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00-01-28: urinary dz > 02 - acute primary renal failure > Flashcards

02 - acute primary renal failure Flashcards

1
Q

(acute primary (instrinsic) renal failure (AIRF))

  1. syndrome when there has been loss of more than 75% of nephron mass - how different from CRF then?
A
  1. possibility for healing of lesions
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2
Q

(acute primary (instrinsic) renal failure (AIRF))

  1. do you see ^ phosphorus in acute or chronic kidney dz?
A
  1. acute (in chronic ^PTH lowers phosphorus)
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3
Q

(acute primary (instrinsic) renal failure (AIRF))

  1. will there be azotemia?
A
  1. yep!
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4
Q

(renal lesions of AIRF)

  1. what is the classical lesion?
  2. what is another possibility?
A
  1. acute tubular necrosis

(secondary to either ishcemic or nephrotoxic causes)

  1. acute interstitial nephritis

(secondary to infectious causes - lepto in dogs)

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5
Q

(ischemic causes of ATN and AIRF)

  1. lots of causes…
A
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6
Q

(nephrotoxins)

  1. what is a true nephrotoxin?
  2. a nephrotoxicant?
A
  1. compound capable of creating renal tubular cell membrane injury directly
  2. cause acute renal injury secondary to causing another condition

(NSAIDS cause hypotension)

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7
Q
A
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8
Q

(AIRF)

1-3. what are the three phases?

A
  1. latent phase
  2. maintenance phase
  3. recovery (or death?)
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9
Q

(AIRF - three phases)

(1st - latent or incipient)

  1. time from initial exposure to the nephrotoxin or ischemic event until there is evidence for renal injury
  2. removal of inciting agent stops further renal injury
A
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10
Q

(AIRF - three phases)

(2nd - maintenance phase)

  1. develops after a critical mass of lethal renal cell injury has occurred
  2. azotemia has developed
  3. fluids, and removal of inciting cause won’t correct azotemia
  4. some will be oliguric or anuric, others may have polyuria
A
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11
Q

(AIRF - three phases)

(phase 3 - end of maintenance phase)

  1. 3 options: death, full recovery, or renal cripple
A
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12
Q

(AIRF)

(tx)

  1. what is the most important aspect of therapy?
  2. important to measure urine output - if not enough urine for awhile use what to ^ urine flow?
  3. dialysis helps but isn’t widely available
A
  1. IV fluid therapy (so kidneys get enough perfusion)
  2. diuretics (if this doesn’t work stop diuretics and decrease IV fluid to avoid overhydration)
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13
Q

(AIRF)

(prog)

  1. what has the best prog?
  2. the worst?
  3. in general, the higher the level of azotemia during maintenance phase, the poorer the prognosis)
A
  1. lepto
  2. ethylene glycol
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14
Q

(AIRF)

(Ethylene Glycol intoxication)

  1. converted to cytotoxic metabolites in the liver by what?
  2. dx based on observation of ingestion, finding a source for possible ingestion, and acute onset of alcohol-like inebriation
  3. PU/PD can be intense shortly after ingestion
  4. azotemia may take greater than 24 hours
A
  1. alcohol dehydrogenase
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15
Q

(AIRF)

(Ethylene Glycol intoxication)

(treatment)

  1. what is best BEFORE EG has been completely metabolized?
  2. tx for anuric dogs?
A
  1. 4-methylpyrazole (antagonizes alcohol dehydrogenase)

(cats require really high doses)

(can also use alcohol)

  1. hemodialysis - if they don’t get this they’ll die
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16
Q

(AIRF)

(leptospirosis)

  1. usually get from what?
  2. now that there is a vx to protect, usually get from atypical serovars (wildlife and farm animals)
  3. oliguria is initally pre-renal, becomes primary as renal lesions accrue
  4. USG often what when AIRF diagnosed?
A
  1. drinking water
  2. isosthenuric
17
Q

(AIRF)

(lepto)

  1. drug to clear organisms from most of body?
  2. to clear carrier state?
  3. also give supportive treatment with IV fluids
  4. prog?
A
  1. penicillin
  2. doxycycline
  3. good if treated early enough
18
Q

(AIRF)

(parenteral abx)

  1. cause AIRF from acute tubular necrosis
  2. all IV abx can at times cause AIRF, what causes the most though?
A
  1. aminoglycosides
19
Q

(AIRF)

(lily intoxication)

  1. only in cats
  2. all parts of lily are toxic, only a small part needs to be eaten
  3. severe azotemia and oligoanuria can be seen. despite massive azotemia some cats have recovered
  4. there is no antidote -> specific toxin yet to be isolated
A
20
Q

(AIRF)

(raisin or grape ingestion)

  1. only in dogs
  2. no antidote availabe; toxin unknown
  3. tx?
A
  1. gastric decontamination
21
Q

(AIRF)

(NSAID ingestion)

  1. can cause AIRF/ATN how?
  2. how can you prevent?
A
  1. causes vasoconstriction -> decreased perfusion

(NSAIDs interfere with kidney’s production of vasodilatory prostaglandins)

  1. ensure euvolemia until NSAID is cleared
22
Q

(AIRF)

(hypercalcemia)

  1. usually occurs following exposure to what?
A
  1. vitamin D or its metabolites, cholecalciferol (rat poison)
23
Q
A

00-01-28: urinary dz (10 decks)

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