renal failure

Question 1

what is azotemia ?

Answer 1

insufficient filtering of the blood by the kidneys

Question 2

what are the uremic symtoms ?

Answer 2

anorexia
pericarditis
astrexis
encephalopathy
platelet dysfunction

Question 3

what are the three mechanisms associated with acute renal failure ?

Answer 3

1- pre renal - where there is insufficient blood flow to the kidneys
2- post renal - obstruction of the urine outflow , needs bilateral obstruction
3- intrinsic - renal dysfunction

Question 4

what are the levels of BUN/cr in acute renal failure ?

Answer 4

it is high in acute renal failure but rises alot higher in acute renal failure from dehydration

Question 5

at what level is urinary sodium considered low ?

Answer 5

less than 20

Question 6

what level is fractional excretion of sodium considered low ?

Answer 6

less than 1%

Question 7

what happens to the urinary osmolarity in ARF ?

Answer 7

very high urinary osmolarity

Question 8

what are the results associated with pre renal failure ?

Answer 8

very high BUN
high cr
high BUN/Cr ratio

Question 9

what are the urinary findings associated with pre renal failure ?

Answer 9

increased urine osmolarity because more water is being held back y the kidneys
low urinary sodium
low fractional excretion of sodium

Question 10

what is the normal BUN/Cr ratio ?

Answer 10

20:1

Question 11

what is the BUN/cr ration in pre renal , renal and post renal azotemias ?

Answer 11

pre renal , the ratio is increased
in renal the ratio remains unchanged
in post renal the ratio is increased

Question 12

what are the urinary findings associated with intrinsic acute renal failure ?

Answer 12

urine osmolality is low
high sodium conc
high fractional excretion of sodium

Question 13

what are the key features associated with post renal failure ?

Answer 13

anuria
hydronephrosis

Question 14

what are the features of the lab results associated with post renal failure ?

Answer 14

the BUN/Cr ratio is increased like pre renal
but the urinary sodium and fractional excretion of sodium are similar to those of intrinsic renal failure

Question 15

how is the fractional excretion of sodium calculated ?

Answer 15

plasma creatinine x urinary sodium
_____________________________
palsma sodium x urinary creatinine

Question 16

what are the pre renal vs intrinsic values of fractional excretion of sodium and the urinary sodium ?

Answer 16

pre renal
fractional excretion < 1
urinary sodium <20

intrinsic
fractional excretion >1
urinary sodium >40

Question 17

what are the most common causes associated with chronic kidney disease ?

Answer 17

hypertension
diabetes

Question 18

what are the stages of CKD ?

Answer 18

stage 1 - >90
stage 2 - 60 -89
stage 3 - 30 - 59
stage 4 - 15 - 29
stage 5 - less than 15 , ESRD

Question 19

what are the indications for dialysis ?

Answer 19

electrolyte abnormality
acidemia
intoxication
overload of fluid
uremic symptoms

Question 20

what are the dialyzable substances ?

Answer 20

SLIME
salicylates
lithium
isopropyl
magnesium laxatives
ethylene glycol

Question 21

what are the methods of dialysis ?

Answer 21

hemodialysis
peritoneal dialysis
hemofiltration

Question 22

what is the most ideal method associated with vascular access of hemodialysis ?

Answer 22

place a fistula in the arm , placed several months before dialysis

Question 23

what are the complications of CKD ?

Answer 23

MAD HUNGER
metabolic acidosis
Dyslipidemia ( mostly trigloyceride )
high potassium
uremia
NA/ and water retention
growth retardation
EPO loss
renal osteodystrophy

Question 24

what are the phosphate , calcium and vit D levels in CKD ?

Answer 24

hyperphosphatemia
hypocalcemia
increased PTH levels
decreased vit D levels

develop secondary hyperparathyroidism

Question 25

if we reach tertiary hyperparathyroidism , what is the next best sted ?

Answer 25

parathyroidectomy

Question 26

what is the presentation associated with renal osteodystrophy ?

Answer 26

bone pain osteitis fibrosa cystica - brown tumors , full of osteoclasts

Question 27

what are the treatment associated with decreasing the occurence of osteodystrophy ?

Answer 27

phosphate binders that bind the phosphate in the GI tract calcium carbonate calcium acetate sevelamer

Question 28

what are the nephrotoxic drugs ?

Answer 28

loop, thiazide , potassium sparing diuretics ACE inhibitors NSAIDS all associated with a decrease in GFR

Question 29

how are normal phosphate levels maintained in the early stages of CKD ?

Answer 29

increased levels of fibroblast growth factor 23 , which promotes renal excretion of phosphate