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58 Cards in this Set
- Front
- Back
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arf is a decrease in ---- over hours to days and associated w/ ------- of waste products including Cr and urea
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GFR
accumulation |
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arf is a decrease in GFR over hours to days and associated w/ accumulation of waste products including --- and ----
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Cr
urea |
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arf is an abrupt increase of serum ----- or abrupt decrease of ------
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Cr >/= 50%
GFR >/= 25% |
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arf is an abrupt ------ of serum Cr >/= 50% or abrupt ----- of GRF >/= 25%
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increase
decrease |
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arf is reductionof urinary output for more than or equal to -- hrs
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6
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risk factors for arf
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> 60 yrs
preexisting renal, liver, cv/vascular, lung disease infection hemorrhage vol depletion dm male nephrotoxins |
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name some nephrotoxins
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contrast media
NSAIDs chemotherapy ACEI ARB antiviral meds cyclosporine/tacrolimus ATBs |
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complications in cv of ARF include
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CHR
elevated/decreased bp arrhythmias |
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complications in electrolytes in arf include
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hyperK
hyperP hyperMg hypo/hyperNa metabolic acidosis |
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complications in hematology in ARF include
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hemorrhage (GI)
anemia |
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most common cause of death in arf
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infection
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---- syndrome is another complication of arf
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uremic
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cv s/s of uremic syndr
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pericarditis
pericardial effusion tamponade |
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gi s/s of uremic syndr
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anorexia
nausea vomiting ileus |
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pshyc s/s of uremic synd
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lethargy
confusion stupor coma agitation seizures |
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in atn there increased/decrased serum Cr, increased/decreased urine output
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increased
decreased |
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increased serum Cr is a product of creatine from the ----
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muscle
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t/f
in atn urine is mainly filtered |
t
and minimally secreted |
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in ATN GFR =
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Clcr
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clinical phases of ATN
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polyuria
oliguria maintenance/diuresis recovery |
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urine vol in oliguric
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< 500 ml/day
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oliguric occurs over ---- days
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1-2 days
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anuria vol
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< 50ml/day
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nonoligiuria
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> 500 ml/day
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oliguria has a better prognonsis
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f
nonoliguria has a better prognosis |
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when does maintenance occur
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over several days to weeks
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what's maintenance/diuretic characterized by
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stable Cr/UOP
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what's maintenance/diuretic phase complicated by
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administration of diuretic
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urine vol of maintenance/diuretic
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1-10 L/day
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in recovery phase there's regeneration of renal --- cells
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tubular
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t/f
recovery may include marked diuresis |
t
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when does recovery begin
how long can it take |
begins 2-3 weeks after last renal insult
may take days to months |
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which phase should be avoided
why |
recovery
cuz txing difficult |
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which arf is characterized by decreased GFR and glomerular hydrostatic pressure
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functional arf
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t/f
there's structural damage in functional arf |
f
no structural damage |
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common cause of functional arf
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ACEI/ARB
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what's pre-renal characterized by
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renal parenchymal hypoperfusion w/ or w/out systemic hypotension
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pre-renal arf
BUN/Cr Na FE |
BUN/Cr >20
Na< 20meq/L FEna < 1% |
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what's prerenal associated w/
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hemorrhage
dehydration HF cirrhosis drugs RAS |
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compensatory response in pre-renal arf
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SNS
RAAS afferent arteriolar vasodilation efferent arteriolar vasoconstriction |
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pre-renal needs prompt adminstration of --- and/or d/c of offending aginets
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fluids
except: HF, Cirrhosis, RAS |
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which arf has structural damage directly to kidney itselft
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intrinsic ARF
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in intrinsic arf
Na? FEna |
Na (U) > 40 meq/L
FE na > 2 % |
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meds that can cause intrinsic arf
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diuretics
cyclosporine tacrolimus NSAIDs amphotericin B ATBs ACEI ARB contrast dye metformin antivirals adenovir acyclovir |
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what should be used instead of NSAIDs
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actaminophen
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limit use/slow infusion of -------
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amphoterecin B
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what formulation of amphoterecin should be used
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liposomal formulation
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what should be used instead of ampho B
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fluconazole or itraconazole
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t/f
to prevent there should be close monitoring of rf |
t
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hydration should be given before -----
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radiocontrast dye
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what's better than Na in hydration
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D5NaHCO3
might not be tolerated by CHF and cirrhosis |
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what should be d/ced before radiocontrast dye
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metformin
one day before |
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prevention meds that are not best choices
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diuretics
thophylline low dose dopamine fenoldapam n-acetylcycteine |
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fluid restriction in ---/---- unless hypovolemic
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anuria
oliguria |
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vol control
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fluid restriction
remove obstruction electrolyte management renal replacement tx: hemodialysis, peritoneal dialysis |
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pharm tx
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d/c nephrotoxin
judicious use of diuretics: continous perfusion preferred/ combo diuretics dopamine |
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dose of da
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dopaminergic agonist 0.5-3 ug/kg/min
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t/f
prevention vs rx |
t
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