15-16 Flashcards
Diagnosing HRS
Low GFR Cr>1.5 Does not respond to fluids No proteinuria Low urine output <500ml/day FENa <1 Urine osm high Na <130
Tx of HRS general
Large volume paracentesis (for edema and ascites)
Avoid overyhydration
Abx if infected
IV steroids for sepsis and renal failure
First line pharmacological therapy for HRS is ___
Albumin and terlipressin (use NE/levophed if not available)
Octreotide
In treating HRS, titrate all meds to increase MAP by how much?
10
cardiorenal syndrome types
1-2 acute CHF leads to AKI or Chronic CHF leads to CKD
3-4 AKI leads to CHF or CKD leads to CHF
5 systemic disorders lead to both AKI AND CHF
Main pathology for cardiorenal syndrome is ____
Volume overload and venous congestion leading to AKI
Pathogenesis of Cardiorenal syndrome
Decreased Cardiac Output Low renal perfusion Activation of renin/Ang Anemia NSAIDs/ACEI/ARB can cause problems
Tx for cardiorenal syndrome
Loops ACEI/ARB Beta blockers Vasodilators Inotropes Dialysis
What is rhabdomyolysis?
Disintegration of striated muscle
-key component is myoglobin, which reaches kidneys and causes dysfunction
Things that can cause rhabdomyolysis
Quail Crush injuries Vascular occlusion (no perfusion) Immobility/compression Trauma
Dx rhabdomyolysis
Blood on dipstick but not on microscope
Urine myoglobin high
CPK high >5000
Contrast nephrotoxicity:
What is the most significant risk?
Renal insufficiency
Main pathophysiology for ARF is ____
Renal vasoconstriction and dehydration
In rhabdomyolysis, fluid accumulates in the affected limb. Dehydration initially causes ____. And you get ___ due to the release of ___ from dying muscles
Hyperalbuminemia
Metabolic acidosis
Organic acids
In rhabdomyolysis ___ accumulates in muscles and ___ is released from muscles
Ca
Phosphorus
