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27 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is definition of Acute Renal Failure (ARF)
--aka acute renal injury |
Rapid decrease in GFR over HOurs to Weeks
--can result in Disturbances in ECF, Volume, and Acid/Base Balcance |
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What are 2 main lab indications of ARF?
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Elevated Cr by 50% (if baseline known)--
or BUN elevated--accum of Nitrogenous Wastes |
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Aside from 50% inc when baseline known, what is specific increases in Cr? What is it related to ?
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0.5-1.0 mg/dL inc above normal-due to affected mm available to generate Cr
--if mm mans man is Pt gonna be higher -for this reason GFR is used more and more |
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aka for Elevated BUN?
Elevated BUN & Confusion? |
Azotemia
Uremia: inc BUN /Azotemic + Confusion (ie systemic signs) azotemia is the number, uremia is the syndrome/systemic effects |
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What are 3 ways to categorize Renal Dz?
--just flip and read-- |
1. Pre-Renal, vs Intrinsic (renal), vs Post-Renal
2. Tubular vs Glomerular 3. etiology: ie, HTN Nephropathy vs Diabetic Nephropathy |
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What is most common cause of ARF?
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Pre-Renal --- this is a pearl
--with True or Effective Volume Depletion being a common cause -Note: Renovascular Dz can be either Pre-Renal OR Intrinsic---ie if Renal a. infarcts kidney |
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A Pre-Renal Origin suggests what about the intrinsic kidney pathology
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That the Intrinsic: Tubules and Glomeruli were NOT the initial location of pathology, tho will eventually become affected
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Case #1: 42yrs. Inc Abd Pain / 6hrs. No N/V/D, No F/C/NS (fever, chills or night sweats)
-10/10 Pain, Over entire Abd-->Back. No Injuries. 40 pack-year TOB, AA member x w yrs. PMH: Pancreatitis. Appears older than Age. Mild Diaphoresis. Rapid Pulse, elevated BP? What can you rule out now based on last 3? |
Probably NOT Dehydrated
-move to labs |
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Case 1 COnt:
Elevated Amylase and LIpase =? Normal Liver Enzymes -Neg Bandemia, Neg Anemia -Muddy Brown Castes =What do last 2 indicate? -Elevated WBCs |
Pancreatitis
Tubular Necrosis |
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Case 1 Cont:
BUN 80 Cr 3 What should be done with these? Important |
Take Creatine Value, multiply it by 20.
Should equal the maximum BUN so Cr = 3 x 20 = 60 Then if BUN : Cr Ration is Greater to 1 = suggests Dehydrated so 80 : 60 suggests Dehy |
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Case 1 cont:
K+ is 6.7 -- What do you check with this? Fe-Na: < 1 (what does this indicate for ARF, whatis formula) |
With elevated K, always check Magnesium.
Fe-Na: U-na * P-cr / P-na * U-cre x 100 --Fe-Na < 1 supports that ARF is Pre-Renal ---this suggests that the Tubules and Gloms were NOT the initial location of Pathology |
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What would be a tip off that problem was chronic?
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Anemia
--due to EPO problems |
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What does it mean if Kidney Functionis compromised, but volume is normal?
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Effective (true) Volume Depletion
--Fluid in 3rd Spacing -- ie in pelvic abscesses, pseudocyst, or any ExtraVascular (but not ICF) place |
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Define Effective Volume Depletion?
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When fluid and/or Blood is NOT reaching kidney for any reason, such that kidney perceives systemic conditions as if body were dry
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What are some clinical examples of Effective Volume Depletion? name 2
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Heart Failure: may have normal, or inc. circulating volume (even excess fluid), but CO is compromised, thus kidney perfusion is diminished
Vasomotor Dilatation: in sepsis: high CO, but Pooling in Periphery instead of maintaing organ perfusion |
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What are 2 elements of Tx for his guy
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Maintain optimal renal perfusion
Maintain optimal intravascular volume |
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NOTE, Previous SLides didnt distniguish Effective and True Volume Depletion
Effective is the weird one with low kidney perfusion for other reasons--ie pancreatitis/3rd spacings --True is |
True VOlume Depletion is just
Hypovolemia With Effective, must watch out for fluid overload |
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Case #2: 35y/o, Male. hot environment
-Gross Hematuria, Sharp R. Flank Pain w/ Cramp/Spasm -bit Tachy, bit elevated BP -Eyes Puffy -HRRR (heart reg rate & rhythm) -LCTABB-(lungs cleart to aus base bilaterally) Abd: mod distention, RLQ more intense What are causes for these findings |
-Pain indicates Kidney Stone (but RLQ pain could be appendix)
-Elevated pulse and BP --likely just due to pain -Possible Edema for eyes/distention --Think Renal Lithiasis ----more common in Summer Months in Males--working in heat |
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What is diff btw BMP and CMP
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BMP: Lytes w/ or w/o BUN&Cr
CMP: BPM + Liver Enzymes, Protein, Calcium --Mg NOT on above panels, but pertinent if Lytes or Kidney Fxn altered |
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What images are indicated for Renal Lithiasis? Why for each? (3)
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Plain Film: can show stones--not all
U/S: shows kidney size, + Dilation of Tubes Prox to stone CT: NOT Indicated go with Radiograph (Abdominal Series) or U/S |
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Case #2 COntinued: Interpret Labs:
1. CMP: BUN= 80, Cr: 2.5, 2. CBC: Hb/Hct high end of normal |
1. Here BUN:Cr is greater than 20 to 1. (ie, with Cr of 2.5, any BUN above 50 is a > 20:1 ratio
==Suggests Dehyrdration --Elevated Cr suggests Renal Compromise 2. Higher Hb and Hct , but normal indicate dehyration |
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Case #2: Treatment:
Labs& Images show Stone what is Tx? Who might you consult |
Still Large amts fluid
but INTO bucket to find stone--flush it out --may need urinary catheter --Likely to give narcotics --Urology Consult |
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What are 3 major Complications of ARF?
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1. Intravascular Volume Overload
2. Hyperkalemia, Hyponatremia + many other Lytes issues---AVOID Mg compounds 3. Metabolic Acidosis |
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Name some conditions for which you consider Temporary Hemodialysis
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- Volume Overload refractory to Diuretics
- Hyperkalemia - Encephalopathy otherwise note explained -Pericarditis, Pleuritis -Severe Metabolic Acidosis compromising Resp/Circ. Fxn |
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What are commonest Pre-Renal causes of ARF?
just flip it babe |
1.Hypovolemia: Dehydration/ ECF Depletion, Viral Synd., Acute Pancreatitis, Diuretics
2. Low CO in CHF 3. Altered Renal/SVR Ration: sepsis, cirrhosis 4. Renal HypoPerfusion w/ impaired Autoregulation: NSAIDs 5. Hyperviscosity Syndrome (rare): Myeloma dont worry about all these |
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What are causes of Intrinsic ARFs?
just flip and read |
1. Renovascular Obstruction: renal A. obstruction: embolism, Disecting AA
2. Dz of Glomeruli or Microvasculature: Accelerated HTN 3. ATN: Iodinated contrast dye for images 4. Interstital Nef: Acute Pyelo, NSAIDs, Also Contrast Dyes 5. Intratubular Deposition & Obstruction Myeloma 6. Renal Allograft Rejection |
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What are causes of Post-Renal ARFs
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Oftentimes a Urinary Obstruction--Blockage
1. Ureteric: calculi, blood clots, sloughed papilla, Cx, External Compression (tumor on kidneys) 2. Bladder Neck: neurogenic bladder, prostatic hypertrophy, calcs, Cx, clots 3. Urethra: stricture, congenital valve, Phimosis (can't retract foreskin) |
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