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Clinical Med - Nephrology > Acute / Chronic Renal Failure > Flashcards

Acute / Chronic Renal Failure Flashcards

1
Q

_______ renal failure is defined as a rapid decline in eGFR in combination with an increase in BUN and sCr levels

A

Acute Renal Failure (AKI)

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2
Q

What are the THREE categories of ARF?

A
  1. Pre-Renal
  2. Intrinsic (Intra-renal)
  3. Post-Renal
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3
Q

Volume depletion, GI Losses, decreased cardiac output, and systemic vasodilation (ie: sepsis) are all causes of ___-renal ARF.

A

Pre-renal

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4
Q

Bilateral ureteral obstruction (ie: stones), neoplasms, BPH are all common causes of ____-renal ARF

A

Post-renal

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5
Q

Renal artery thrombus, Malignant HTN glomerulonephritis, and ATN are all common causes of ____-renal ARF.

A

Intra-Renal (Intrinsic)

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6
Q

What Medications are considered exotoxins associated with ATN?

A 
NSAIDs
ACEi
Aminoglycosides
Cisplatin
Radiocontrast Dye
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7
Q

Other than renal failure, what could also cause an elevated BUN?

Creatinine?

A

BUN: Steroids, GI Bleed, Hypercatabolism

Creatinine: Muscle breakdown

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8
Q

What ‘clues’ in the H&P could tip you off to renal failure?

A 
Change in Urination 
Heamturia
Prescription Medications
HTN
Recent Contrast
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9
Q

What radiology may help you work up ARF?

A

US
CT
Angiography

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10
Q

A BUN and sCr ratio >20:1 would indicate what?

A

Acute Pre-Renal Failure

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11
Q

If you placed a foley on a patient with ARF and there was a LARGE amount of urine output, where may the ‘problem/obstruction’ be?

Is this pre-renal, post-renal, or intra-renal?

A

Bladder, Urethra, Prostate

Post-Renal

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12
Q

If you placed a foley on a patient with ARF and there was a SMALL amount of urine output, where may the ‘problem/obstruction’ be?

Is this pre-renal, post-renal, or intra-renal?

A

Ureter

Post-Renal

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13
Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed WBC Casts, it would indicate what?

A

Pyelonephritis

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14
Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed Muddy Casts, it would indicate what?

A

ATN

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15
Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed Waxy Casts, it would indicate what?

A

Chronic Renal Disease

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16
Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed RBC Casts, it would indicate what?

A

Glomerulonephritis

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17
Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed Hyaline Casts, it would indicate what?

A

Normal Finding

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18
Q

How is Pre-Renal Failure treated?

A

Fluid Replacement
Cardiac Support
Shock Treatment

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19
Q

How is Post-Renal Failure treated?

A

Treat the underlying cause

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20
Q

How is Intra-Renal Failure treated?

A

Diuretics (Loop)

Dopamine

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21
Q

What do you need to monitor when working up and managing ARF?

A 
Fluids
Electrolytes 
Hematologic (Platelets)
Infection
Arrhythmias
GI Sx
Neurologic (Confusion, Lethargy)
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22
Q

In what settings does ARF have the highest mortality?

There are THREE

A

Multi-organ Failure
ARDS
Hypotension

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23
Q

During ARF, when would dialysis be indicated?

Hint: A,E, I, O, U

A 
A - Intractable Acidosis
E - Electrolyte Abnormalities
I - Intoxications
O - Fluid Overload
U - Uremia
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24
Q

______ ______ _____ is defined as a spectrum of different pathological processes associated with abnormal kidney function and progressive decline in eGFR for at least 3 months

A

Chronic Kidney Disease

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25
Q

What two co-morbidities are commonly seen in patients with CKD?

What medication is most commonly seen with CKD?

A

DM (Leading cause of KD in the USA)
HTN

NSAIDs

26
Q

Other than DM, HTN, and NSAID use, what additional risk factors are associate with CKD?

A 
CVD
Obesity
HLD
FHx
Repeated Episodes of ARF
Inheritied Diseases (Alport's, Hyperoxaluria)
27
Q

What THREE types of depositions are commonly seen on histology of CKD?

A
  1. Deposition of immune complexes in situ
  2. Deposition of anti-Glomerular Basement Membrane antibodies
  3. Depositions of an immunoglobulin in the glomerulus
28
Q

What Sx may a patient with CKD (Stage 1-3) present with?

Would this patient likely be hypertensive or hypotensive?

Would you expect the BUN/Cr to be elevated or decreased?

What about the eGFR?

What might you see on UA?

A

Sx:

Fatigue, Edema, Urination Change, Loss of Appetite

Hypertensive

BUN/Cr: Elevated

eGFR: Decreased

UA: Hematuria, Proteinuria

29
Q

In a patient with Stage 4 CKD or greater would you expect them to possibly be……

Anemic or polycythemic?

Acidodic or Alkalodic?

Hyperkalemic or hypokalemic?

Hypercalcemic or hypocalcemic?

Hyperphosphatemic or hypophosphatemic?

A

Anemic

Acidodic

Hyperkalemic

Hypocalcemic

Hyperphosphatemic

30
Q

A eGFR of 89-60 would indicated Stage __ CKD

A

2

31
Q

A eGFR of 29-15 would indicated Stage __ CKD

A

4

32
Q

A eGFR of > 90 would indicated Stage __ CKD

A

1

33
Q

A eGFR of < 15 would indicated Stage __ CKD

A

5

34
Q

A eGFR of 59-30 would indicated Stage __ CKD

A

3

35
Q

At what stage does CKD start to become irreversible?

A

Stage 3-4

36
Q

At what stage of CKD is a patient considered to have ESRD?

A

Stage 5

37
Q

What are the only two treatment options for a patient in Stage 5 CKD (ESRD)?

A

Dialysis

Transplant

38
Q

When working up CKD, it is important to obtain a serum and urine electrophoresis to rule out what disease?

A

Multiple Myeloma

39
Q

What is the ‘Gold Standard’ for diagnosing CKD?

A

eGFR

40
Q

What type of casts are commonly seen in the urine of a patient with CKD?

A

Waxy Casts

41
Q

T/F: Proteinuria and Microalbuminuria are common findings in CKD

A

True

42
Q

__________ RBCs are commonly seen on microscopic urinalysis in a patient with CKD.

This indicates they are directly coming from the kidneys themselves

A

Dymorphic RBCs

43
Q

In a CKD patient, would you expect EPO levels to be elevated or decreased

A

Decreased

44
Q

What is the goal BP in a patient with CKD?

What medications are recommended for managing BP?

A

130/80

ACEi
ARB
Diuretics

45
Q

What is the goal HBgA1c in a CKD patient?

A

6.5-7.5%

46
Q

What is the goal Hgb level in a patient with CKD?

What medications are used to manage this?

A

11-12

EPO
Fe2+ Supplementation
Anti-platelet therapy

47
Q

What medication should be AVOIDED in CKD patients?

A

NSAIDs

48
Q

Other than the influenza vaccination, what vaccine should be given each year in a patient with CKD?

A

Pneumoccocal

49
Q

T/F: Mg2++ should be given to patients with CKD

A

False

It should be avoided

50
Q

Which Stage 5 CKD management option has the highest success rate?

A

Transplantation

51
Q

What is the most common complication of CKD?

A

Secondary HTN

52
Q

Secondary HTN in patients with CKD is most commonly a result of ___ and ____ retention in combination of activation of the ____.

A

Na+
H2O

RAAS

53
Q

T/F: A patient with CKD is more likely to develop metabolic alkalosis

A

False

Metabolic Acidosis

54
Q

Would you expect a patient with CKD to develop hypoparathyrpoidism or hyperparathyroidism?

How is this treated?

A

Hyperparathyroidism (Secondary)

Tx: Vit-D Supplementation

55
Q

CKD results in elevated Ca2+ and Phosphate levels…..

What cardiovascular manifestations may this result in?

A

MI and CVA (Ischemic)
CHF (Increased BP)
Pericarditis (Uremic Toxins)

56
Q

Why may a patient with CKD become anemic?

How is this treated?

A

Decreased levels of EPO production

Tx: EPO Supplementation

57
Q

If a patient ith CKD presents with iron deficiency….

What must you rule out before you can consider it a result of renal pathology?

A

GI Bleed

58
Q

Why may CKD result in hypocoagulability?

A

Uremic toxins inhibit platelet factor III

59
Q

In a patient with CKD and DM are you more concerned with hypoglycemia or hyperglycemia?

Why?

A

Hypoglycemia

Insulin is cleared by the kidneys, so when they fail, less insulin is cleared.

60
Q

What is a common dermatologic manifestation of CKD?

What is this a result of?

A

Pruritus

Build up of nitrogenous waste under the skin

61
Q

Would you expect a patient with CKD to have a lighter or darker pigmentation?

A

Darker

Clinical Med - Nephrology (7 decks)

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