RENAL-Kidney Failure Flashcards
Pt shows the following, what is most likely DX? What other keys to DDX Rise in serum creatinine Decreased GFR oliguria Active urine sediment Casts Na+ urine cont. changes.
Acute Renal Failure
Duration
Acute - hours to days
Rapidly progressing - weeks to months
Chronic - progressive, months/years
Acute insult on chronic failure
Compare UA, creatinine Sx duration
Hospitalized pt’s close monitoring - daily
Monitor events - hypotension, drugs, contrast
This PT present with..what are the at risk for
Hypotension or hyopvolemia (renal perfusion dfx)
DM, HTN: (out of control l/t ERSD)
Trauma- drugs, contrast, car accident
RA
Vascular Dz
Intrinsic Kidney Disease
AKI, ARF
What test will identify Kidney Problems - Markers?
#1-UA micro BMP 24hr urine Polyuria: >2500ml Oliguria: <500ml Anuria: <100ml (body conserve or AKI) Dialysis
Specific gravity
dipstick/UA: 1.005-1.020
What are normal and ABN Serum Cr on BMP
N-0.6-1.2mg/dl, Skeletal muscle, diet
Inc. = glomerular/tubular injury/Dz, not etiology of problem
GFR ususally reduced by ~50% prior to INc. SCR
Normal- does not equal normal GFR
What is on BMP?
Na/K Cl/CO2 BUN/CR Glucose Cystatin C w/ creatinine-rare, early detect
Pt has GI bleedinng and dehyrdated. What determines etiology of AKI?
BUN to Creatinine Ratio
N- 5-20mg/dl
Elevated in: dehydration renal dz, GI bleeding
What determines CKD? What other markers will be needed?
*Urine Microalbumin-Albumin to creatinine ratio
GFR - (120mL/min)
Dec. implies renal Dz
Progression = CKI
Increase = improvement
Pt has the following Wk 1
ASX
Feel off- weak, fatigue, N, edema, Rare Flank
Urinary sx
decreased GFR (20-50%)
Increased creatinine, renal “insufficiency”
Azotemia
The following week the Pt has the following. Creatinine high, GFR 5-10% Lethargy, Confusion, Seizures Edema Pruitius -no rash N/V-anorexia Cramps, neuropain Anemic Metabolic Acidosis-RR
Uremia
Severe azotemia, renal “failure”
Pt has the following…What stage is present?
Medicatin the l/t hypoperfusion, low resistance and Shock.
Volume depletion - intravascular.Dehydration, blood loss (trauma, GI) burns, hypoalbuminemia
MI, CHF, arrhythmias, PE, PNA,etc. Decreased cardiac output
UA/CMP SrCR inc. SpGr- >1.020 BUN to Creatinine Ratio =/>20/1-Glomeruli, tubules are intact Osmol urine- >500 Na <20 FeNA <1% Bland Oliguria
Prerenal
MC
Acute
“Bland” sediment (no casts)
Reversible, if treated promptly
Acute prerenal on chronic renal failure
What are 3 Intrarenal/Intrinsic Causes?
Glomerular
Tubular
Vascular
Pt has h/o urine sediment*, URI, RA, Mom Hx of IgA nephropathy, DM, etc
BUN to Creatinine ratio also =>20/1 SpGr- >1.020, 1.000 BUN to Creatinine Ratio =/>20/1-Glomeruli, tubules are intact Osmol urine- >500 Na <20 FeNA <1% ***Multiple CAST-RBC Variable
AGN: Acute glomerulonephritis
Intrarenal Cause - Glomerular dz.
Focal: mild AKI – dysmorphic RBC’s, red cell casts (nephritic), mild proteinuria
Diffuse: signif AKI(SCr 4.0) – nephritic w/ heavy proteinuria (nephrotic), HTN, edema
Hospital Elder Pt d/t sepsis from car accident w/ burns, rhabdo, heat stroke, and snake bite in dessert.
Tx not resolving with w/ volume tx d/t Dx of Prenal AKI. BUN/Cr <20/1 (10/1)
Na + urine inc. >2%
Muddy brown, granual, epthtieal casts
BUN to Creatinine ratio also <20/1 SpGr- < 1.000, brown Osmol urine-300 Na >20 FENa high ***Active CAst- WBC, Ftth, Muddy brown Oliguria/Anuria
What is dx? why is volume not helping?
ATN: Acute Tubular Necrosis
Inner kidney can’t filtrate
Pt has h/o inc NSAIDs, Meds d/t RA with current infection of PNA and allergies: fever, rash esinophils
WBC casts, protien, RBC
BUN/CR <20/1
What is the cause and DX
Her Dad has a hx of rapid inc HTN, w. renal artery occulision. Caugh early w/Bruits, emobli
Her mom had Vasciulitis, Thrombocytopenia (HUS/TTP) and sclerodoma
BUN to Creatinine ratio also <20/1 SpGr- < 1.000, brown Osmol urine-<300 Na >20 FENa high ***Active CAst- WBC, Ftth, Muddy brown Oliguria/Anuria
AIN - Acute interstitial nephritis
Intrarenal Causes - Tubular
Dx – renal biopsy but…consider, stop the offender, monitor
Large Vessel Dz:
Small Vessel Dz, Vasculitis common
Hemolytic uremic syndrome
Thrombotic thrombocytopenic purpura
What must occur to DX the PT w/ the following:
oliguria, pain, w/ prostatiis, and Cancer.
US- Stones, blood clots, crystals
BUN to Creatinine ratio also 10/1 or higher SpGr- variable BUN to Creatinine Ratio =/>20/1-Glomeruli, tubules are intact Osmol urine-300 Na <20 FENa high Hematuria Oliguria/Anuria
Post Renal ARF
Must obstruct both kidneys.–Examine body!
What are the ideal was to Estimating GFR @ Bedside
Cockcroft-Gault: Creatinine Clearance (CrCl)-Best for CKD
M-90-140ml/min males;
F- 80-125 females
Modification of Diet in Renal Disease
accurate than CrCl; best for CKD, not acute; commonly used for
GFR >90 normal,
GFR <60 abnormal
CKD-EPI: Chronic Kidney Dz Epidemiology Collaboration
Better in mild Dz; better for risk prediction
Recently: better than CrCl or MDRD
Pediatric GFR
Schwartz formula
24hr urine Creatinine Clearance
What Calculations FENa Distinguishes ATN from Prerenal AKI and advanced AKI only?
FENa = fractional excretion of sodium
Prerenal, AGN <1%
Postrenal =/>1%
ATN: usually high, =/>3%,
AIN variable: 1-3%
