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Flashcards in Acute Renal Failure Deck (23):
0

Acute renal failure? Indicator?

Abrupt decline in GFR, Indicated by increases in creatinine

1

Anurea? Differential diagnosis should include?

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

2

Oligurea?

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

3

Uremia Sx?

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

4

Azotemia?

Elevated BUN without symptoms

5

BUN to creatinine ratio in prerenal azotemia

20+

6

Causes of prerenal azotemia?

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

Most common causes of postrenal azotemia?

1. Prostatic obstruction
2. Uterine obstruction due to malignancy

8

Causes of intrinsic acute renal failure?

1. Acute tubular necrosis
2. Glomerulonephritis
3. Tubulointerstitial nephritis

9

Causes of acute tubular necrosis?

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

10

Causes of glomerulonephritis?

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

11

Causes of tubulointerstitial nephritis?

1. Drugs (cephalosporins, methicillin, rifampin)
2. Infection (pyelonephritis, HIV)

12

Specific gravity and microscopic findings in:
1. Prerenal failure
2. postrenal failure

1. High specific gravity and normal microscopic findings
2. Unable to concentrate urine (isosthenuria) and various microscopic findings

13

Microscopic findings if postrenal azotemia is caused by:
1. Stones or crystals
2. Prosthetic hypertrophy
3. Extrinsic compression from a tumor

1. Hematuria
2. Leukocytes
3. No change

14

Tubulointerstitial nephritis – see what in urine?

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

15

FEna<20? UA will show?

1. Prerenal failure. Concentrated urine with normal sediment

2. Early post-renal failure

16

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

1. ATN. Isosthenuria with muddy brown casts

2. Interstitial nephritis. Proteinuria with RBCs, WBCs and RBC casts

3. Late post renal failure. Variable.

17

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

Glomerulonephritis. Severe proteinuria with RBCs and RBC casts

18

EKG shows peaked T waves. Cause? Transient Treatment?

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

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

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

20

Indications for dialysis?

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

21

Drugs to use in the clinical treatment of hyperkalemia?

C BIG K
Calcium
HCO3/beta agonist
Insulin
Glucose
Kayexalate

22

Recap - FENa/UNa and UA findings in:

1. GN
2. Tubular interstitial nephritis
3. Prerenal
4. ATN

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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