Renal Failure

Question 1

Two patterns of the loss of kidney filtration

Answer 1

Acute

Chronic

Question 2

Stages of Chronic Kidney Disease

Answer 2

1 - GFR 90%+
2 - GFR 60-89%
3 - GFR 30-59%
4 - GFR 15 - 29%
5 - GFR <15%

Question 3

Diagnosis of Chronic Kidney Disease

Answer 3

Albuminuria
Imaging shows kidney structural changes
Electrolyte disturbances due to tubular dysfunction

GFR <60

Question 4

Albuminuria Categories

Answer 4

A1 - <30
A2 - 30-300
A3 - >300

Question 5

Creatinine Staging of Kidney Injury

Answer 5

1 - Cr 1.5 to 1.9 baseline of >0.3 increase
2 - 2.0 - 2.9 baseline
3 - 3x baseline (or more than 4.0)

These must also occur with low urine output

Question 6

Prerenal v. Filtration v. Postrenal AKI

Answer 6

Prerenal - perfusion disruption (blood loss, etc.)

Filtration - Pathology of glomeruli or tubules

Postrenal - obstruction to rnal pelvis, ureters, bladder, urethrea

Question 7

Symptoms of Renal Failure or Injury

Answer 7

Decreased GFR
Increased creatinine
Albumin in urine

Clinical symptoms are often vague or common with other diseases

Question 8

Most common cause of AKI

Answer 8

Hospitalization with reduced perfusion and exposure to nephrotoxic medications

Question 9

Stage 4 / 5 CKD

Answer 9

Must refer to nephrology! All CKD should be referred, but 4/5 will required dialysis

Question 10

CKD Complications

Answer 10

Atherosclerosis
Heart failure
HTN
Pulmonary edema
Pericarditis
N/V
Anorexia
electrolyte issues
Anemia (Anemia of chronic disease)

Question 11

Acute Renal Problem Symptoms

Answer 11

Oliguria (<400ml per day)
Edema
Confusion
Anorexia

Question 12

Management of CKD

Answer 12

BP control is top priority (ACE-I)
Diet - low protein
Limit nephrotoxic drugs
Smoking cessation
Lipid Control