric

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Length of maintenance phase of ATN

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1-3 weeks

Front 79

MC cause of death in ATN

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infection

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Mortality rate in ATN

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20-70% (usually due to infection)

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What occurs during the maintenance phase?

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cellular repair and removal of debris

Front 82

Essentials of diagnosis for Acute Interstitial nephritis

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fever in 80%, transient maculopapular rash, acute renal insufficiency, pyuria, and WBC casts and hematuria

Front 83

This condition is an interstitial inflammatory response with edema and tubular damage possible

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acute interstitial nephritis

Front 84

Causes of Acute Interstitial Nephritis

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70% drugs; others- infectious diseases, immunological disorders, or as an idiopathic condition

Front 85

Symptoms that patients with AIN present with

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fever, rash, and arthralgias

Front 86

BUN: Creatinine Ration in Acute Interstitial Nephritis

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<20:1

Front 87

A Wright or Hansel stain to evaluate for eosinophils will help make the diagnosis of what condition

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AIN

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Recovery period for AIN

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usually within weeks to months with a good overall prognosis

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Tx of AIN

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supportive measures and removing inciting agents or treating infection. If renal failure persists, use a short course of steroids

Front 90

Essentials of diagnosis for Acute Glomerulonephritis

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hematuria, dysmorphic RBCs, RBC casts, and mild proteinuria; dependent edema and hypertension, acute renal insufficiency

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What causes prognosis for ARF to be poor?

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oliguria, advanced age, multiple organ failure

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Acronym used for graded definition of ARF

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RIFLE--- Risk, Injury, Failure, Loss (loss of > 3 mo) function > 4 weeks), ESRD (complete loss of function