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Renal Exam III > Acute renal Failure CIS Pales > Flashcards

Acute renal Failure CIS Pales Flashcards

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1
Q

AKI=

A

Acute kidney injury or acute renal failure

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2
Q

AKI=

A

Acute kidney injury or acute renal failure

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3
Q

AKI definition

A

Absolute increase in serum creatinine of 0.3 mg/dL
or
50% increase in serum Creatinine
or
Reduction in urine output consisting of oliguria of less than 0.5 mL/kg/hr for longer than 6 hours

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4
Q

Acute vs. Chronic renal failure

A 
Compare with Creatinine from before
Size of kidneys on US
Sediment on u/a
Stigmata of Chronic Renal Failure
   Anemia
   Hyperparathyroidism (osteodystrophy)
   A/V fistula
   Hyperphosphatemia
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5
Q

casts are more likely to be…

A

acute?

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6
Q

prerenal ua

A

Normal or hyaline casts

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7
Q

Intrarenal causes of AKI

A

Tubular cell injury
interstitial nephritis
glomerulonephritis
vascular disorders

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8
Q

tubular cell injury ua

A

Muddy-brown, granular, epithelial casts

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9
Q

interstitial nephritis ua

A

Pyuria, hematuria, mild proteinuria, granular and epithelial casts, eosinophils

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10
Q

glomerulonephritis ua

A

Hematuria, marked proteinuria, red blood cell casts, granular casts

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11
Q

vascular disorders ua

A

Normal or hematuria, mild proteinuria

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12
Q

postrenal ua

A

Normal or hematuria, granular casts, pyuria

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13
Q

Pre-renal

FENa
Urine Na
BUN/Creat.Rati0

A

20:1

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14
Q

ATN

FENa
Urine Na
BUN/Creat.Rati0

A

> 1%

>20

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15
Q

Toxic Injury

FENa
Urine Na
BUN/Creat.Rati0

A

> 1%

>20

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16
Q

glomerulonephritis (early)

FENa
Urine Na
BUN/Creat.Rati0

A
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17
Q

Vascular disorders (early)

FENa
Urine Na
BUN/Creat.Rati0

A
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18
Q

Fractional Excretion of Na (FENa)

A

(Urine Na x Plasma Cr x 100)/

Plasma Na x Urine Cr

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19
Q

renal ultrasound

A 
Signs of hydronephrosis
Kidneys size
PCKD
Stones
Tumors
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20
Q

What damage does the kidneys sustain with prerenalazothemia?

A

no damage shown if you biopsy

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21
Q

Causes of pre-renal azothemiaand/or ischemia

A

Intravascular volume depletion and or hypotension
Decreased effective intravascular volume
Systemic vasodilation/renal vasoconstriction
Large-vessel renal vascular disease

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22
Q

Intravascular volume depletion and or hypotension

A

Hemorrhage
GI loss: vomiting/diarrhea
Renal loss: diuretics, diabetes (mellitus and incipidus)
Dermal losses (sweating)

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23
Q

Decreased effective intravascular volume

A

Congestive heart failure
Cirrhosis
Hepatorenalsyndrome,
Peritonitis

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24
Q

Systemic vasodilation/renal vasoconstriction

A

Sepsis

Hepatorenalsyndrome

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25
What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?
``` Cyclosporine Tacrolimus ACEIs, ARBs, NSAIDs Radiocontrast agents Diuretics? ```
26
What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?
``` Cyclosporine Tacrolimus ACEIs, ARBs, NSAIDs Radiocontrast agents Diuretics? ```
27
AKI definition
Absolute increase in serum creatinine of 0.3 mg/dL or 50% increase in serum Creatinine or Reduction in urine output consisting of oliguria of less than 0.5 mL/kg/hr for longer than 6 hours
28
Acute vs. Chronic renal failure
``` Compare with Creatinine from before Size of kidneys on US Sediment on u/a Stigmata of Chronic Renal Failure Anemia Hyperparathyroidism (osteodystrophy) A/V fistula Hyperphosphatemia ```
29
casts are more likely to be...
acute?
30
extension gfr low/falling
cellular apoptosis/necrosis>disrupstion of normal epithelial integrity abrnomal tubular function (filtrasion/clearance) cellular sloughing>luminal obstruction inglammation> capillary sludging and worsening ischemia
31
Intrarenal causes of AKI
Tubular cell injury interstitial nephritis glomerulonephritis vascular disorders
32
tubular cell injury ua
Muddy-brown, granular, epithelial casts
33
interstitial nephritis ua
Pyuria, hematuria, mild proteinuria, granular and epithelial casts, eosinophils
34
glomerulonephritis ua
Hematuria, marked proteinuria, red blood cell casts, granular casts
35
vascular disorders ua
Normal or hematuria, mild proteinuria
36
postrenal ua
Normal or hematuria, granular casts, pyuria
37
Pre-renal FENa Urine Na BUN/Creat.Rati0
20:1
38
ATN FENa Urine Na BUN/Creat.Rati0
> 1% | >20
39
Toxic Injury FENa Urine Na BUN/Creat.Rati0
>1% | >20
40
glomerulonephritis (early) FENa Urine Na BUN/Creat.Rati0
41
Vascular disorders (early) FENa Urine Na BUN/Creat.Rati0
42
Fractional Excretion of Na (FENa)
(Urine Na x Plasma Cr x 100)/ | Plasma Na x Urine Cr
43
renal ultrasound
``` Signs of hydronephrosis Kidneys size PCKD Stones Tumors ```
44
What damage does the kidneys sustain with prerenalazothemia?
no damage shown if you biopsy
45
Causes of pre-renal azothemiaand/or ischemia
Intravascular volume depletion and or hypotension Decreased effective intravascular volume Systemic vasodilation/renal vasoconstriction Large-vessel renal vascular disease
46
Intravascular volume depletion and or hypotension
Hemorrhage GI loss: vomiting/diarrhea Renal loss: diuretics, diabetes (mellitus and incipidus) Dermal losses (sweating)
47
Decreased effective intravascular volume
Congestive heart failure Cirrhosis Hepatorenalsyndrome, Peritonitis
48
Systemic vasodilation/renal vasoconstriction
Sepsis | Hepatorenalsyndrome
49
Large-vessel renal vascular disease
Renal artery thrombosis or embolism Renal artery stenosis Cholesterol emboli
50
What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?
``` Cyclosporine Tacrolimus ACEIs, ARBs, NSAIDs Radiocontrast agents Diuretics? ```
51
What findings do you expect to see on the u/a of patient with pre-renal azothemia?
hyaline casts sodium less than ten
52
upper gi bleeding,
bc it is reabsorbed and causes an increase in bun,
53
giving fluids to renal problems
atn takes longer prerenal is better right away
54
initiation gfr falling
``` prolonged prerenal state hemorrhage sepsis vascular disrupstion (trauma, coronary artery bypass, aortic crossclamp) nephrtoxins ``` these all lead to ischemia
55
extension gfr low/falling
cellular apoptosis/necrosis>disrupstion of normal epithelial integrity abrnomal tubular function (filtrasion/clearance) cellular sloughing>luminal obstruction inglammation> capillary sludging and worsening ischemia
56
maintenance gfr stable/low
cellular dedifferentiation and proliferation>reestablishment of tubular epithelium
57
Recovers GFR rising
Cellular repolarization> reestablishment of normal tubular function (filtration/clearance)
58
what percentage of atn pts get better
97%
59
obstruction causing hydronephrosis
catheter to release the kidney out unilateral does not cause renal failure this case is bilateral
60
What medications may cause acute renal failure?
``` Aminoglycosides Radiocontrastagents Acyclovir Cisplatin Sulfonamides Methotrexate Cyclosporine Tacrolimus AmphotericinB Foscarnet Pentamidine Ethylene glycol Toluene Cocaine HMG-CoAreductaseinhibitors ```
61
acute interstitial nephritis recovery?
acute interstitial nephritis, never fully recover if contrast nephropathy fully recover, causes vasospasm so you decrease flow to kidneys
62
What is the significance of the negative finding for eosinophills. What condition it rules out?
acute interstitial nephritis
63
Interstitial Nephritis | β-LACTAM ANTIBIOTICS
PenicillinCephalosporinsAmpicillinMethicillinNafcillin
64
Interstitial Nephritis | diuretics
DIURETICSFurosemideHydrochlorothiazideTriamterene
65
Interstitial Nephritis | other antibiotics
SulfonamidesVancomycinRifampinAcyclovirIndinavir
66
Interstitial nephritis nsaids
IbuprofenNaproxenIndomethacin
67
What is the significance of RBC casts?
glomerulonephritis
68
What is the differential for glomerulonephritisand what tests should we order?
goodpastures anti gbm wgeners panca ana acuet lupus nephritis
69
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Renal Exam III (17 decks)

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