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32 Cards in this Set

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  • Back
describe the general process in pre-renal, intrinsic, and post renal failure
pre: decreased perfusion

intrinsic: pathologic changes within the kidney

post: obstruction to urinary outflow
most common cause of intrinsic renal failure?
ischemic ARF

traditionally known as acute tubular necrosis and now called acute kidney injury
what type of renal failure does this describe:

thirst, orthostatic light-headedness, and decreasing urine output
cardiac arrest, severe sepsis, or other causes of systemic hypotension lead to?
Ischemic acute kidney injury
flank pain and hematuria likely is what kind of nephropathy?
crystal induced

aka nephrolithiasis

papillary necrosis can present this way too
rhabdomyolisis (myalgais, recent coma, seizures, recreational intoxication, excessive exercise) and hemolysis (recent blood transfusion) can have what type of ARF?
pigment induced
darkening urine and edema with or without constitutional symptoms such as fever, malaise and rash should raise suspicion for?
acute glomerulonephritis

preceded by pharyngitis or cutaneous infection
fever, arthralgia, and rash are common with what?
acute interstitial nephritis
Cough, dyspnea, hemopytsis can raise the suspicion for what renal syndromes?


what GFR typically indicates kidney failure?
give a dd of prerenal failure
Hypovolemia (GI, diruetics, burns)

Hypotension (septic, hemorrhage, decreased CO)

Renal artery and small vessel dz (embolism, thrombosis)
Significant permanent loss of renal function occurs over the course of how many days in the setting of complete obstruction?

10-14 days

the risk of permanent RF increases significantly if obstruction is complicated by UTI
Most common cause of in-hospital ARF?

Radiocontrast-induced nephropathy

IV contrast
elevated uric acid levels causes crystal induced nephropathy...this can be caused by medications including?
acyclovir, sulfonamides, indinavir, triamterene
ARF in the setting of ACE inhibitor initiation should prompt consideration of?
bilateral renal artery stenosis

maintenance of GFR is depended on postglomerular arteriole vasoconstriction
how do NSAIDs lead to ARF?
decreased prostaglandins

results in decreased GFR and renal blood flow
what class of abx can cause direct tubular toxicity?
In patients with no renal function (GFR=0) serum Cr levels increase how?
1--3 mg/dL a day
In the setting of prerenal failure, the serum ratio of BUN to Cr is?
typically >20
what renal lab can be increased in the setting of protein loading, GI bleed, or trauma?
UNa/PNa / UCr/Pcr

Give the urine osmolality and FeNa% for the following:

Prerenal azotemia
Osmol >500

FeNa < 1%
Give the urine osmolality and FeNa% for the following:

Renal azotemia (tubular injury, ischemia, nephrotoxins)
Osmol < 350

FeNa >1%
Give the urine osmolality and FeNa% for the following:

Postrenal azotemia
Osmol >500

FeNa >1%
Osmol >500

FeNa >1%

general cause of ARF?
Post renal
Osmol >500

FeNa < 1%

general cause of ARF?
Pre renal
Osmol < 350

FeNa >1%

general cause of ARF?
intrinsic renal failure
in intermittent or partial obstruction, hydronephrosis may NOT be present and it may even be ABSENT in complete obstruction in the setting of what problem?
retroperitoneal fibrosis
Test of choice for urologic imaging in the setting of ARF?
Renal US

has 90% sensitivity and specificity for detecting hydronophrosis due to mechanical obstruction
Indications for emergent dialysis?

Acidosis (resistant to NaHCO3)

Electrolytes (hyper K>6.5, Na <115 or >165)

Ingestion/Intox (lithium, aspirin, mehanol, ethylene glycol, theophylline)


Uremia (pericarditis, encephalopathy, asterixis, seizure, bleeding)
Radiocontrast induced nephropathy begins to be significant concern when GFR is ?

Gadolinium based contrast for MRI should not be given if GFR is < __?__

due to the risk of what?


risk of nephrogenic systemic fibrosis