Acute / Chronic Renal Failure Flashcards by Zachary Schulz

Q

_______ renal failure is defined as a rapid decline in eGFR in combination with an increase in BUN and sCr levels

A

Acute Renal Failure (AKI)

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Q

What are the THREE categories of ARF?

A

Pre-Renal
Intrinsic (Intra-renal)
Post-Renal

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Q

Volume depletion, GI Losses, decreased cardiac output, and systemic vasodilation (ie: sepsis) are all causes of ___-renal ARF.

A

Pre-renal

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Q

Bilateral ureteral obstruction (ie: stones), neoplasms, BPH are all common causes of ____-renal ARF

A

Post-renal

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Q

Renal artery thrombus, Malignant HTN glomerulonephritis, and ATN are all common causes of ____-renal ARF.

A

Intra-Renal (Intrinsic)

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Q

What Medications are considered exotoxins associated with ATN?

A

NSAIDs
ACEi
Aminoglycosides
Cisplatin
Radiocontrast Dye

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Q

Other than renal failure, what could also cause an elevated BUN?

Creatinine?

A

BUN: Steroids, GI Bleed, Hypercatabolism

Creatinine: Muscle breakdown

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Q

What ‘clues’ in the H&P could tip you off to renal failure?

A

Change in Urination 
Heamturia
Prescription Medications
HTN
Recent Contrast

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Q

What radiology may help you work up ARF?

A

US
CT
Angiography

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Q

A BUN and sCr ratio >20:1 would indicate what?

A

Acute Pre-Renal Failure

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Q

If you placed a foley on a patient with ARF and there was a LARGE amount of urine output, where may the ‘problem/obstruction’ be?

Is this pre-renal, post-renal, or intra-renal?

A

Bladder, Urethra, Prostate

Post-Renal

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Q

If you placed a foley on a patient with ARF and there was a SMALL amount of urine output, where may the ‘problem/obstruction’ be?

Is this pre-renal, post-renal, or intra-renal?

A

Ureter

Post-Renal

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Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed WBC Casts, it would indicate what?

A

Pyelonephritis

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Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed Muddy Casts, it would indicate what?

A

ATN

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Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed Waxy Casts, it would indicate what?

A

Chronic Renal Disease

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Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed RBC Casts, it would indicate what?

A

Glomerulonephritis

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Q

In a patient with intrinsic renal failure…..

If the microscopic evaluation revealed Hyaline Casts, it would indicate what?

A

Normal Finding

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Q

How is Pre-Renal Failure treated?

A

Fluid Replacement
Cardiac Support
Shock Treatment

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Q

How is Post-Renal Failure treated?

A

Treat the underlying cause

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Q

How is Intra-Renal Failure treated?

A

Diuretics (Loop)

Dopamine

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Q

What do you need to monitor when working up and managing ARF?

A

Fluids
Electrolytes 
Hematologic (Platelets)
Infection
Arrhythmias
GI Sx
Neurologic (Confusion, Lethargy)

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Q

In what settings does ARF have the highest mortality?

There are THREE

A

Multi-organ Failure
ARDS
Hypotension

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Q

During ARF, when would dialysis be indicated?

Hint: A,E, I, O, U

A

A - Intractable Acidosis
E - Electrolyte Abnormalities
I - Intoxications
O - Fluid Overload
U - Uremia

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Q

______ ______ _____ is defined as a spectrum of different pathological processes associated with abnormal kidney function and progressive decline in eGFR for at least 3 months

A

Chronic Kidney Disease

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What two co-morbidities are commonly seen in patients with CKD? What medication is most commonly seen with CKD?

DM (Leading cause of KD in the USA) HTN NSAIDs

Other than DM, HTN, and NSAID use, what additional risk factors are associate with CKD?

``` CVD Obesity HLD FHx Repeated Episodes of ARF Inheritied Diseases (Alport's, Hyperoxaluria) ```

What THREE types of depositions are commonly seen on histology of CKD?

1. Deposition of immune complexes in situ 2. Deposition of anti-Glomerular Basement Membrane antibodies 3. Depositions of an immunoglobulin in the glomerulus

What Sx may a patient with CKD (Stage 1-3) present with? Would this patient likely be hypertensive or hypotensive? Would you expect the BUN/Cr to be elevated or decreased? What about the eGFR? What might you see on UA?

Sx: Fatigue, Edema, Urination Change, Loss of Appetite Hypertensive BUN/Cr: Elevated eGFR: Decreased UA: Hematuria, Proteinuria

In a patient with Stage 4 CKD or greater would you expect them to possibly be...... Anemic or polycythemic? Acidodic or Alkalodic? Hyperkalemic or hypokalemic? Hypercalcemic or hypocalcemic? Hyperphosphatemic or hypophosphatemic?

Anemic Acidodic Hyperkalemic Hypocalcemic Hyperphosphatemic

A eGFR of 89-60 would indicated Stage __ CKD

2

A eGFR of 29-15 would indicated Stage __ CKD

4

A eGFR of > 90 would indicated Stage __ CKD

1

A eGFR of < 15 would indicated Stage __ CKD

5

A eGFR of 59-30 would indicated Stage __ CKD

3

At what stage does CKD start to become irreversible?

Stage 3-4

At what stage of CKD is a patient considered to have ESRD?

Stage 5

What are the only two treatment options for a patient in Stage 5 CKD (ESRD)?

Dialysis | Transplant

When working up CKD, it is important to obtain a serum and urine electrophoresis to rule out what disease?

Multiple Myeloma

What is the 'Gold Standard' for diagnosing CKD?

eGFR

What type of casts are commonly seen in the urine of a patient with CKD?

Waxy Casts

T/F: Proteinuria and Microalbuminuria are common findings in CKD

True

__________ RBCs are commonly seen on microscopic urinalysis in a patient with CKD. This indicates they are directly coming from the kidneys themselves

Dymorphic RBCs

In a CKD patient, would you expect EPO levels to be elevated or decreased

Decreased

What is the goal BP in a patient with CKD? What medications are recommended for managing BP?

130/80 ACEi ARB Diuretics

What is the goal HBgA1c in a CKD patient?

6.5-7.5%

What is the goal Hgb level in a patient with CKD? What medications are used to manage this?

11-12 EPO Fe2+ Supplementation Anti-platelet therapy

What medication should be AVOIDED in CKD patients?

NSAIDs

Other than the influenza vaccination, what vaccine should be given each year in a patient with CKD?

Pneumoccocal

T/F: Mg2++ should be given to patients with CKD

False It should be avoided

Which Stage 5 CKD management option has the highest success rate?

Transplantation

What is the most common complication of CKD?

Secondary HTN

Secondary HTN in patients with CKD is most commonly a result of ___ and ____ retention in combination of activation of the ____.

Na+ H2O RAAS

T/F: A patient with CKD is more likely to develop metabolic alkalosis

False Metabolic Acidosis

Would you expect a patient with CKD to develop hypoparathyrpoidism or hyperparathyroidism? How is this treated?

Hyperparathyroidism (Secondary) Tx: Vit-D Supplementation

CKD results in elevated Ca2+ and Phosphate levels..... What cardiovascular manifestations may this result in?

MI and CVA (Ischemic) CHF (Increased BP) Pericarditis (Uremic Toxins)

Why may a patient with CKD become anemic? How is this treated?

Decreased levels of EPO production Tx: EPO Supplementation

If a patient ith CKD presents with iron deficiency.... What must you rule out before you can consider it a result of renal pathology?

GI Bleed

Why may CKD result in hypocoagulability?

Uremic toxins inhibit platelet factor III

In a patient with CKD and DM are you more concerned with hypoglycemia or hyperglycemia? Why?

Hypoglycemia Insulin is cleared by the kidneys, so when they fail, less insulin is cleared.

What is a common dermatologic manifestation of CKD? What is this a result of?

Pruritus Build up of nitrogenous waste under the skin

Would you expect a patient with CKD to have a lighter or darker pigmentation?

Darker