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24 Cards in this Set
- Front
- Back
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What is the equation for fractional excretion of Na normalized to overall GFR?
In what situation is it useful? |
FE(Na) = 100% x (Una x Scr / Sna x Ucr)
oliguric kidney injury, can help distinguish pre-renal azotemia from acute tubular injury. <1% = pre renal >1% = acute tubular injury |
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Decompensated Heart or liver failure can lead to which type of pre-renal injury?
How about diarrhea, hemorrhage, etc.? |
\Effective circulating volume
True volume depletion |
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Low urine sodium, low Fractional excretion, high BUN/Creat suggests that the kidney thinks the volume of the body is increase/decreased?
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decreased.
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What is abdominal compartment syndrome?
How is the dx made? Tx? |
^intraabdominal pressure --> compress renal arteries --> prevent perfusion = pre-renal injury
measure hydrostatic pressure w/i the bladder. pressure relief via laparotomy |
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What should you do to tx true volume depletion pre-renal sx?
decreased effect Circulatory vol? |
expand BV w/ saline infusion
attempt to tx underlying condition. |
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What can bladder cath rule out in suspected post-renal azotemia?
What's the best way to try to dx post-renal azotemia? Are pts with post-renal azotemia oliguric? |
lower tract obstruction
Renal US Often, but not always. Can be polyuric, remember why. |
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What is post-obstructive diuresis? What are the two partial causes?
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polyuria following relief of obstruction
- appropiate clearence now that obstruction is gone - transient dysfunction of distal nephron with inability to concentrate the urine. |
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Do pts with post-renal azotemia recover?
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complete if brief, irreversible injury can develop if longer though.
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The high end of mortality seen with intra-renal azotemia acquired during hospitalization is 50%.
T/F? |
T
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What are some typical lab findings (both positive and negative) in ATN cases?
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- acute rise in BUN or creatinine w/ or w/o oliguria.
- "Classic" sediment fx are "muddy brown" granular casts - Urine Na and FE are typically *NOT* low. |
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The "cycle of differentiation" seen in with ATInjury (ATN):
loss of polarity / brush border --> cell apoptosis --> sloughing off --> spreading and thinning --> reproliferation --> etc. what does this imply re: the rate of recovery for pts with ATN even after you remove the cause? |
it will take awhile.
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Is the ability of the kidney to get the salt out the excreted urine an active or passive process?
What does this mean re: Na lvls in ATN? |
active; thus in the case of ATN sodium lvls will not be low in urine.
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What is the key to avoiding radiocontrast nephrotoxicity?
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Volume expansion, preferably w/ bicarb containing solutions.
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Why is large scale death of muscle cells --> myoglobin release a problem?
What is the classic clue for rhabdomyalsis? |
MW of myoglobin is below the threshold for glomerular filtration --> efficiently filtered and appears in the lumen
strong heme positive urine on dipstick with few RBCs. |
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What is the key tx to limit rhabdomyolysis nephrotoxicity?
What is the pt remains oliguric after volume expansion? Do most pts recover? |
Expansion of ECFV w/ normal saline.
rate of fluid admin must be slowed. yes, but dialysis dependence may last up to 6 weeks. |
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Pt presents with acute azotemia w/ peripheral eosinophilia, fever, and rash. Urine sed shows white cell casts, hematuria, and low grade proteinuria. What might you think?
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acute interstitial nephririts (Intrarenal Acute kidney injury)
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What drugs can cause intrarenal acute kidney injury? What is unique about the type caused by NSAIDs?
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Virtually any drug
typically no rash, rever, or eosinophilia, and proteinuria may be in nephrotic range. |
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Treatment for TTP?
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plasma exchange transfusion.
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What is the name we give to a decline in GFR and profound oliguria w/o volumen depletion or nephrotoxic injury?
- does the kidney hold onto Na in this state? |
when it's in pts with advanced, decompensated liver dz, it's called hepatorenal syndrome.
- yes, profoundly. |
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Pt presents with ascites and edema, and oliguria. Urinalysis and urine sediment are normal. Likely dx?
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Hepatorenal sx.
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When approaching the pt with acute renal injury clinically, should we have a high or low threshold for placing a bladder catheter?
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low.
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If urine contains the following, think what?
1. urine sediment benign, urine volumes low with low urine sodium and fractional excretion 2. dysmorphic RBCs and/or red cell casts 3. thrombocytopenia and schistocytes 4. muddy brown casts w/ high urine sodium / FE+ 5. white cells & WBC casts 6. Abundant crystals Are these fx specific? |
1. pre renal azotemia
2. glomerulonephritis, atheroemboli 3. TMA (TTP) or malignant HTN 4. acute tubular injury 5. interstitial nephritis 6. Intratubular obstruction No! often non-specific! |
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SPEP and UPEP are tests run if you are suspicious of...
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multiple myeloma
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What are some complications of dialysis?
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bleeding
infection CV instability |
