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57 Cards in this Set
- Front
- Back
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What is the most common cause of Acute Renal Failure?
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Acute Tubular Necrosis
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What is Acute Renal Failure?
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Loss of renal function in < 24 hours
Oliguria or Anuria |
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Apart from ATN, what are some other causes of Acute Renal Failure
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Post-Renal: BPH, invasive cervical cancer
Vascular - Malignant Htn RPGN, Drugs, DIC |
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What are the two major subsets of Acute Tubular Necrosis?
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Ischemic and Nephrotoxic
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What is the most common cause of Ischemic ATN?
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Pre-renal Azotemia due to Hypovolemia
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What is the result of damage to endothelial cells done by Ishcemic ATN?
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Endothelial cells can't produce vasodilators like NO, PGI2
Increased production of vasoconstrictors like endothelin Constricts afferent arteriole, decreasing GFR |
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What does Ischemic ATN do to the tubule cells?
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Damage to tubule cells causes them to fall off and obstruct lumen
Increases intra-tubule pressure, lowering GFR, causing oliguria |
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What type of casts are produced in Ischemic ATN?
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Pigment renal tubule casts
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Which portions of the tubule are most susceptible to damage in Ischemic ATN?
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1. Straight portion of proximal tubule - most susceptible
2. Medullary portion of TAL - Na-K-2Cl transporter location |
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What are the most common causes of Nephrotoxic ATN?
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Drugs - Aminoglycosides
Radiocontrast Heavy Metals |
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What are the clincal findings of Acute Tubular Necrosis?
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1. Oliguria
2. Pigment Renal Tubule Casts 3. Hyperkalemia w/ increased anion gap metabolic acidosis 4. Decreased BUN:Cr 5. Hypokalemia during diuresis phase |
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What are the treatment options for ATN?
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1. Remove offending agent
2. Vol expansion if needed 3. Dopamine 4. Dialysis |
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What is Tubulointerstial Nephritis?
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Inflammation of the tubules and interstitium
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What are the most common causes of TIN?
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Acute Pyelonephritis (most common)
Drugs SLE Infection |
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What is the most common cause of Acute Pyelonephritis in women?
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E. Coli
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What are major risk factors for Acute Pyelonephritis?
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1. Indwelling Catheter
2. Obstruction 3. Medullary Sponge Kidney 4. Diabetes, Pregnancy 5. Sickle Cell Trait |
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What is the most common pathogenic mechanism of Acute Pyelonephritis ?
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Vesicoureteral Reflux (VUR)
Portion of ureter that enters in to bladder fails to properly compress during urination resulting in backflow of contents |
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Which portion of the kidney is likely to become infection in Acute Pyelonephritis in a patient that has VUR?
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Renal pelvis and parenchyma
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What is the main gross and misroscopic finding of Acute Pyelonephritis?
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Gross - abscess in renal medulla and cortex
Micro - microabscess in tubules |
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What are the clnical findings of Acute Pyelonephritis?
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1. Flank Pain
2. Fever 3. WBC's in urine 4. Dysuria (painful pissing) 5. Polyuria |
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What are clnical findings seen in Acute Pyelonephritis but not in a lower UTI?
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Fever, Flank Pain, WBCs
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What are some of the complications that can arise from Acute Pyeloneprhitis?
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1. Chronic Pyleopnephritis
2. Perinephric Abscess 3. Renal Papillary Necrosis 4. Septicemia |
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What is the primary treatment for Acute Pyelonephritis?
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Cipro
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What are the 2 major causes of chronic pyelonephritis?
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1. VUR
2. Obstruction - hydronephrosis |
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What are the differences in gross findings seen in chronic pyelonephrtis seen in the VUR type and obstructive type?
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VUR - U-shaped cortical scars
Obstructive - Dialated renal calyx |
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What is a key microscopic findings of the renal tubules in Chronic Pyelonephritis?
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"Thyroidization" of tubules - due to eosinophilic material
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What are the most common drugs associated with drug-induced TIN?
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Penicillin, Methicillin, Rifampin, Sulfmonamides, Diuretics, NSAIDS
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What is the pathogenic mechanism responsible for drug-induced TIN?
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Type I and IV hypersensitivity
~2 weeks after starting the drug |
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What are the most common clinical findings of drug-induced TIN?
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Fever, Rash, Oliguria
Sx resolve w/ removal of drug |
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What is the BUN:Cr in drug-induced TIN?
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< 15
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What is a highly predictive lab finding for drug-induced TIN?
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Eosinophiluria
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What is the primary treatment of drug-induced TIN?
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Withdrawing from drug
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What drugs are implicated in being the cause of Analgesic Nephropathy?
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Acetominophen + Aspirin
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What is the mechanism by which Analgesic Nephropathy occurs?
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Acetominophen creates free radicals which damages the tubule cells in the renal medulla
Aspirin inhibits PGE2 and causes vasoconstriction of afferent areteriole resulting in lower blood flow to medulla |
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What cancer risk is increased with analgesic nephropathy?
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Renal Transitional Cell and Bladder Cancer
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What are the major complications that occur due to Analgesic Nephropathy?
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Renal Papillary Necrosis
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What is a diagnostic finding of Renal Papillary Necrosis on IVP?
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"Ring Defect" - where one or more papilla used to be
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What are the primary causes of Urate Nephropathy?
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Lead Poisoning, Gout
Massive Release of purines after treatment of disseminated cancer |
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What is the GFR that correlates to End-Stage Renal Disease?
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GFR < 15 mL/min
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In descending order, what are the main causes of Chronic Renal Failure?
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DM > HTN > Chronic GN (RPGN, FSGS) > Cystic Renal Dysplasia
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What is the gross apperance of the kidney in Chronic Renal Failure?
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Bilateral, Shrunken Kidneys
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What is the primary hematologic abnormality in Chronic Renal Failure? What is it due to?
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Normocytic Anemia
Decreased renal production of erythropoetin |
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What are the 3 osteodystrophies that result from Chronic Renal Failure?
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Osteitis Fibrosa Cystica - due to Vitamin D defeciency - loss of Ca uptake - stimulates PTH - cystic bone lesions
Osteomalacia - due to low Ca due to low Vit D Osteoporosis - due to metabolic acidosis buffering by bone |
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What are the cardiovascular findings most commonly due to Chronic Renal Failure?
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1. HTN from salt retention
2. Hemorrhagic fibrinous pericarditis 3. CHF |
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What are the 2 major causes of hypocalcemia in CRF?
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Hypovitminosis D
Hyperphosphatemia - drives calcium into bone - metastic calcification |
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What are the non-pharmalogic treatments for CRF?
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Low-salt Diet
Low-protein Diet Kidney Transplant |
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What are the pharmalogic treatments for CRF?
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ACEI - reduce proteinuria and htn
Vitamin D supplements or Ca Erythropoetin Phosphate Binder - Sevelamer |
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What is the most common kidney disease that is caused by essential hypertension?
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Benign Nephrosclerosis
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What is the pathogenic mechanism of benign nephrosclerosis?
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Hyaline arteriolsclerosis of arterioles
Tubular Atrophy, Interstitial Fibrosis, Glomerular Sclerosis |
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What is the gross apperance of kidneys in benign nephrosclerosis?
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Small kidneys, Cobblestone appearance
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What are the laboratory findings of benign nephrosclerosis?
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Mild Proteinuria
Hematuria w/o RBC casts |
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What is malignant hypertensions?
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Sudden onset of a major increase in BP
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What underlying renal pathology is most associated with risk of malignant hypertension?
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Benign Nephrosclerosis
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What are the main risk factors for developing malignant hypertension?
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Benign Nephrosclerosis (most common)
Hemolytic-Uremic Syndrome Thrombotic Thrombocytopenic Purpura Systemic Sclerosis |
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What is the pathogenesis of malignant hypertension?
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Damage to arterioles and arteries
Hyperplastic Arteriosclerosis ("onion-skin" lesion) "flea-bitten" kidneys |
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What is the BUN:Cr in malignant hypertension?
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< 15
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What is the initial treatment for malignant hypertension?
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IV Sodium Nitroprusside
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