Acute Renal Failure CIS

Question 1

aleve

Answer 1

NSAID

Question 2

elevated creatinine

Answer 2

represent renal failure**

Question 3

creatinine represents

Answer 3

GFR

Question 4

acute kidney injury

Answer 4

acute renal failure

• 50% increased in serum Cr
• increase in serum Cr - 0.3
• reduction in urine output less than 0.5 longer than 6 hours

Question 5

acute or chronic kidney problem?

Answer 5

• sediment
• kidney size
• compare previous Cr

Question 6

acute sediment

Answer 6

active - casts

Question 7

chronic sediment

Answer 7

bland

Question 8

acute kidney size

Answer 8

normal

Question 9

chronic kidney size

Answer 9

small and scarred

Question 10

stigmata for chronic renal failure

Answer 10

• anemia
• hyperPTH
• A/V fistula
• hyperP

Question 11

acute kidney injury

Answer 11

prerenal
renal
post renal

Question 12

renal causes of acute kidney

Answer 12

ischemia
toxic
glomerulonephritis
acute interstitial nephritis
renovascular obstruction

Question 13

endogenous toxins

Answer 13

cause AKI > renal > toxic

-Mg, Hg, light chain, calcium, uric acid

Question 14

hyaline casts

Answer 14

prerenal AKI**

Question 15

muddy brown casts

Answer 15

intrarenal tubular cell injury
-ATN** - acute tubular necrosis

epithelial casts

Question 16

eosinophils

Answer 16

intrarenal - interstitial nephritis

Question 17

RBC casts

Answer 17

glomerularnephritis AKI

Question 18

FeNa

Answer 18

urine Na x plasma Cr x 100 / plasma Na x Urine Cr

Question 19

pre-renal FeNa

Answer 19

<10

Question 20

urine Na

Answer 20

usually looked a for AKI work up

low in pre-renal
high in renal - can’t reabsorb

Question 21

prerenal urine Na

Answer 21

<10

Question 22

ATN urine Na

Answer 22

> 20

Question 23

toxic injury urine Na

Answer 23

> 20

Question 24

renal ultrasound

Answer 24

hydronephrosis
kidney size
cysts
stones
tumors

Question 25

prerenal azotemia

Answer 25

no change to kidney | -hypoperfusion will recover normally

Question 26

causes of prerenal azotemia

Answer 26

shock , dehydration, hemorrhage, sepsis, vomiting, diarrhea, sweating, diuretics, DM, cirrhosis, CHF, hepatorenal syndrome, peritonitis, hepatorenal syndrome, renal a stenosis, embolism

Question 27

meds make prerenal azotemia worse

Answer 27

``` NSAIDs ACE (-) diuretics contrast dye tacrolimus cyclosporine ARBs ```

Question 28

urinary sodium >20

Answer 28

think acute tubular necrosis

Question 29

acute interstitial nephritis

Answer 29

with NSAIDs

Question 30

upper GI bleed

Answer 30

can result in very high BUN

Question 31

muddy brown casts

Answer 31

ATN | -acute tubular necrosis

Question 32

stages of ATN

Answer 32

initiation - polarized cell extension - depolarized cell maintenance - dedifferentiated cell recovery - polarized again usually takes 1 week to recover**

Question 33

initation of ATN

Answer 33

falling GFR | polarized cell

Question 34

extension of ATN

Answer 34

depolarized cell - apoptosic/necrosis/lumen obstruction - GFR falling

Question 35

maintenance of ATN

Answer 35

dedifferentiated cells are reestablishing as tubular epithelium

Question 36

recovery of ATN

Answer 36

cell repolarization | -GRF rising

Question 37

neurogenic bladder

Answer 37

can be due to multiple sclerosis | -Tx catheter

Question 38

unilateral ureter obstruction

Answer 38

causes postrenal azotemia if they have one kidney or chronic kidney disease

Question 39

majority of postrenal azotemia

Answer 39

from bilateral ureter obstruction

Question 40

nephrotoxic meds

Answer 40

``` aminoglycosides contrast acyclovir cisplatin sulfa methotrexate cyclosporine tacrolimus amphotericin B foscarnet pentamidine ethylene glycol toluene cocaine HMG-CoA recuctase (-) ```

Question 41

legs petechia, lung consolidations, RBC casts in urine,

Answer 41

wegeners granulomatosis

Question 42

causes of acute interstitial nephritis

Answer 42

beta-lactam antibiotics diuretics other antibiotics NSAIDs **eosiniphils in urine, rash, and elevated Cr

Question 43

RBC casts

Answer 43

something wrong with glomerulus

Question 44

wegeners

Answer 44

kidney, lung, sinus

Question 45

goodpasture

Answer 45

anti-GBM antibodies

Question 46

wegeners

Answer 46

c-ANCAs

Question 47

polyareritis nodosa

Answer 47

p-ANCAs

Question 48

final step if nothing else works

Answer 48

urinalysis, ultrasound, antibody check *do biopsy*