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Elaina: last minute renal > renal failure > Flashcards

renal failure Flashcards

1
Q

what will the BUN/creatinine ratio be in prerenal vs. intrarenal failure?

A

BUN/creatinine ratio 40:1 in prerenal

BUN/creatinine ratio less than 20:1 in intrinsic renal

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2
Q

why is inulin a good test to measure GFR?

A

it is 100 percent filtered and excreted, NOT reabsorbed

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3
Q

what must we make sure to adjust when calculating GFR with the cockroft-gault equation?

A

with women, multiply by .85 to accommodate for smaller muscle mass

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4
Q

what is the term for azotemia with symptoms?

A

uremia

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5
Q

95 percent of patients with kidney failure will also have what issue?

A

BP problems

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6
Q

what type of kidney failure does multiple myeloma cause? why?

A

prerenal; hyperviscosity causes renal hypoperfusion

look for bence jones protein in urine!

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7
Q

burns may cause what type of renal failure?

A

prerenal due to third spacing

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8
Q

why may NSAIDS and epinephrine cause prerenal failure?

A

they cause vasoconstriction and decreased perfusion to kidneys

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9
Q

ACE inhibitors and antihypertensives will cause what type of kidney failure?

A

prerenal due to lower BP

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10
Q

symptoms of prerenal failure?

A

low urinary output
thirst
dizziness, hypotension, orthostasis
tachycardia

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11
Q

what will urinalysis of prerenal failure show?

A

HYALINE CASTS
low urine sodium, concentrated urine! our kidneys are still capable of working hard to hold onto sodium and increase volume in our body

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12
Q

what is the most common cause in intrinsic renal failure?

A

prerenal failure!

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13
Q

common causes of acute tubular necrosis?

A

nephrotoxins:

1) radiocontrast
2) aminoglycosides (gentamycin, tobramycin)
3) cyclosporin (post organ transplant)
4) chemotherapy (cisplatin)
5) solvents (ethylene glycol)

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14
Q

what is radiocontrast induced nephropathy?

A

intrarenal vasoconstriction resulting in acute tubular necrosis 24-48 hours post exposure

age is biggest risk factor!

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15
Q

what are common signs of intrinsic renal failure?

A

often NONE! history of exposure

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16
Q

muddy brown casts in the urine make you think of what?

A

ischemic and nephrotoxic intrinsic renal failure

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17
Q

red cell casts in the urine make you think what?

A

acute glomerular injury or nephritis

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18
Q

white cell casts in the urine make you think what?

A

interstitial nephritis

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19
Q

eosinophilic casts in the urine make you think what?

A

allergic nephritis

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20
Q

how do we treat allergic interstitial nephritis and vasculitis?

A

glucocorticoids

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21
Q

two classifications of glomerular diseases?

A

1) primary (those affecting kidney)

2) secondary (diffuse or systemic diseases that affect glomerulus in addition to other organ systems)

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22
Q

what is common amongst all types of intrinsic renal diseases?

A

1) oliguria (less than 400 cc/24 hrs)

2) progressive azotemia

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23
Q

most common signs of acute nephritis and rapid progressive glomerulonephritis?

A

inflammation, oliguria, low GFR, HYPERTENSION, edema, casts in urine, hematuria, SUB NEPHROTIC RANGE proteinuria (less than 3.5g/24 hrs)

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24
Q

what is pathognomonic for rapid progressive glomerulonephritis/?

A

“Crescentic” moon shaped lesion in bowman’s space

25
Q

what is the most common cause of nephritis and RPGN?

A

immune complex nephropathies

specifically; post-streptococcal GN!

26
Q

what are signs of post-streptococcal glomerulonephritis?

A

10 days after strep throat:

1) nephritis
2) hematuria
3) headache, N/V
4) back pain (they are inflamed)
5) urine sediment
6) low complement levels
7) circulating levels of antistreptolysin antibodies (ASO)

27
Q

how do we treat post-streptococcal GN?

A

treat infection!
control HTN
diuretics if edema

28
Q

anti-GBM disease causes what?

A

anti-glomerular basement membrane disease; antibodies against type 4 collagen cause rapid progressive glomerular nephritis (RPGN)

treat with immunosuppressants post biopsy (see IgG)

29
Q

what are two common treatments for nephritic syndrome?

A

steroids

cyclophosphamide (if patient has deposition of antibody, you can suppress the immune system)

30
Q

wegener’s granulomatosis causes what type of intrinsic renal disease?

A

pauci immune glomerulonephritis (Ig will not be present)

test for ANCA, it will be positive

31
Q

when you see over 3.5 grams of protein in the urine over 24 hours, what are we thinking?

A

nephrotic syndrome

the glomerular basement membrane leaks protein that overwhelms ability to absorb

32
Q

key features of nephrotic syndrome

A

1) low serum albumin; and thus edema
2) high cholesterol (increased hepatic synthesis)
3) lipiduria (increased hepatic synthesis)
4) hypercoagulability (due to altered anti-thrombin III, C or S)

33
Q

which kidney problem increases your risk for DVT?

A

nephrotic syndrome

34
Q

common causes of nephrotic syndrome?

A

1) membranous glomerulopathy (think GBM without inflammation)
2) diabetes mellitus nephropathy
3) amyloidosis

this powerpoint is a mess. im trying

35
Q

treatment of nephrotic syndrome?

A

1) treat underlying cause
2) treat edema with diuretics
3) statin for lipid lowering
4) anti-coagulation if hypercoaguable
5) dietary protein restriction
6) ACE inhibitor (decreases glomerular pressure & proteinuria)

36
Q

any diabetic with high BP and proteinuria should be on what drug?

A

ace inhibitor

37
Q

what is the most common glomerulopathy worldwide?

A

IgA nephropathy (Berger’s disease)

most common cause of benign hematuria; they get gross hematuria post infection

38
Q

how do we diagnose IgA nephropathy (Berger’s disease)?

A

IgA on immunofluorescence
blood in the urine
history of infection

39
Q

alport’s syndrome is a hereditary nephritis composed of what features?

A

deafness, eye problems, hematuria

40
Q

what is the most common cause of end stage renal disease?

A

diabetic nephropathy

41
Q

mechanisms behind diabetic nephropathy?

A

INTRAGLOMERULAR HYPERTENSION, hyperglycemia, glomerular hypertrophy

there is an injured filtration barrier with thickened GBM, the pores are bigger & the electrical charge barrier favors passage of protein

42
Q

how can we screen for diabetic nephropathy?

A

have every diabetic pee in a cup once a year to look for protein in urine!

43
Q

polyarteritis nodosa may cause vasculitis in the kidneys, what are the typical features?

A

HTN
urine sediment
renal insufficiency
negative ANCA

TX: gluococorticoids

44
Q

what drugs are responsible for drug induced nephropathies?

A

1) NSAIDS
2) gold?
3) penicillinamine
4) IV heroin

45
Q

what are some infectious causes of glomerular disease?

A

hepatitis B, C, endocarditis, endovascular infections (infected catheters), syphilis

46
Q

what are the three types of tubular kidney disorders?

A

1) polycystic kidney disease
2) medullary sponge kidney
3) renal tubular acidosis

47
Q

what makes up 10 percent of ESRD patients?

A

polycystic kidney disease (autosomal dominant more common)

48
Q

symptoms of PKD?

A

1) flank pain
2) high infection risk
3) STONE FORMATION!
4) HTN
5) progressive renal failure

49
Q

how do we treat polycystic kidney disease?

A

control hypertension, treat UTIs and infections aggressively

may eventually need dialysis

50
Q

what is medullary sponge kidney (tubular disease) characterized by?

A

1) sporadic or heritable
2) cystic dilation of collecting ducts
3) kidney stones, infections, hematuria

51
Q

if you have acidosis with a LOW CO2 and a HIGH CHLORIDE, what should you think?

A

renal tubular acidosis!

these patients will be hyperchloremic!

52
Q

what is renal tubular acidosis type 1 usually associated with?

A

lupus or systemic disorder

53
Q

what is the most common type of renal tubular acidosis?

A

type 4!

“hyperchloremic distal RTA”

54
Q

what are common features of RTA type 4?

A

1) hyperchloremic, hyperkalemic acidosis

2) they will have high chloride and high potassium in blood

55
Q

what may cause renal tubular acidosis type 4?

A

1) insufficient aldosterone production (so you hold onto K, CL)
2) can be induced by NSAIDS, ACE inhibitors, other meds
3) also seen in diabetic nephropathy

56
Q

how do we treat renal tubular acidosis type 4?

A

1) low potassium diet! (the problem is they are hyperkalemic!)
2) stop any offending meds (spironolactone, ACE)
3) mineralcorticoids

57
Q

what is the most common type of glomerular disease?

A

IgA nephropathy

others: hereditary nephritis, thin basement membrane disease

58
Q

key findings with glomerulonephritis?

A

1) hematuria
2) red cell casts
3) proteinuria
4) usually need biopsy to confirm

Elaina: last minute renal (2 decks)

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