Acute / Chronic Renal Failure Flashcards
_______ renal failure is defined as a rapid decline in eGFR in combination with an increase in BUN and sCr levels
Acute Renal Failure (AKI)
What are the THREE categories of ARF?
- Pre-Renal
- Intrinsic (Intra-renal)
- Post-Renal
Volume depletion, GI Losses, decreased cardiac output, and systemic vasodilation (ie: sepsis) are all causes of ___-renal ARF.
Pre-renal
Bilateral ureteral obstruction (ie: stones), neoplasms, BPH are all common causes of ____-renal ARF
Post-renal
Renal artery thrombus, Malignant HTN glomerulonephritis, and ATN are all common causes of ____-renal ARF.
Intra-Renal (Intrinsic)
What Medications are considered exotoxins associated with ATN?
NSAIDs ACEi Aminoglycosides Cisplatin Radiocontrast Dye
Other than renal failure, what could also cause an elevated BUN?
Creatinine?
BUN: Steroids, GI Bleed, Hypercatabolism
Creatinine: Muscle breakdown
What ‘clues’ in the H&P could tip you off to renal failure?
Change in Urination Heamturia Prescription Medications HTN Recent Contrast
What radiology may help you work up ARF?
US
CT
Angiography
A BUN and sCr ratio >20:1 would indicate what?
Acute Pre-Renal Failure
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?
Bladder, Urethra, Prostate
Post-Renal
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?
Ureter
Post-Renal
In a patient with intrinsic renal failure…..
If the microscopic evaluation revealed WBC Casts, it would indicate what?
Pyelonephritis
In a patient with intrinsic renal failure…..
If the microscopic evaluation revealed Muddy Casts, it would indicate what?
ATN
In a patient with intrinsic renal failure…..
If the microscopic evaluation revealed Waxy Casts, it would indicate what?
Chronic Renal Disease
In a patient with intrinsic renal failure…..
If the microscopic evaluation revealed RBC Casts, it would indicate what?
Glomerulonephritis
In a patient with intrinsic renal failure…..
If the microscopic evaluation revealed Hyaline Casts, it would indicate what?
Normal Finding
How is Pre-Renal Failure treated?
Fluid Replacement
Cardiac Support
Shock Treatment
How is Post-Renal Failure treated?
Treat the underlying cause
How is Intra-Renal Failure treated?
Diuretics (Loop)
Dopamine
What do you need to monitor when working up and managing ARF?
Fluids Electrolytes Hematologic (Platelets) Infection Arrhythmias GI Sx Neurologic (Confusion, Lethargy)
In what settings does ARF have the highest mortality?
There are THREE
Multi-organ Failure
ARDS
Hypotension
During ARF, when would dialysis be indicated?
Hint: A,E, I, O, U
A - Intractable Acidosis E - Electrolyte Abnormalities I - Intoxications O - Fluid Overload U - Uremia
______ ______ _____ is defined as a spectrum of different pathological processes associated with abnormal kidney function and progressive decline in eGFR for at least 3 months
Chronic Kidney Disease
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?
- Deposition of immune complexes in situ
- Deposition of anti-Glomerular Basement Membrane antibodies
- 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
