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40 Cards in this Set
- Front
- Back
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what can cause elevated BUN?
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ARF
catabolic drugs (steroids) GI/soft tissue bleeding dietary protein intake (nl 7-21) |
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what can cause elevated Cr?
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muscle breakdown
drugs (ACEIs, ARBs) (nl 0.5-1.2) |
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what drugs can precipitate prerenal failure?
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NSAIDs
ACEIs cyclosporin (immunosuppressant) *in pts with decreased renal perfusion |
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what are the lab findings of prerenal failure? (6)
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oliguria
bland urine sediment incr BUN/Cr ratio (>20:1) incr urine/plasma Cr ratio (>40:1) incr urine osmolality (>500 mOsm/kg) decr urine Na (<20) |
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what substances are known to cause nephrotoxic ARF? (8)
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antibiotics (aminoglycosides "-thromycins")
radiocontrast NSAIDs poisons myoglobinuria hemoglobinuria chemotherapeutic drugs (cisplatin) multiple myloma (kappa/gamma light chains) |
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what are the laboratory findings in intrinsic renal failure? (4)
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decr BUN/Cr ratio (<20:1)
decr urine-plasma Cr ratio (<20:1) incr urine Na (>40 mEq/L) decr urine osmolality (<350 mOsm/kg) |
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what are the (3) potential basic causes of ARF?
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prerenal (40-80%)
renal (10-30%) postrenal (5-15%) |
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what are the (3) major prerenal causes of ARF?
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volume loss/sequestration
decr cardiac output hypotension |
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what are the (4) major renal causes of ARF?
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glomerulonephritis
vascular disorder - small vessel - large vessel interstitial disorder acute tubular necrosis |
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what are the (2) major postrenal causes of ARF?
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intrarenal
- crystals - proteins extrarenal - pelvis/ureter - bladder/urethra |
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what are the (4) types of urinary casts and what does each imply?
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hyaline casts - (prerenal failure)
RBC casts - (glomerular disease) WBC casts - (renal parenchymal inflamm) fatty casts - (nephrotic syndrome) |
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what is FENa and what do the different values imply?
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compares urine/plasma electrolytes
= (U[Na]/P[Na]/U[Cr]/P[Cr]) x 100 <1% suggests prerenal failure 2-3% suggests acute tubular necrosis (most useful if oliguria is present) |
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what is the renal failure index and what do the different values imply?
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= U[Na] / (U[Cr]/P[Cr]) x 100
<1% suggests prerenal failure >1% suggests acute tubular necrosis |
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what are the (2) mc causes of mortal complications in the early phase of ARF?
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hyperkalemic cardiac arrest
pulmonary edema |
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what are the different degrees of CRF and their assd GFR values?
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mild (70-120 mL/min)
moderate (30-70 mL/min) severe (<30 mL/min) ESRD (<10 mL/min) |
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what are the characteristic fluid/electrolyte abnormalities of CRF? (5)
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hypervolemia (look for pulmonary edema)
hyperkalemia (decr urinary secretion) hypermagnesemia (decr urinary loss) hyperphosphatemia (decr renal clearance) metabolic acidosis |
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how do you correct the hyperphosphatemia assd with CRF?
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calcium citrate
(phosphate binder) |
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what are (3) common symptoms of uremia?
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N/V
decr mental status (lethargy, seizure) pericarditis (dialysis is indicated) |
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what are the absolute indications for dialysis?
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"AEIOU"
(A)cidosis - metabolic (E)lectrolytes - hyperkalemia (I)ntoxication (O)verload - hypervolemia (U)remia - clinical symptoms |
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what are (5) dialyzable substances (toxins)?
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salicylic acid
lithium ethylene glycol magnesium-containing laxatives methanol |
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what's the definition of proteinuria?
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>150 mg protein/24 hrs
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what are the (5) key features of nephrotic syndrome?
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proteinuria (>3.5 g/24hr)
hypoalbuminemia (-> edema) hyperlipidemia (secondary to albumin synthesis) hypercoagulable (anticoagulant loss - antithrombin III) incr infections (immunoglobulin loss) |
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what are the mcc's of primary glomerular disease leading to nephrotic syndrome?
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membranous nephropathy (50%)
FSGS (25%) membranoproliferative GN (15%) minimal change disease (75% children) |
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what is the definition of hematuria?
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>3 erythrocytes/HPF on urinalysis
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what are the typical features of nephritic syndrome? (3)
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hematuria
HTN azotemia |
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what (2) diseases are associated with minimal change disease?
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Hodgkin's disease
non-Hodgkin's lymphoma (mc in children) |
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describe the changes seen on microscopy in minimal change disease
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no abnormalities (light microscopy)
fusion of foot process (electron microscopy) |
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how do you treat minimal change disease?
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steroids for 4-8 wks
(excellent prognosis) |
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what is the most common cause of glomerular hematuria?
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IgA nephropathy
(Berger's disease) |
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what are the histological findings in IgA nephropathy (Berger's disease)?
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mesangial deposition of IgA and C3
(electron microscopy) |
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what are the typical features of hereditary nephritis (Alport's syndrome)?
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hematuria
pyuria proteinuria high-frequency hearing loss (x-linked or autosomal dominant) |
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what usually causes membranoproliferative glomerulonephritis?
association? |
hepatitis C infection
(also hepB, syphilis and lupus) associated with cryoglobinemia |
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what is the mcc of nephritic syndrome?
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poststreptococcal GN
(group A B-hemolytic streptococcus) |
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what unique product is found elevated in poststreptococcal GN?
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antistreptolysin-O
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what is the classic triad seen in Goodpasture's syndrome?
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"PPI"
proliferative GN (crescentic) pulmonary hemorrhage IgG anti-glomerular basement membrane Ab (lung disease precedes kidney disease) |
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what are (4) causes of a falsely low FeNa?
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Acute glomerulonephritis
Rhabdomyolysis Contrast-induced nephropathy Acute obstruction |
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what is the definition of acute renal failure?
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a rapid decline in renal function with an incr in serum creatinine:
- relative increase of 50% - absolute increase of 0.5-1.0 mg/dL |
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what is the definition of pyuria?
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presence of 4 or more neutrophils per HPF of urine
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what does metabolic acidosis do to potassium levels?
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acidosis causes the potassium to move out of the cells and thus increases the serum potassium
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what should you think if dipstick is positive for blood, but urinalysis does not reveal RBCs?
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hemoglobinuria ro myoglobinuria is likely present
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