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Clin Med III - GU/Renal > Acute Renal Failure > Flashcards

Acute Renal Failure Flashcards

1
Q

Define azotemia

A

Excess of urea or other nitrogenous compounds in blood (aka high BUN)

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2
Q

MC causes of AKI

A
  • Prerenal (RBF, 40-80% of cases)
  • Intrinsic renal (small vessels, glomeruli, tubules)
  • Postrenal (obstruction to urine flow in ureters, bladder, urethra)
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3
Q

Pathophys of AKI

A
  • Low RBF leads to ischemia and cell death
  • Continued cell injury even after restoration of RBF
  • GFR is decreased and infiltrates leak
  • Dying cells slough off which obstruct tubules
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4
Q

Recovery from AKI is dependent upon what?

A

Restoration of normal RBF

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5
Q

Clinical presentation of prerenal failure

A
  • Hypovolemia
  • Elders w/vague mental status
  • CHF w/low renal perfusion
  • Restricted fluid access
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6
Q

Clinical presentation of intrinsic renal failure

A
  • Nephritic syndrome
  • Acute tubular necrosis
  • Pigment induced AKI
  • Allergic interstitial nephritis
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7
Q

Nephritic diseases are characterized by:

A

Active urine sediment w/glomerular hematuria (and often with proteinuria)

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8
Q

Clinical presentation of postrenal failure

A
  • Older men w/prostatic obstruction
  • Gyn surgery or abd/pelvic malignancy
  • Flank pain and hematuria
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9
Q

What is the most important thing to assess in clinical presentation of AKI?

A

Volume status!

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10
Q

Relationship of urine output and AKI?

A
  • Most causes of AKI are nonoliguric

- Normal urine output

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11
Q

Interpretation of urine electrolytes

A

May be erroneous in nonoliguric states (normal urine output)

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12
Q

What is FENa?

A
  • Marker of Na excretion in kidneys
  • Useful only in oliguria (to determine whether prerenal or intrinisic failure)
  • Less than 1% is prerenal
  • Greater than 1% is ATN
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13
Q

How is GFR measured for kidney function?

A
  • Not possible to measure directly

- Serum Cr is used as a surrogate to calculate (estimate) GFR

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14
Q

Treatment of AKI

A

-Correct volume and electrolytes
-Avoid nephrotoxic agents, adjust doses of renal excreted meds
-Salt and fluid restriction
(mainly supportive tx)

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15
Q

What are the RIFLE criteria?

A
  • Uniform, accepted definition of AKI

- Risk, Injury, Failure, Loss, ESRD

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16
Q

Iatrogenic renal injury occurs MC when?

A

When RBF is low

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17
Q

What happens once RBF is restored?

A
  • Remaining functional nephrons increase their filtration leading to hypertrophy
  • Continued hyperfiltration results in progressive glomerular sclerosis
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18
Q

How does urine output correlate with GFR?

A

Urine output does NOT correlate well with changes in GFR

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19
Q

How does urine output present in most cases of AKI?

A

50-60% of all causes of AKI are nonoliguric (urine output does not change)

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20
Q

If serum Cr is greater than or equal to 1.5 mg/dL/day, what must be ruled out?

A

Rhabdomyolysis

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21
Q

What is a quick way to determine furosemide dose?

A

Age + BUN

22
Q

How does AKI MC present in children?

A

Prerenal - hypovolemia due to gastroenteritis (profuse vomiting)

23
Q

What should be suspected when bladder pressure is over 25 mm Hg?

A

Suspect AKI as a result of abdominal compartment syndrome

24
Q

What is the hallmark of intrinsic failure?

A

Structural injury in the kidney (either ischemic or cytotoxic)

25
Q

What causes most cases of intrinsic failure AKI?

A

Acute tubular necrosis (ATN)

26
Q

Where is the main site of cell death in ATN?

A

Distal nephron

27
Q

What causes the reduced GFR in ATN?

A

Intrarenal vasoconstriction

28
Q

What is found on urinalysis that indicates ATN?

A

Urine sediment with pigmented granular casts and renal tubular epithelial cells

29
Q

What are the major causes of ATN?

A

Ischemic (inadequate GFR/RBF)

Exogenous nephrotoxins

30
Q

How to treat ATN?

A
  • Avoid volume overload and hyperkalemia
  • Loop diuretics, IV thiazides
  • Nutrition support preventing excessive catabolism
31
Q

What causes interstitial nephritis?

A

70% of cases caused by hypersensitivity to drugs (penicillins, cephalosporins, sulfas, NSAIDs, PPIs, etc.)

32
Q

How does interstitial nephritis present?

A
  • Fever
  • Transient rash
  • Acute/chronic kidney injury
  • Pyuria
33
Q

Treatment of interstitial nephritis?

A
  • Supportive including removal of inciting agent

- Short course of steroids if necessary

34
Q

Prognosis of interstitial nephritis?

A

Good prognosis, rarely progresses to ESRD

35
Q

Describe glomerulonephritis

A
  • Intrinsic failure AKI

- Caused by immune reaction

36
Q

What is the universal finding of glomerulonephritis?

A

Hematuria

37
Q

What does urinalysis show for GN?

A

RBC casts

38
Q

What causes postrenal AKI?

A
  • Tubular obstruction from crystals
  • BPH, prostate cancer
  • Renal vein thrombosis
  • Intra-abdominal HTN
39
Q

Classic presentation of vascular AKI?

A
  • Lower extremity rash
  • Livedo reticularis
  • Eosinophils in urine
40
Q

Treatment of vascular AKI?

A

BP should be controlled and further intra-arterial procedures should be limited

41
Q

How does vascular AKI occur?

A

1 day to several weeks after undergoing invasive vascular procedure or major trauma

42
Q

Causes of renal artery stenosis

A
  • Athero (80-90%)
  • Fibromuscular dysplasia (rare)
  • HTN
  • Patients starting ACEI
43
Q

How does renal artery stenosis present?

A
  • Refractory or new onset HTN
  • Pulm edema w/poorly controlled BP
  • AKI upon starting ACEI
44
Q

How is renal artery stenosis diagnosed?

A

Renal angiography

45
Q

How does fibromuscular dysplasia present?

A

“Beads on a string” on renal angiography

46
Q

Treatment of renal artery stenosis?

A
  • Medical management

- Angioplasty with or w/o stenting

47
Q

What are the nephritic glomerular diseases?

A
  • Postinfectious GN
  • IgA nephropathy
  • Henoch Schonlein Purpura
  • Pauci-Immune GN
  • Anti-GBM GN (Goodpasture)
  • Cryoglobulin GN
  • Idiopathic MPGN
  • HCV and SLE
48
Q

What are the nephrotic glomerular diseases classified into?

A

Primary renal disorders

Systemic disorders

49
Q

What are the primary renal nephrotic glomerular diseases?

A
  • Minimal Change Disease
  • Membranous nephropathy
  • Focal segmental glomerulosclerosis
50
Q

What are the systemic nephrotic glomerular diseases?

A
  • Amyloidosis
  • Diabetic nephropathy
  • HIV associated nephropathy

Clin Med III - GU/Renal (9 decks)

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