Renal Failure

Front 1

Definition of acute renal failure

Back 1

"Rapid decline in renal fxn with increase in serum Cr levels (by 50% or 0.5 --> 1.0)

Front 2

2 most common clinical findings in ARF

Back 2

Wt gain and edema

Front 3

Most common cause of death in ARF

Back 3

Infection (75%), then cardiorespiratory complications

Front 4

3 types of ARF

Back 4

"Prerenal (decreased renal blood flow), Intrinstic (damaged renal parenchyma), Postrenal (urinary tract obstruction)

Front 5

Causes of prerenal ARF

Back 5

"Decreased systemic arterial blood volume or renal perfusion (can be a complication of any dz that causes hypovolemia, low CO or systemic vasodilation)

VASCULAR- CHF, peripheral vasodilation, renal artery obstruction, hypovolemia (dehydration, diuretics, V, D, burns, hemorrhage)
METABOLIC/SYST- cirrhosis, hepatorenal syndrome
DRUGS/TOXINS- NSAIDs, ACE inhibitors, cyclosporin "

Front 6

Causes of postrenal ARF

Back 6

"MCC = urethral obstruction 2/2 BPH

METABOLIC/SYST- obstruction of solitary kidney, nephrolithiasis
NEOPLASTIC- BPH, obstructing neoplasm

Front 7

Diagnostic approaches in ARF

Back 7

"1. Baseline Cr
2. Classify. Volume depletion/CHF = prerenal, allergic rxn = interstitial; suprapubic mass/bph/bladder dysfxn = postrenal
3. med review
4. u/a
5. urine chem
6. renal u/s"

Front 8

Pathophys of Prerenal ARF

Back 8

"Decreased renal blood flow --> lowered GFR --> decreased clearance of metabolites

Normal renal parenchyma --> conserve Na and H2O"
Clinical features of prerenal ARF

Front 9

Causes of intrinsic renal failure

Back 9

"VASCULAR-- ischemia (tubular dz), vascular dz (renal artery occlusion, TTP, HUS)
METABOLIC/SYSTEMIC-- glomerular dz (goodpasture's, WG, poststrep, lupus)
DRUGS/TOXINS-- allergic rxn to drugs"

Front 10

Lab findings of intrinsic ARF

Back 10

"BUN:Cr <20:1 but still elevated

Front 11

When is FeNA most useful diagnostically?

Back 11

If oliguria is present

Front 12

3 basic tests for postrenal failure ARF

Back 12

"1. physical exam (palpate bladder)
2. U/S
3. catheter"

Front 13

Diagnostic tests for ARF

Back 13

"1. Blood tests (Chem 7, albumin, CBC with diff)
2. UA
3. UChem
4. Renal u/s unless obviously not postrenal

If suspect infection --> UCx
If renal u/s shows abnormality --> CT
Suspect acute GN/acute allergic --> Renal bx

Front 14

What does urine NA most depend on?

Back 14

dietary intake

Front 15

Complications of ARF

Back 15

"1. PULMONARY EDEMA
2.
METABOLIC -- hyperkalemia, metabolic acidosis w increased AG, hypocalcemia, hyponatremia, hyperphosphatemia, hyperuricemia
3. UREMIA
4. INFECTION"

Front 16

"GFR values for:
1. Mild CRF
2. Moderate CRF
3. Severe CRF
4. ESRD"

Back 16

"1. Mild CRF 70-120
2. Moderate CRF 30-70
3. Severe CRF <30
4. ESRD <10"

Front 17

Treatment of ARF

Back 17

"1. correct fluids, Bp 120-140/80-90
2. dialysis if symptomatic uremia, intractable acdemia, hyperkalemia, volume overload

PRERENAL- treat underlying, NS if no edema, stop offending meds, if unstable: Swan-Ganz
INTRINSIC-- if ATN- supportive; t/o furosemide if oliguric
POSTRENAL-- bladder catheter, uro consult?"

Front 18

What is CRF?

Back 18

Irreversible, progressive reduction in GFR and other renal fxns occuring over a pd of months to years

Front 19

Top 3 causes of CRF

Back 19

"1. DM (30%)
2. HTN (25%)
3. Chronic GN (15%)"

Front 20

Clinical features of CRF

Back 20

"CV: HTN, CHF
Neuro: asterixis, weakness, hyperreflexia, restless legs, hypocalcemia (lethargy, confusion, tetany)
Heme: normocytic normochromic anemia
End: hyperphos, hypocalc (long standing --> hypercalc), renal osteodystrophy, calciphylaxis (vascular calcifications --> necrotic skin lesions); low testosterone, amenorrhea, infertility, hyperprolactinemia; pruritis
Fluid: pulm edema, hyperk, hyperMg, hyperphos, met acid

Uremic sx: pericarditis, N, V, anorexia, seizures, platelet dysfxn, infections"

Front 21

What meds should be avoided in ARF?

Back 21

NSAIDs, aminoglycosides, radiocontrast agents, ACE inhibitors

Front 22

What meds should be avoided in CRF?

Back 22

antiplatelet agents

Front 23

"Rx of CRF:
1. Diet
2. BP
3. Meds given
4. Only cure?

If:
1. diabetes
2. hyperphosphatemia
3. acidosis
4. anemia
5. pulm edema
6. pruritis"

Back 23

"Rx of CRF:

1. Diet = low protein, Na, K, phosphate, Mg
2. BP = ACE inhibitors
3. Meds given = ACE inhibitors, long-term Ca/Vit D
4. Only cure = transplant

If:
1. diabetes = glycemic ctl
2. hyperphosphatemia = Ca citrate
3. acidosis = bicarb
4. anemia = erythropoietin
5. pulm edema = diuresis --> dialysis
6. pruritis = capsaicin cream or cholestyramine + UV light"

Front 24

"When do you dialyze a pt with:

1. CRF?
2. ARF?
3. No renal failure?"

Back 24

"1. CRF: bridge to transplant

2. ARF:
-Signs of uremia (N, V, change in MS, pericarditis)
-Pulm edema
-Severe met acidosis
-Severe, refractory electrolyte disturbance

3. No renal failure: OD of meds
-salicylic acid
-lithium
-ethylene glycol
-Mg-containing laxatives"

Front 25

Definition of acute renal failure

Back 25

"Rapid decline in renal fxn with increase in serum Cr levels (by 50% or 0.5 --> 1.0)

Front 26

2 most common clinical findings in ARF

Back 26

Wt gain and edema

Front 27

Most common cause of death in ARF

Back 27

Infection (75%), then cardiorespiratory complications

Front 28

3 types of ARF

Back 28

"Prerenal (decreased renal blood flow), Intrinstic (damaged renal parenchyma), Postrenal (urinary tract obstruction)

Front 29

Causes of prerenal ARF

Back 29

"Decreased systemic arterial blood volume or renal perfusion (can be a complication of any dz that causes hypovolemia, low CO or systemic vasodilation)

VASCULAR- CHF, peripheral vasodilation, renal artery obstruction, hypovolemia (dehydration, diuretics, V, D, burns, hemorrhage)
METABOLIC/SYST- cirrhosis, hepatorenal syndrome
DRUGS/TOXINS- NSAIDs, ACE inhibitors, cyclosporin "

Front 30

Causes of postrenal ARF

Back 30

"MCC = urethral obstruction 2/2 BPH

METABOLIC/SYST- obstruction of solitary kidney, nephrolithiasis
NEOPLASTIC- BPH, obstructing neoplasm

Front 31

Diagnostic approaches in ARF

Back 31

"1. Baseline Cr
2. Classify. Volume depletion/CHF = prerenal, allergic rxn = interstitial; suprapubic mass/bph/bladder dysfxn = postrenal
3. med review
4. u/a
5. urine chem
6. renal u/s"

Front 32

Pathophys of Prerenal ARF

Back 32

"Decreased renal blood flow --> lowered GFR --> decreased clearance of metabolites

Normal renal parenchyma --> conserve Na and H2O"
Clinical features of prerenal ARF

Front 33

Causes of intrinsic renal failure

Back 33

"VASCULAR-- ischemia (tubular dz), vascular dz (renal artery occlusion, TTP, HUS)
METABOLIC/SYSTEMIC-- glomerular dz (goodpasture's, WG, poststrep, lupus)
DRUGS/TOXINS-- allergic rxn to drugs"

Front 34

Lab findings of intrinsic ARF

Back 34

"BUN:Cr <20:1 but still elevated

Front 35

When is FeNA most useful diagnostically?

Back 35

If oliguria is present

Front 36

3 basic tests for postrenal failure ARF

Back 36

"1. physical exam (palpate bladder)
2. U/S
3. catheter"

Front 37

Diagnostic tests for ARF

Back 37

"1. Blood tests (Chem 7, albumin, CBC with diff)
2. UA
3. UChem
4. Renal u/s unless obviously not postrenal

If suspect infection --> UCx
If renal u/s shows abnormality --> CT
Suspect acute GN/acute allergic --> Renal bx

Front 38

What does urine NA most depend on?

Back 38

dietary intake

Front 39

Complications of ARF

Back 39

"1. PULMONARY EDEMA
2.
METABOLIC -- hyperkalemia, metabolic acidosis w increased AG, hypocalcemia, hyponatremia, hyperphosphatemia, hyperuricemia
3. UREMIA
4. INFECTION"

Front 40

"GFR values for:
1. Mild CRF
2. Moderate CRF
3. Severe CRF
4. ESRD"

Back 40

"1. Mild CRF 70-120
2. Moderate CRF 30-70
3. Severe CRF <30
4. ESRD <10"

Front 41

Treatment of ARF

Back 41

"1. correct fluids, Bp 120-140/80-90
2. dialysis if symptomatic uremia, intractable acdemia, hyperkalemia, volume overload

PRERENAL- treat underlying, NS if no edema, stop offending meds, if unstable: Swan-Ganz
INTRINSIC-- if ATN- supportive; t/o furosemide if oliguric
POSTRENAL-- bladder catheter, uro consult?"

Front 42

What is CRF?

Back 42

Irreversible, progressive reduction in GFR and other renal fxns occuring over a pd of months to years

Front 43

Top 3 causes of CRF

Back 43

"1. DM (30%)
2. HTN (25%)
3. Chronic GN (15%)"

Front 44

Clinical features of CRF

Back 44

"CV: HTN, CHF
Neuro: asterixis, weakness, hyperreflexia, restless legs, hypocalcemia (lethargy, confusion, tetany)
Heme: normocytic normochromic anemia
End: hyperphos, hypocalc (long standing --> hypercalc), renal osteodystrophy, calciphylaxis (vascular calcifications --> necrotic skin lesions); low testosterone, amenorrhea, infertility, hyperprolactinemia; pruritis
Fluid: pulm edema, hyperk, hyperMg, hyperphos, met acid

Uremic sx: pericarditis, N, V, anorexia, seizures, platelet dysfxn, infections"

Front 45

What meds should be avoided in ARF?

Back 45

NSAIDs, aminoglycosides, radiocontrast agents, ACE inhibitors

Front 46

What meds should be avoided in CRF?

Back 46

antiplatelet agents

Front 47

"Rx of CRF:
1. Diet
2. BP
3. Meds given
4. Only cure?

If:
1. diabetes
2. hyperphosphatemia
3. acidosis
4. anemia
5. pulm edema
6. pruritis"

Back 47

"Rx of CRF:

1. Diet = low protein, Na, K, phosphate, Mg
2. BP = ACE inhibitors
3. Meds given = ACE inhibitors, long-term Ca/Vit D
4. Only cure = transplant

If:
1. diabetes = glycemic ctl
2. hyperphosphatemia = Ca citrate
3. acidosis = bicarb
4. anemia = erythropoietin
5. pulm edema = diuresis --> dialysis
6. pruritis = capsaicin cream or cholestyramine + UV light"

Front 48

"When do you dialyze a pt with:

1. CRF?
2. ARF?
3. No renal failure?"

Back 48

"1. CRF: bridge to transplant

2. ARF:
-Signs of uremia (N, V, change in MS, pericarditis)
-Pulm edema
-Severe met acidosis
-Severe, refractory electrolyte disturbance

3. No renal failure: OD of meds
-salicylic acid
-lithium
-ethylene glycol
-Mg-containing laxatives"

Front 49

Definition of acute renal failure

Back 49

"Rapid decline in renal fxn with increase in serum Cr levels (by 50% or 0.5 --> 1.0)

Front 50

2 most common clinical findings in ARF

Back 50

Wt gain and edema

Front 51

Most common cause of death in ARF

Back 51

Infection (75%), then cardiorespiratory complications

Front 52

3 types of ARF

Back 52

"Prerenal (decreased renal blood flow), Intrinstic (damaged renal parenchyma), Postrenal (urinary tract obstruction)

Front 53

Causes of prerenal ARF

Back 53

"Decreased systemic arterial blood volume or renal perfusion (can be a complication of any dz that causes hypovolemia, low CO or systemic vasodilation)

VASCULAR- CHF, peripheral vasodilation, renal artery obstruction, hypovolemia (dehydration, diuretics, V, D, burns, hemorrhage)
METABOLIC/SYST- cirrhosis, hepatorenal syndrome
DRUGS/TOXINS- NSAIDs, ACE inhibitors, cyclosporin "

Front 54

Causes of postrenal ARF

Back 54

"MCC = urethral obstruction 2/2 BPH

METABOLIC/SYST- obstruction of solitary kidney, nephrolithiasis
NEOPLASTIC- BPH, obstructing neoplasm

Front 55

Diagnostic approaches in ARF

Back 55

"1. Baseline Cr
2. Classify. Volume depletion/CHF = prerenal, allergic rxn = interstitial; suprapubic mass/bph/bladder dysfxn = postrenal
3. med review
4. u/a
5. urine chem
6. renal u/s"

Front 56

Pathophys of Prerenal ARF

Back 56

"Decreased renal blood flow --> lowered GFR --> decreased clearance of metabolites

Normal renal parenchyma --> conserve Na and H2O"
Clinical features of prerenal ARF

Front 57

Causes of intrinsic renal failure

Back 57

"VASCULAR-- ischemia (tubular dz), vascular dz (renal artery occlusion, TTP, HUS)
METABOLIC/SYSTEMIC-- glomerular dz (goodpasture's, WG, poststrep, lupus)
DRUGS/TOXINS-- allergic rxn to drugs"

Front 58

Lab findings of intrinsic ARF

Back 58

"BUN:Cr <20:1 but still elevated
UNa >40, FeNA >2-3%
UOsm <350
Urine:plasma Cr <20:1"

Front 59

When is FeNA most useful diagnostically?

Back 59

If oliguria is present

Front 60

3 basic tests for postrenal failure ARF

Back 60

"1. physical exam (palpate bladder)
2. U/S
3. catheter"

Front 61

Diagnostic tests for ARF

Back 61

"1. Blood tests (Chem 7, albumin, CBC with diff)
2. UA
3. UChem
4. Renal u/s unless obviously not postrenal

If suspect infection --> UCx
If renal u/s shows abnormality --> CT
Suspect acute GN/acute allergic --> Renal bx

Front 62

What does urine NA most depend on?

Back 62

dietary intake

Front 63

Complications of ARF

Back 63

"1. PULMONARY EDEMA
2.
METABOLIC -- hyperkalemia, metabolic acidosis w increased AG, hypocalcemia, hyponatremia, hyperphosphatemia, hyperuricemia
3. UREMIA
4. INFECTION"

Front 64

"GFR values for:
1. Mild CRF
2. Moderate CRF
3. Severe CRF
4. ESRD"

Back 64

"1. Mild CRF 70-120
2. Moderate CRF 30-70
3. Severe CRF <30
4. ESRD <10"

Front 65

Treatment of ARF

Back 65

"1. correct fluids, Bp 120-140/80-90
2. dialysis if symptomatic uremia, intractable acdemia, hyperkalemia, volume overload

PRERENAL- treat underlying, NS if no edema, stop offending meds, if unstable: Swan-Ganz
INTRINSIC-- if ATN- supportive; t/o furosemide if oliguric
POSTRENAL-- bladder catheter, uro consult?"

Front 66

What is CRF?

Back 66

Irreversible, progressive reduction in GFR and other renal fxns occuring over a pd of months to years

Front 67

Top 3 causes of CRF

Back 67

"1. DM (30%)
2. HTN (25%)
3. Chronic GN (15%)"

Front 68

Clinical features of CRF

Back 68

"CV: HTN, CHF
Neuro: asterixis, weakness, hyperreflexia, restless legs, hypocalcemia (lethargy, confusion, tetany)
Heme: normocytic normochromic anemia
End: hyperphos, hypocalc (long standing --> hypercalc), renal osteodystrophy, calciphylaxis (vascular calcifications --> necrotic skin lesions); low testosterone, amenorrhea, infertility, hyperprolactinemia; pruritis
Fluid: pulm edema, hyperk, hyperMg, hyperphos, met acid

Uremic sx: pericarditis, N, V, anorexia, seizures, platelet dysfxn, infections"

Front 69

What meds should be avoided in ARF?

Back 69

NSAIDs, aminoglycosides, radiocontrast agents, ACE inhibitors

Front 70

What meds should be avoided in CRF?

Back 70

antiplatelet agents

Front 71

"Rx of CRF:
1. Diet
2. BP
3. Meds given
4. Only cure?

If:
1. diabetes
2. hyperphosphatemia
3. acidosis
4. anemia
5. pulm edema
6. pruritis"

Back 71

"Rx of CRF:

1. Diet = low protein, Na, K, phosphate, Mg
2. BP = ACE inhibitors
3. Meds given = ACE inhibitors, long-term Ca/Vit D
4. Only cure = transplant

If:
1. diabetes = glycemic ctl
2. hyperphosphatemia = Ca citrate
3. acidosis = bicarb
4. anemia = erythropoietin
5. pulm edema = diuresis --> dialysis
6. pruritis = capsaicin cream or cholestyramine + UV light"

Front 72

"When do you dialyze a pt with:

1. CRF?
2. ARF?
3. No renal failure?"

Back 72

"1. CRF: bridge to transplant

2. ARF:
-Signs of uremia (N, V, change in MS, pericarditis)
-Pulm edema
-Severe met acidosis
-Severe, refractory electrolyte disturbance

3. No renal failure: OD of meds
-salicylic acid
-lithium
-ethylene glycol
-Mg-containing laxatives"