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9 Cards in this Set
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Why are BUN/Cr elevated in ARF?
How much is Cr elevated? What affects Cr amounts? elevated BUN = ? elevated BUN + confusion = ? Most common form of ARF? |
kidneys can't excrete
0.5-1 mg above normal; affected by muscle mass of pt elevated BUN = azotemia elevated BUN + confusion = uremia pre-renal |
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Pre-renal ARF:
common cause of pre-renal ARF? _____ renal artery stenosis is a cause. Case #1: 42 y/o m c/o abd pain x 6 hrs. Explain significance of: HPI: No N/V/D, F/C/NS elevated serum amylase,lipase |
effective volume depletion
EARLY renal artery stenosis Case #1: HPI - no infection amylase,lipase - pancreatitis |
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Case #1:
Significance of: BUN 80, Cr 3 K+ 6.7 Fe(Na) < 1.0 What is third spacing? |
BUN/Cr ratio > 20 = dehydration or effective volume depletion
hyperkalemia 2ndary to ARF Fe(Na) < 1.0 = pre-renal third spacing = non vascular, non cells |
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Examples of volume depletion and effective volume depletion:
radiology imaging you can use? Which one is better, but why can it be worse? |
volume depletion - diarrhea/vomiting, dehydration
effective volume depletion - heart failure (decreased CO), sepsis (vasomotor dilation) Abd U/S, CT - CT better imaging, but contrast can further compromise tubular lining |
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Treatment basics for pre-renal ARF?
Case #2: 35 y/o m, construction worker, R flank pain, gross hematuria, mild edema Why is renal lithiasis more common in summer? |
maintain optimal renal perfusion, intravascular volume
Case #2: renal lithiasis dehydration more common |
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What labs should you check in renal lithiasis? Why check Mg?
What radiologic imaging? Why is it important for kidney stones? |
BMP, CMP, CBC
Mg is important for K+ exchange in electrolyte or kidney alteration U/S - advantage - can show dilation proximal to stone, kidney size |
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Case #2:
Would you expect his Fe(Na) to be < 1? Complications of ARF? |
No - post renal ARF
ARF complications intravascular volume overload hyperkalemia/hyponatremia, other electrolyte abnormalities metabolic acidosis |
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Pre, Intra, or Post Renal:
#1: dehydration, viral syndromes, diuretics, pancreatitis: #2: renal artery obstruction, glomeruli, ATN from contrast dye: |
#1: Pre-renal
#2: Intra-renal |
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Pre, Intra, Post-Renal?
#1: CHF, sepsis, cirrhosis: #2: myeloma, interstitial nephritis: #3: stone in ureter, blood clot, tumor compression: #4: BPH, phimosis, neurogenic bladder: |
#1: Pre-renal
#2: intra-renal #3: post-renal #4: post-renal |
