13-14

Question 1

Prerenal or functional renal failure is caused by a reduction in ___

Answer 1

Glomerular perfusion

Question 2

Most prerenal ARF is caused by a decrease in ___

Answer 2

Effective intra-arterial volume

Question 3

RBF remains remarkably constant through autoregulation despite wide variations in ____

Answer 3

BP and renal perfusion pressure from 70-150 mmHg

Question 4

Maintenance of GFR is by combined ___

Answer 4

Afferent arteriolar vasodilation and efferent arteriolar vasoconstriction, which increases FF contributing to Na ad H2O retention

Question 5

___ constructs the efferent arteriole and is the predominant influence in maintaining GFR

Answer 5

Ang II

Question 6

BUN:Cr in acute renal failure (ARF)

Answer 6

>20:1  = prerenal failure
<5-10:1 = liver disease

Question 7

Muddy brown, dirty brown casts, DARK, think ___

But no blood or protein

Answer 7

Acute tubular necrosis

Question 8

With prerenal azotemia and ATN what will you find with US?

Answer 8

Normal kidneys

Question 9

What segments in the kidney are most susceptible to ischemia and nephrotoxins

Answer 9

PT

Thick a limb

Question 10

3 phases of ATN

Answer 10

1. Initial: ischemia or toxin exposure
2. Maintenance: injury is established. GFR stabilizes at 5-10 urine output is lowest at this point
3. Recovery: gradual rise in urine output and decrease in Cr caused by diuresis from salt and water accumulation

Question 11

Tx of acute kidney injury:
Intravascular volume depletion:
___ is the replacement fluid of choice until stabilized.

Answer 11

NaCl - 0.9% - normal saline

Crystalloids

Question 12

Tx of acute kidney injury:
Decreased Effective Volume:
Bacterial sepsis causes excessive ___ and ____. Treatment includes ____ and _____

Answer 12

Vasodilation and intrarenal vasoconstriction

Tx: NaCl and vasopressors

Question 13

Tx of acute kidney injury:
Decreased Effective Volume:
Cirrhosis tx:

Answer 13

Lasix

Spironolactone

Question 14

I’m treatment of impaired renal compensatory responses, stop use of ____

Answer 14

NSAIDs and ACEI

Question 15

Pharmacological therapy for ATN:

What not to use/do

Answer 15

Dopamine
Loop diuretics
ANP 
Fenoldopan
Acetylcysteine
Protein restriction

Question 16

therapy for ATN:

Keep blood sugar between ____

Answer 16

110-149 mg/dL

Question 17

Profound renal vasoconstriction in the setting o histologically normal kidneys

Answer 17

Hepatorenal syndrome

Question 18

Hepatorenal syndrome resembles prerenal azotemia. The defining feature is ___

Answer 18

Lack of improvement with volume expansion. Improves with liver transplant

Question 19

Hepatorenal syndrome pathogenesis:

*primary mechanism is decrease in ____ which leads to hyperdynamic circulation and activation of vasoconstrictor systems

Answer 19

Impaired Na and H2O handling leads to fluid retention causing ascites and edema.
*splanchnic and systemic vascular resistance

Question 20

Pathophys of HRS:
- a reduction in ____ due to ____ in the splanchnic circulation, triggered by ____. Caused by increased production or activity of ____, such as ____

Answer 20

1. SVR
2. Primary arterial vasodilation
3. Portal HTN
4. Vasodilator factors
5. NO, Carbon monoxide, endogenous cannabinoids

Question 21

HRS has a ___ survival rate

Answer 21

Very low

Question 22

HRS
Stage 1
Stage 2

Answer 22

1. Portal HTN is moderate, increased Cardiac output increases to compensate for decreased vascular resistance
2. Severe portal HTN, cardiac output cannot compensate, vasoconstrictors are activated.

Question 23

HRS

Causes ____ retention which leads to ascites and edema. This leads to renal failure by causing ____

Answer 23

Na and H2O

Cortical vasoconstriction and hypoperfusion

Question 24

Renal failure rarely occurs in cirrhosis without ___

Answer 24

Ascites

Question 25

HRS

Type I

Answer 25

Rapid decline in renal function
At least double Cr >2.5 or reduction of Clearance of Cr by 50% or more to <20ml/min over duration of <2 weeks
Bad prognosis

Question 26

Type I HRS is usually seen in which patients?

Answer 26

Hospitalized with advanced cirrhosis or fulminate hepatic failure

Question 27

HRS

Type II

Answer 27

Moderate or stable reduction in GFR 
Cr=2
Insidious onset
Slow progression 
Better prognosis