Intro to Renal Failure Lecture

Question 1

Urine
Serum
Radiography

Answer 1

3 ways to assess kidney function

Question 2

Goes up quickly in ARF due to ischemia and radio contrast (complication of x-ray dye studies such as IVP, CT scans)

• Peaks 3-5d after contrast
• Peaks 7-10d after ischemia

Answer 2

Creatinine

*not correlative with symptoms

Question 3

Sodium reflets _____ status

Answer 3

volume

Question 4

I&Os
Urine sodium
Body weight
Toxin levels

Answer 4

Ways to monitor kidney function

Question 5

Can people with kidney disease concentrate their urine?

Answer 5

No..

urine concentration is low

Question 6

Collectively, the measure of renal function
*If low, leads to azotemia
Can be estimated by serum creatinine
*Affected by age, sex, weight, fluid status, and medical condition (illnesses, nutritional status, drugs on board, etc.)

Answer 6

GFR

Question 7

Creatinine is secreted in the….

Answer 7

proximal tubule

Question 8

Men:(140-age) x (wt in kg) divided by 72 x serum creatine

Answer 8

Cockcroft-Gault equation

*calculates GFR

Question 9

Defined as excess of urea and nitrogenous compounds in blood

Due to breakdown of protein

Answer 9

Azotemia

Question 10

Metabolism of carbs and fats yields…

Answer 10

water and CO2

Question 11

Best first radiographic test…

will exclude obstruction of kidney

Answer 11

Ultrasound

Question 12

Non invasive
No risky contrast dye
Readily available

Answer 12

Advantages to ultrasound

Question 13

Avoid contrast in…

Answer 13

ARF and CRF

Question 14

Biopsy may be needed in ____ for intrinsic disease

Answer 14

ARF

Question 15

Volume overload
Hyponatremia
Hypocalcemia (paresthesia, cramps, seizures, confusion)

Answer 15

Complications of ARF

Question 16

Whats more common in renal failure, HyperNa or HypoNa?

Answer 16

HypoNa

Question 17

• Hyperkalemia, phosphatemia, magnesemia
• Metabolic acidosis
• HTN

Answer 17

Complications of ARF

Question 18

ARF is usually….

Answer 18

reversible

Question 19

Due to renal hypoperfusion
Usually reversible if restoring renal blood flow (RBF)
Parenchyma usually not damaged
In severe cases, ischemia/injury

Answer 19

Prerenal azotemia

Question 20

• Hypovolemia (Fluid loss, Decreased cardiac output, Decreased systemic vascular resistance)
• Renal hypoperfusion

Answer 20

Prerenal azotemia

Question 21

• Leads to epinephrine release and subsequent vasoconstriction
• Also activations of renin angiotensin system–>Vasoconstriction
• Release of arginine vasopressin (AVP)

Answer 21

Hypovolemia

Question 22

• Renal vasoconstriction due to epinephrine
• ACE inhibitors
• Cyclooxygenase inhibitors (i.e.: NSAID’s)
• Hyperviscosity syndromes

Answer 22

Can cause renal hypoperfusion

Question 23

• Cirrhosis leads to intrarenal vasoconstriction
• Sodium retention
• Precipitated by bleeding, paracentesis, diuretics, vasodilation, cyclooxygenase inhibitors

Answer 23

Hepatorenal syndrome

Question 24

Symptoms: Thirst, dizzy
Signs: Low blood pressure, tachycardia, orthostasis, Low UOP

Answer 24

Pre-renal

Question 25

- Renovascular obstruction..lg vessel dz | - Glomerular or microvascular diseases

Answer 25

Intrinsic renal failure

Question 26

``` Glomerulonephritis Vasculitis Acute tubular necrosis Ischemic or nephrotoxic Interstitial nephritis Renal allograft rejection ```

Answer 26

Glomerular diseases

Question 27

Ischemia from prerenal azotemia

Answer 27

Most common cause of acute tubular necrosis

Question 28

``` Radiocontrast (Intrarenal vasoconstriction) Aminoglycosides (Decrease GFR) Cyclosporin Chemotherapy (Cisplatin) Solvents (ethylene glycol) ```

Answer 28

Nephrotoxins

Question 29

Mechanism: Intrarenal vasoconstriction resulting in acute tubular necrosis (ATN) abrupt onset 24-48h aftercontrast exposure

Answer 29

Radiocontrast induced nephropathy

Question 30

Biggest risk factor for radiocontrast induced nephropathy

Answer 30

Age****!

Question 31

Features: Decreased GFR, Sediment, Reversible, Elevation of BUN and creatinine Avoidance: Use non ionic contrast (more expensive but safer Outcome: Typically resolves in 1-2 weeks

Answer 31

Radiocontrast induced nephropathy

Question 32

Rhabdomyolysis (Due to crush, injury, ETOH) Hemolysis (toxic to renal tubule) Uric acid (Same thing that causes gout) Myeloma (Plasma cell malignancy) Hypercalcemia (Causes renal vasoconstriction)

Answer 32

Endogenous nephrotoxins

Question 33

Allergic (Antibiotics such as beta-lactams), NSAID’s, diuretics Infection (Bacterial-pyelonephritis, viral-CMV, Fungus-Candidiasis) Infiltration (Lymphoma, leukemia, sarcoidosis) Idiopathic

Answer 33

Interstitial nephritis

Question 34

Symptoms-Often none May have history of nephrotoxin exposure Signs-Azotemia on lab testing Nephritic syndrome (Oliguria, edema, HTN, Urine sediment)

Answer 34

intrinsic renal failure

Question 35

Oliguria, edema, HTN, urine sediment

Answer 35

Nephritic syndrome

Question 36

Microscopy: Muddy brown casts (ischemia and nephrotoxic) Red cell casts (acute glomerular injury or nephritis) White cell casts (interstitial nephritis) Eosinophilic casts (allergic nephritis) Often no casts Hematuria

Answer 36

Intrinsic renal failure lab results

Question 37

This can be seen in intrinsic renal failure and is due to impaired reabsorption at proximal tubules

Answer 37

Proteinuria

Question 38

``` Prostate disease Neurogenic bladder I.e.: spinal cord injuries Anticholinergics Blood clots Stones Tumor or other extrarenal obstruction ```

Answer 38

Post renal

Question 39

Bladder distension Abdominal pain-colic Renal distension (ultrasound) History of risk factors (prostate disease, stones, etc.)

Answer 39

Post renal signs and symptoms