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Nephrology > Kidney Failure > Flashcards

Kidney Failure Flashcards

1
Q

Sudden decrease in renal function

Renal function deterioration over hours to days

A

Acute Renal Failure

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2
Q

What is the most common cause of acute renal failure?

A

Hypoperfusion

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3
Q

What are the three mechanisms of renal failure? Which one is the most common?

A

Prerenal azotemia (most common)
Intrinsic renal failure
post-obstructive azotemia

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4
Q

What is the term for nitrogenous waste accumulation?

A

Azotemia

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5
Q

What are the signs of acute renal failure?

A

Rapidly rising creatinine
Electrolyte abnormalities
Acid/base alterations
Inability to excrete nitro wastes

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6
Q

BUN:Cr is a marker to help determine acute renal failure. What is the ratio that would indicate this?

A

BUN:Cr (increased >20:1)

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7
Q

This calculation is used to help differentiate between prerenal azotemia and ATN? What are the levels to differentiate?

A

FeNa

FeNa <1% ~ prerenal cause, volume depletion
FeNa >2% ~ ATN

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8
Q

What does FeNa stand for?

A

fractional excretion of sodium

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9
Q

What are the three main causes of intrinsic renal failure?

A

acute tubular necrosis
interstitial nephritis
glomerulonephritis

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10
Q

What is the most common cause of intrinsic renal failure?

A

Acute tubular necrosis – 85%

Prolonged ischemia – think “shock”

Nephrotoxic agents – contrast dye, ACE-Is, NSAIDs, aminoglycosides, amphotericin B, cyclosporine

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11
Q

Which cause of intrinsic renal failure is described below?

Muddy brown casts

Urine specific gravity <1.010 (very light, very dilute)

Hyperkalemia

Hyperphosphatemia

FeNa >1

BUN: Cr <20:1

A

Acute tubular necrosis

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12
Q

Which cause of intrinsic renal failure is described below?

Fever – 80%

Rash – 50%

Renal dysfunction

Pyuria

Arthralgias

Eosinophilia

UA: hematuria, WBC casts, pyuria (eosinophils)

A

Acute interstitial nephritis

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13
Q

Which cause of intrinsic renal failure is described below?

LE livedo reticularis or necrotic areas of the distal digits

A

Cholesterol emboli

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14
Q

Which cause of intrinsic renal failure is described below?

Occurs with hemolysis or rhabdomyolysis

Void of RBCs

A

Pigment-induced injury

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15
Q

What is the least common cause/mechanism of acute kidney failure?

A

Post-Obstructive

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16
Q

Progressive decline in renal function

GFR < 15

Rarely reversible

Affects 20 million in US

A

Chronic Renal Failure

17
Q

What are the two most common causes of chronic renal failure?

A

AODM and HTN

18
Q

List some broad categories of causes for chronic renal failure

A

Primary Glomerular disease (problem is within the glomerulus)
Secondary Glomerular disease (problem is outside of the glomerulus)
Tubulointerstitial nephritis (affects the tubules and interstium)
Hereditary disease
Vascular disease
Obstructive nephropathies

19
Q

Which Primary Glomerular Disease is described below?

Usually presents with nephrotic syndrome

Can be primary renal or secondary to something else (ex: drug ingestion, systemic disease)

1/3 progress to ESRD and the remainder enter remission or have
slowly declining renal function

Histology - You’ll see thick capillary walls

A

Membranous Nephropathy

20
Q

Which Primary Glomerular Disease is described below?

Primary renal disease of IgA deposition in the glomerular
mesangium

Most often idiopathic

Presentation: Asymptomatic hematuria with mild proteinuria or recurrent episodes of gross hematuria

May be concomitant with URI, GI symptoms, or viral illness

A

IgA Nephropathy

21
Q

Which Secondary Glomerular Disease is described below?

Most common cause of ESRD in USA

Likely to have prior evidence of AODM > 10 years

Presentation - Albuminuria precedes the decline in GFR, Increased abnormal glycosylation of IgG

There is a predicable trajectory - Other end organ damage is common

A

Diabetic Nephropathy

22
Q

Which Secondary Glomerular Disease is described below?

Presentation: Proteinuria, Glomerular hematuria

Usually follows a group A beta-hemolytic strep infection by 1-3
weeks

Usually self-limiting and resolves spontaneously

A

Post-infectious glomerulonephritis

23
Q

Which Tubulointerstitial Nephritis Disease is described below?

Seen in persons who ingest large quantities of analgesic combinations

NSAIDS most common culprit

A

Analgesic Nephropathy

24
Q

Which Tubulointerstitial Nephritis Disease is described below?

Significant cause of renal failure

Primarily a disorder of childhood - Patients are typically young,
hypertensive, and have a history of recurrent UTIs

Mild proteinuria is common

A

Reflux/Chronic Pyelonephritis

25
Q

This disease is one of the most common hereditary diseases in the US

A

Polycystic kidney disease

26
Q

In patients with polycystic kidney disease, what percentage will reach ESRD by age 60?

A

50%

27
Q

What disease can you also see arterial aneurism of the circle of Willis?

A

Polycystic kidney disease

28
Q

In patients with polycystic kidney disease, what percentage will have coexisting hepatic cysts?

A

25%

29
Q

Which vascular disease is described below?

Vascular structure thickening and diminished perfusion

May have mild proteinuria and nocturia

1-5% will develop renal failure and azotemia

A

Hypertensive Nephrosclerosis

30
Q

Which vascular disease is described below?

Produced by atherosclerotic occlusive disease or fibromuscular dysplasia

Acute kidney injury develops rapidly in patients started on ACE-I therapy (Creatinine will skyrocket)

May also present with new-onset HTN and poorly controlled HTN with pulmonary edema

A

Renal Artery Stenosis

31
Q

In renal artery stenosis, what percentage of cases are caused by atherosclerotic occlusive disease versus fibromuscular dysplasia (F>M)

A

90% caused by atherosclerotic occlusive disease

10% fibromuscular dysplasia (F>M)

32
Q

What is the most common demographic of patients that renal artery stenosis is seen in?

A

Most commonly found in >45 year olds with known atherosclerotic disease

33
Q

What is the gold standard imaging for renal artery stenosis?

A

Renal angiography

34
Q

This procedure is also called “renal replacement therapy”

A

Dialysis

35
Q

What fistula is best in dialysis?

A

The artery-vein fistula

Nephrology (4 decks)

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