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Clin Med 2 > acute and chronic renal failure > Flashcards

acute and chronic renal failure Flashcards

1
Q

What are the three main ways to approach renal disease?

A

1) HOW
-Duration, UA (+/- protein), GFR
2) Type of azotemia?
3) Duration
acute (hours and days)
chronic (months to years)

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2
Q

How much time can elapse before collection and analysis of UA?

A

No more than 1 hour!

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3
Q

heavy proteinuria and lipiduria

A

Nephrotic syndrome

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4
Q

hematuria, RBC casts, and mild proteinuria

A

glomerulonephritis

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5
Q

WBC, WBC casts, and mild proteinuria

A

interstitial nephritis

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6
Q

WBC alone suggests

A

pyelonephritis

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7
Q

Pyuria suggests

A

UTI (lower)

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8
Q

What might an albumin spike be suggestive of?

A

an abnormality in glomerular basement membrane

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9
Q

What conditions might elevate serum creatinine?

A

Ketoacidosis, drugs such as cefoxitin, aspirin, cimetidine, trimethoprim

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10
Q

What conditions decrease creatinine?

A

Advanced age, cachexia, liver disease

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11
Q

What causes an increase in BUN?

A

Dehydration, GI bleed, steroid use, CHF

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12
Q

What causes a decrease in BUN?

A

liver disease

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13
Q

What imaging studies are indicated in renal failure?

A

U/S, IVP, CT (for neoplasms)

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14
Q

What are contraindications for IVP contrast?

A

DM with Cr>2.0
chronic renal failure with Cr>5.0
MM

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15
Q

What is used in place of CT when contrast is contraindicated?

A

MRI

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16
Q

What is the main indication for percutaneous needle biopsy?

A

Unexplained renal failure, proteinuria, lesions

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17
Q

A or C RF: Which has elevated Cr? In which is BUN and Cr elevated?

A

Acute; Chronic

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18
Q

A or C RF: Which has minimal proteinuria? More proteinuria?

A

Acute; Chronic

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19
Q

A or C RF: Which has elevated PTH with high calcium and alkalne phosphatase? Which has normal PTH?

A

Chronic; Acute

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20
Q

A or C RF: Which presents with anemia? Which has a normal CBC?

A

Chronic, Acute

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21
Q

A or C RF: Which has a small kidney? Which has a normal sized kidney?

A

Chronic; Acute

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22
Q

A or C RF: Which presents with oliguria? Which has gradual fluid retention?

A

Acute (sudden); Chronic

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23
Q

ACF presentation

A 
Sudden increase in BUN or Cr
oliguria
N/V
malaise, confusion
pericardial effusion, friction rub
\+/- rales in the lung
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24
Q

ACF labs

A

+/- hyperkalemia, anemia from decreased erythropoietin

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25
Q

What is the most common cause of acute renal failure?

A

Prerenal azotemia (due to HYPOPERFUSION)

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26
Q

What causes decreased renal perfusion?

A

a decrease in IV volume, a change in vascular resistance (sepsis, ACE-I, NSAIDs, Epi), low cardiac output (CHF, PE, arrhythmias)

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27
Q

What should you do in the very beginning of diagnosing prerenal azotemia?

A

Do a careful assessment of volume status (mucosal membranes), drug usage, and cardiac function (orthostatic, edema)

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28
Q

UA prerenal azotemia

A

volume depletion, tubular casts

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29
Q

Labs prerenal

A

high BUN/Cr,

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30
Q

in what cause of prerenal azotemia will urine sodium be low? high?

A

Volume depletion; acute tubular necrosis

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31
Q

What is the least common but most important cause of ACF?

A

post renal azotemia due to urine flow obstruction

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32
Q

What is the most common cause of Postrenal azotemia in men? What are other causes?

A

BPH; anticholinergic drugs, stones

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33
Q

What are signs and symptoms of ACF?

A

Lower abd pain, distended bladder

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34
Q

What are labs in ACF?

A

High urine osmolality, low urine sodium, high BUN/Cr

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35
Q

If you suspect postrenal as a cause of ACF, which studies should you do?

A

1) bladder U/S or catheterization.

If normal, consider CT or MRI

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36
Q

What constitutes 50% of renal failure? What must you exclude before you diagnose this as the cause?

A

Intrinsic renal failure; exclude prerenal and postrenal causes

37
Q

What accounts for 85% of intrinsic renal failure? What are the major causes of this?

A

Acute tubular necrosis; Ischemia and exogenous toxins

38
Q

What is the origination of ischemia that might cause acute tubular necrosis?

A

When prerenal azotemia is not corrected, i.e. hypotension, hypoxemia, dehydration, shock or sepsis

39
Q

What is the origin of toxins that might cause ATN?

A

AGs, some cephalosporins, contrast media (esp in DM), cyclosporine for transplant rejection

40
Q

What are some endogenous toxins that can cause ATN?

A

Myoglobinuria, hemoglobin, bence jones protein

41
Q

What will labs of intrinsic renal failure show?

A

UA shows brown urine and pigmented granular casts, may see hyperkalemia and hyperphosphatemia (increased reabsorption)

42
Q

What is the main goal of treatment of acute tubular necrosis?

A

Avoid volume overload and hyperkalemia, try loop diuretics and restriction of dietary protein

43
Q

When do you think of dialysis for a patient with ATN?

A

With a life threatening electrolyte disturbance, no response to diuresis, worsening acidosis (tried insulin and glucose for entry of hyperkalemia and it’s not working…)

44
Q

What is the prognosis for ATN?

A

20-50% in medical illness, 70% in surgery. Increased mortality with advanced age and comorbidities

45
Q

What percentage of interstitial nephritis is caused by drugs?

A

70%, usually PCN, cephs, sulfas, NSAIDs, allopurinol

46
Q

What infections can cause interstitial nephritis?

A

strep, CMV, histoplasmosis

47
Q

What are the signs and symptoms of interstitial nephritis?

A

Fever (infectious origin), rash, arthralgias

48
Q

What will labs show with interstitial nephritis?

A

Peripheral blood eosinophila, +/- RBCs WBCs and white cell casts
Proteinuria if NSAIDS are the cause

49
Q

What is the treatment for interstitial nephritis?

A

removal of offending agent and short term, high dose prednisone, good prognosis

50
Q

What is an uncommon cause of RF that presents with HTN, periorbital and scrotal edema, hematuria, proteinuria, and red cell casts? What is the treatment?

A

Glomerulonephritis; high dose steroids (unless it’s post strep)

51
Q

What is a cause of ARF that is a/w high ASO titer and cola-colored urine?

A

Post-infectious glomerulonephritis

52
Q

What is the most common form of glomerulonephropathy in the US? In whom is it see? What is its common presenting complaint?

A

IgA nephropathy; children and young adults; gross hematuria is most common presenting complaint

53
Q

What other signs are seen in IgA nephropathy?

A

cola-colored or red urine, asymptomatic hematuria, serum IgA increase in 50%

54
Q

How do you diagnose IgA nephropathy? What is the prognosis?

A

Renal biopsy; 33% enter remission, 40-50% progress to renal insufficiency

55
Q

What are two types of membranous nephropathies?

A

Immune-mediated and amyloidosis

56
Q

What are some causes of immune-mediated membranous nephropathy?

A

hep B, endocarditis, SLE, thyroiditis, CA

57
Q

Where does amyloidosis originate? What is the prognosis?

A

enter ESRD in 2-3 years, 5 year survival is less than 20%

58
Q

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

A

DM>HTN

59
Q

What is one additional sign of CRD as opposed to ARD

A

Uremic fetor as BUN increases (fishy odor on breath)

60
Q

What is the key to treatment in any pt with renal failure?

A 
Identify and correct all possibly reversible causes, i.e.
UTI
HTN
CHF
Toxins
61
Q

Labs of CRF

A

elevated BUN and Cr

62
Q

Imaging and diagnosis of CRF

A

U/S reveals bilat small kidneys

63
Q

Complications of CRF

A

Hyperkalemia from endogenous or exogenous causes
Metabolic acidosis from limiting production of ammonia for H+ excretion in the kidney
HTN from salt and water retention
CHF from ECF overload

64
Q

Treatments for CRF

A

Protein restriction
salt and water restriction
potassium restriction

65
Q

What is the major complication of standard dialysis?

A

Hypotension

66
Q

What is the major complication of peritoneal dialysis?

A

Peritonitis

67
Q

What are the indications for dialysis in CRF?

A

Uremic symptoms appear, fluid overload unresponsive to diuretics, refractory hyperkalemia, severe metabolic acidosis, neuro symptoms

68
Q

Nephrotic syndome

A

urine protein >3.5g/24 hours, albumin <3 grams, and peripheral edema

69
Q

What is the CP of nephrotic syndrome?

A

Edema due to sodium retention, dyspnea due to pulmonary edema, pleural effusions, or ascites
HYPERLIPIDEMIA

70
Q

When do you get a biopsy for nephrotic syndrome?

A

Anytime DM or amyloid IS NOT the cause

71
Q

treatment for nephrotic syndrome

A

moderate protein restriction to avoid negative nitrogen balance
dietary salt restriction and probs diuretic tx (thiazide or loop) if hypoalbuminemia, may need to increase diuretic dose

72
Q

What should you do to treat nephrotic syndrome if serum albumin is less than 2 grams?

A

May need AC therapy due to losses of antithrombin III, Protein C, and Protein S

73
Q

What is the most common cause of ESRD in the US?

A

Diabetic nephropathy

74
Q

What can be used to prevent diabetic nephropathy?

A

microalbuminuria screens, strict glycemic control and treatment of HTN, ACE inhibitors

75
Q

You have all signs of CRF plus UA hematuria. What is at the top of your differential?

A

Acute tubulointerstitial disease

76
Q

What do you need to diagnose acute tubulointerstitial disease?

A

U/S, CT, maybe MRI

77
Q

What is the cause of chronic tubulointerstitial disease?

A

obstructive uropathy, vesicoureteral reflux, analgesics, or heavy metals

78
Q

What are the most common causes of obstructive uropathy leading to chronic tubulointerstitial disease?

A

prostatic disease, bilateral uterteral calculi,

CA of cervix, colon, or bladder

79
Q

Kid with chronic UTI. What is it and how do you diagnose?

A

vesicoureteral reflux; U/S or IVP

80
Q

What are the effects of aspirin, NSAIDs, and acetaminophen on the kidneys?

A

Chronic tubulointerstitial disease–decreases medullary blood flow

81
Q

What do you see with tylenol, ibuprofen, and aspirin overdoses?

A

hematuria, mild proteinuria, polyuria, or anemia

DO AN IVP

82
Q

signs and sx of tubulointerstitial dz

A

polyuria due to damage to tubular area causing inability to concentrate urine
hyperkalemia (aldosterone resistance)
hyperchloremic acidosis due to reduced ammonia

83
Q

simple cyst in 50% of people over age 50. What is it, how do you diagnose/differentiate?

A

cystic disease of the kidney, must do an ultrasound or CT to differentiate from malignancy

84
Q

How to qualify as a simple cyst?

A

echo-free, sharply demarcated with smooth walls, an enhanced back wall

85
Q

PKD can cause CRF. Sx?

A

50% in ESRD by 60. abdo or flank pain with hematuria

86
Q

MM protein can’t be detected on a dipstick. Why?

A

light chain

87
Q

Primary manifestation of sickle cell dz

A

proteinuria

88
Q

Why do more adverse side effects occur in older population?

A

altered Vd, altered drug half life, altered elimination

Clin Med 2 (13 decks)

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