Acute Renal Failure Flashcards Preview

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Flashcards in Acute Renal Failure Deck (23)
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0
Q

Anurea? Differential diagnosis should include?

A

Less than 50 mL of urine output 24 hours. Acute obstruction, cortical necrosis, and vascular catastrophes (aortic dissection)

1
Q

Acute renal failure? Indicator?

A

Abrupt decline in GFR, Indicated by increases in creatinine

2
Q

Oligurea?

A

Less than 400 mL of urine output 24 hours (physiologically the lowest amount of urine person on a normal diet can make)

3
Q

Uremia Sx?

A

/fatigue, nausea/vomiting, itchiness, confusion, pericarditis due to retention waste products.

4
Q

Azotemia?

A

Elevated BUN without symptoms

5
Q

BUN to creatinine ratio in prerenal azotemia

A

20+

6
Q

Causes of prerenal azotemia?

A
  1. Volume depletion (blood loss, G.I. loss, renal loss)
  2. Reduced effective blood volume (nephrotic syndrome, cirrhosis, SIRS, burns)
  3. Drugs (ACE inhibitors, NSAIDs)
  4. Decreased cardiac output (tamponade, CHF)
7
Q

Most common causes of postrenal azotemia?

A
  1. Prostatic obstruction

2. Uterine obstruction due to malignancy

8
Q

Causes of intrinsic acute renal failure?

A
  1. Acute tubular necrosis
  2. Glomerulonephritis
  3. Tubulointerstitial nephritis
9
Q

Causes of acute tubular necrosis?

A
  1. Nephrotoxic agents (aminoglycosides, radiocontrast, chemo)
  2. Ischemic (hypertension, vascular catastrophe)
10
Q

Causes of glomerulonephritis?

A
  1. Postinfectious
  2. Vasculitis
  3. Immune complex diseases
  4. Cholesterol emboli
  5. HUS/TTPo
11
Q

Causes of tubulointerstitial nephritis?

A
  1. Drugs (cephalosporins, methicillin, rifampin)

2. Infection (pyelonephritis, HIV)

12
Q

Specific gravity and microscopic findings in:

  1. Prerenal failure
  2. postrenal failure
A
  1. High specific gravity and normal microscopic findings

2. Unable to concentrate urine (isosthenuria) and various microscopic findings

13
Q

Microscopic findings if postrenal azotemia is caused by:

  1. Stones or crystals
  2. Prosthetic hypertrophy
  3. Extrinsic compression from a tumor
A
  1. Hematuria
  2. Leukocytes
  3. No change
14
Q

Tubulointerstitial nephritis – see what in urine?

A
  1. Mild proteinuria
  2. Leukocytes and white Cell Casts
  3. Urinary eosinophils
15
Q

FEna<20? UA will show?

A
  1. Prerenal failure. Concentrated urine with normal sediment

2. Early post-renal failure

16
Q

FEna>1% and Una>20? UA will show?

A
  1. ATN. Isosthenuria with muddy brown casts
  2. Interstitial nephritis. Proteinuria with RBCs, WBCs and RBC casts
  3. Late post renal failure. Variable.
17
Q

FEna<1% and variable Una? UA will show?

A

Glomerulonephritis. Severe proteinuria with RBCs and RBC casts

18
Q

EKG shows peaked T waves. Cause? Transient Treatment?

A

Hyperkalemia.

  1. Intravenous calcium. Calcium will oppose the effects of high potassium in the heart
  2. Insulin. Drives potassium into ( also can use Beta agonist like albuterol)
  3. Intravenous sodium bicarbonate
19
Q

Definitive treatment of hyperkalemia (as opposed to transient treatment)?

A
  1. Diuretic
  2. Kayexalate (Cationic exchange resin that exchanges Na for K in colon)
  3. Emergency dialysis
20
Q

Indications for dialysis?

A
AEIOU
Acidosis
Electrolyte disturbances (hyperK, hyperPO4)
Ingestions
Overload (fluid, pulmonary edema)
Uremia and Uremic pericarditis
21
Q

Drugs to use in the clinical treatment of hyperkalemia?

A
C BIG K
Calcium
HCO3/beta agonist
Insulin
Glucose
Kayexalate
22
Q

Recap - FENa/UNa and UA findings in:

  1. GN
  2. Tubular interstitial nephritis
  3. Prerenal
  4. ATN
A
  1. Low/variable ; protein with RBCs and RBC casts
  2. High/high; protein WBCs with eosinophils, RBCs and WBC/RBC casts
  3. low/low normal sediment
  4. High/high; Isosthenuria with muddy brown casts

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