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Clin Med- Renal/GU > acute renal failure > Flashcards

acute renal failure Flashcards

1
Q

AKI/ARF Epidemiology

A

1% of patients admitted to hospitals have acute kidney injury (AKI) at the time of admission
Incidence rate of AKI is ~ 2-5% during hospitalization
67% of ICU patients

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2
Q

Nephritic disease are characterized by what?

A

by the presence of an active urine sediment with glomerular hematuria and often with proteinuria

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3
Q

Nephrotic disease is characterized by?

A

proteinuric with bland urine sediments (no cells or cellular cast

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4
Q

prognosis for AKI/ ARF

A

12.5% of survivors of AKI are dialysis dependent
19-31% of them have chronic kidney disease
Stage 3 AKI in patients with advanced CKD – mortality rate 40.7%

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5
Q

Pathophys of AKI/ ARF

A

Initial ischemic insult triggers a cascade
Events continue to cause cell injury even after restoration of RBF
Tubular cellular damage results in disruption of tight junctions between cells, allowing back leak of glomerular filtrate
Dying cells slough off into the tubules, forming obstructing casts, further decreasing GFR

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6
Q

Risk factors for AKI/ARF

A 
Hypertension
Congestive cardiac failure
Diabetes
Multiple myeloma
Chronic infection
CHF
blood loss
exposure
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7
Q

Prerenal Failure symptoms

A

thirst, decreased urine output, dizziness & orthostatic hypotension
mental status change–> elderly
advanced cardiac failure leading to depressed renal perfusion may present with orthopnea and paroxysmal nocturnal dyspnea
Insensible fluid losses can result in severe hypovolemia

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8
Q

ATN (acute tubular necrosis) should be suspected after period of what?

A

hypotension secondary to cardiac arrest, hemorrhage, sepsis, drug overdose, or surgery
Exposure to nephrotoxins

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9
Q

what 3 symptoms indicates glomerular etiology

A

Hematuria, edema, and HTN indicates

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10
Q

Suspect pigment-induced AKI is who?

A

in patients with possible rhabdomyolysis or hemolysis

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11
Q

Suspect allergic interstitial nephritis with what symptoms?

A

with fevers, rash, arthralgias, and exposure to certain medications (NSAIDs)

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12
Q

Postrenal failure

A

Older men with prostatic obstruction
gynecologic surgery or abdominopelvic malignancy
Flank pain & hematuria - possible renal calculi or papillary necrosis
tubular obstruction by crystals

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13
Q

Skin Physical exam for AKI/ARI

A

Livido reticularis, digital ischemia
Systemic vasculitis - butterfly rash, palpable purpura
Maculopapular rash - Allergic interstitial nephritis
Track marks Endocarditis
Petechiae, purpura

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14
Q

Eye physical exam for AKI/ ARI

A 
jaundice
kerititis
uveitis
signs of DM or HTN
ocular palsy
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15
Q

Pulm and ear physical exams for AKI/ ARI

A

hearing loss
rales
hematoptysis

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16
Q

cardiovascular exam for AKI/ ARI

A

murmurs
JVP
rales
volume status is very important– BP, pulse, edema

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17
Q

Signs of Nephrologic Disease (6)

A

reduction in glomerular filtration rate (GFR) (azotemia)
abnormalities of urine sediment
abnormal excretion of serum proteins (proteinuria)
disturbances in urine volume
presence of hypertension and/or expanded total body fluid volume (edema)
electrolyte abnormalities

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18
Q

What are the 2 hallmarks of renal failure?

A

BUN and creatinine elevations

BUN to creatinine can exceed 20:1

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19
Q

What needs to be ruled out if serum creatinine increases to more than 1.5 mg/dL/d

A

serum creatinine increases to more than 1.5 mg/dL/d, rhabdomyolysis must be ruled out

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20
Q

What are 3 specific findings based on etiology for AKI/ARF

A

Myoglobin or free hemoglobin
Increased serum uric acid level
Serum lactate dehydrogenase

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21
Q

What do serological tests show for glomerular disease

A

antinuclear antibody (ANA), ANCA, anti-GBM antibody, hepatitis, and antistreptolysin (ASO) & complement levels

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22
Q

urinanalysis results suggest the presence of myoglobin or hemoglobin

A

Reddish brown or cola-colored urine suggests the presence of myoglobin or hemoglobin

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23
Q

What urinanalysis results would be suggestive of tubular necrosis?

A

granular, muddy-brown casts

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24
Q

What results are suggestive of glomerular inflammation?

A

Dysmorphic RBCs or RBC casts

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25
What results would suggest pyelonephritis or acute interstitial nephritis
WBCs or WBC casts
26
What suggests interstitial nephritis
eosinophils, as visualized with Wright stain or Hansel stain
27
What are Calcium oxalate crystals usually present in?
ethylene glycol poisoning
28
FENa is useful only in what?
may detect extreme renal avidity for sodium | useful only in the presence of oliguria
29
Exceptions to the rule (FENa 
Diuretics within the previous 24 hours Glucosuria Metabolic alkalosis w/ high urinary bicarbonate, obligatory loss of Na Chronic kidney disease with a high baseline Na excretion
30
GFR is related to what?
directly to the urine creatinine excretion and inversely to the serum creatinine (UCr/PCr)
31
Patients that have a bladder pressure of what should be suspected of having AKI
bladder pressures > 25 mm Hg should be suspected of having AKI as a result of abdominal compartment syndrome
32
Ultrasonography is useful for what?
Useful for evaluating existing renal disease and obstruction | showing small kidneys suggest chronic renal failure
33
Doppler ultrasonography
useful for detecting the presence & nature of renal blood flow used to diagnose thromboembolic or renovascular disease
34
What are nuclear scans used for?
assess renal blood flow & tubular functions | Usefulness limited due to marked delay in tubular excretion of radionuclide in prerenal & intrarenal disease
35
Renal Biopsy
In 40% of cases renal biopsy reveal an unexpected diagnosis | Acute cellular or humoral rejection in a transplanted kidney can be definitively diagnosed only by renal biopsy
36
What do you correct severe acidosis with?
with bicarbonate administration can be important as a bridge to dialysis
37
Dietary modification for AKI/ARF
Salt and fluid restriction in oliguric renal failure (unable to excrete toxins or fluids) Potassium and phosphorus are not excreted optimally in patients with AKI, blood levels of these electrolytes tend to be high
38
What is furosemide inhibit?
sodium and chloride reabsorption in the thick ascending loop of Henle and the distal renal tubule
39
Nifedipine
relaxes smooth muscle and produces vasodilation, improves blood flow and oxygen delivery
40
Indications for dialysis in patients with AKI (5)
Volume expansion that cannot be managed with diuretics Hyperkalemia refractory to medical therapy Correction of severe refractory acid-base disturbances Severe azotemia (BUN >80-100) Uremia
41
prerenal AKI/AFI
Most common form of kidney injury decreased renal perfusion volume loss hepatorenal syndrome
42
volume depletion can be caused by?
``` Renal losses (diuretics, polyuria) GI losses (vomiting, diarrhea) Cutaneous losses (burns, Stevens-Johnson syndrome) Hemorrhage Pancreatitis ```
43
decreased cardic output can be caused by?
``` Heart failure Pulmonary embolus Acute myocardial infarction Severe valvular disease Abdominal compartment syndrome ```
44
systemic vasodilation can be caused by?
Sepsis Anaphylaxis Anesthetics Drug overdose
45
Afferent arteriolar vasoconstriction can be caused by the following
Hypercalcemia Drugs Hepatorenal syndrome
46
cardiorenal syndrome signs
Cardiac dysfunction: signs or symptoms of heart failure, ischemic injury or arrhythmias Kidney disease: acute or chronic, depending on type of cardiorenal syndrome.
47
cardiorenal syndrome
disorder of the heart & kidneys wherein the acute or chronic deterioration of one organ results in the acute or chronic deterioration of the other
48
initiation phase of renal damage
ATP depletion resulting in proximal tubule, endothelial, and smooth muscle injury & apoptosis
49
extension phase of renal damage
occurs with persistent ischemia, vascular congestion, and ongoing hypoxia
50
What is the hallmark of intrinsic AKI
Structural injury in the kidney | ischemic, cytotoxic
51
diagnostic features interstitual nephritis
Fever Transient maculopapular rash Acute or chronic kidney injury Pyuria (including eosinophiluria), white blood cell casts, and hematuria Classic triad of fever, rash, and arthralgias
52
Treatment/ prognosis of interstitual nephritis
removal of the inciting agent Short course of corticosteroids can be given if persistent with removal of agent Rarely progresses to ESRD
53
acute tubular necrosis for diagnostic findings
Acute kidney injury Ischemic or toxic insult Urine sediment w/ pigmented granular casts & renal tubular epithelial cells is pathognomonic but not essential
54
Acute Tubular Necrosis Treatment
Avoid volume overload and hyperkalemia Loop diuretics Intravenous thiazide diuretics to augment urinary output Nutritional support preventing excessive catabolism
55
Indications for dialysis in AKI from acute tubular necrosis
life-threatening electrolyte disturbances volume overload unresponsive to diuresis worsening acidosis uremic complications In gravely ill patients, less severe but worsening abnormalities may also be indications for dialysis
56
Diagnostic features for renal artery stenosis
Produced by atherosclerotic occlusive disease (80–90% of patients) or fibromuscular dysplasia (10–15%) Hypertension Acute kidney injury in patients starting ACE inhibitor therapy May have abdominal bruit
57
What is the gold standard for renal artery stenosis?
Renal angiography is the gold standard for diagnosis
58
Renal artery stenosis treatment
Medical management, angioplasty with or without stenting, and surgical bypass, intervention may be no better than optimal medical management Angioplasty Stenting Angioplasty as effective and safer than surgery
59
Angioplasty reduces what?
reduces antihypertensive medications; no change in progression of kidney dysfunction
60
nephritic syndrome
``` HTN cola colored urine oliguria inflammation of the glomeruli IgA= MC of primary glomerulonephritis ```
61
nephrotic
hypoalbuminemia hyperlipidemia peripheral edema massive proteinuria

Clin Med- Renal/GU (7 decks)

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