Acute Renal Failure Flashcards

1
Q

What is acute renal failure?

A

ARF refers to a syndrome of rapidly deteriorating GFR with the accumulation of nitrogenous wastes (urea and creatinine) refered to as azotemia. Serum creatinine acutely increases by more than 0.5 mg/dL or more than 50% over baseline levels.

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2
Q

What are the criteria for AKI?

A

RIFLE: Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and ESRD.

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3
Q

What two diseases account for most of the cases of ARF?

A

reduced renal perfusion and acute tubular necrosis

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4
Q

What are the categories of ARF?

A

pre-renal, renal, and post-renal

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5
Q

What is a key element that can help distinguish the cause of ARF?

A

A thorough medical history

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6
Q

What are the general symptoms of ARF?

A

N/V, diarrhea, pruritis, drowsiness, dizziness, hiccups, SOB, anorexia and hematochezia.

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7
Q

What are the common physical findings for pre-renal ARF?

A

tachycardia and hypotension

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8
Q

What are the common physical findings for post-renal ARF?

A

a distended bladder, CVA tenderness, or enlarged prostate

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9
Q

What is the key parameter to measure renal function?

A

GFR

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10
Q

What is the UA for post-renal ARF? Pre-renal?

A

Both have generally normal UA, with only a few hyaline casts.

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11
Q

What is the UA for a renal ARF?

A

Granular casts, WBCs and casts, RBCs and casts, proteinuria and tubular epithelial cells indicate intrinsic renal causes

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12
Q

Low GFR, Low urine sodium, accompanied by elevated urine osmolality, BUN:Cr (> 20:1), and specific gravity would be characteristics of which type of ARF?

A

Pre-renal

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13
Q

Decreased BUN:Cr accompanied with increased FeNa and urine sodium would be characteristics of which type of ARF?

A

Intrinsic Renal

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14
Q

What can you do if the presentation is undistinguishable between acute and chronic kidney disease? What will you see?

A

Renal US, a smaller kidney will indicate chronic disease

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15
Q

How do we treat ARF?

A

Treatment involves correction of the underlying problem. Achieve normal hemodynamics if pre-renal, adjust and avoid nephrotoxic medications in intrinsic renal, relieve obstruction in post-renal.

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16
Q

What type of acid base disorder is usually accompanying ARF?

A

Anion gap or non-anion gap metabolic acidosis

17
Q

What is the most common type of ARF?

A

Pre-renal

18
Q

What is the diagnostic study of choice for identifying acute tubular necrosis?

A

FeNa, it will be the only kidney disease with a value greater than 1%, Urinary Na will also be > 20.

19
Q

What is the etiology of acute interstitial nephritis?

A

allergic reaction, drug reaction, infection, or collagen vascular disease

20
Q

What do we find on the UA of ATN and AIN?

A

ATN- granular (muddy brown) casts, renal tubular casts

AIN- WBCs and casts w/ or w/out eosinophils