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Genitourinary > Acute Renal Failure > Flashcards

Acute Renal Failure Flashcards

1
Q

Percentage of pt’t that have some degree of Acute renal failure upon admission to hospitial

A

5%

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2
Q

About ____ percentage of all hospitalized pts will develop ARF during hospitalization

A

25%
typically secondary to:
medications, illness, sx, radiologic contrast, etc

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3
Q

Approximately ____ percent of all ICU pts have ARF

A

30%

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4
Q

True or False- ACF although potentially dangerous is not known to cause in increase in mortality in hospitalizations

A

False- there is an increased mortality and poorer outcomes in ARF pts

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5
Q

Diagnostic criteria for Acute Kidney Injury in pts includes any of the following:

A

Increase in serum creatinine by ≥ 0.3 mg/dL within 48 hours

Increase in serum creatinin to ≥ 1.5 times baselin, which is known or presumed to have occurred within prior 7 days

Urine volume < 0.5 mL/kg/hr for 6 hours (or < 500 mL in 24 hrs)

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6
Q

Stage 1 ARI correlates with

A

serum creatinine increase in ≥ o.3 mg/dL or to 150%-200% from baseline

Urine output- < 0.5 mL/kg/hr for >6 hours

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7
Q

Stage 2 ARI correlates to

A

Serum creatinine increase to 201%-300% from baseline

Urine output of < .5 mL/kg/hr for >12hours

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8
Q

Stage 3 ARI correlates to

A

Serum increase >300% from baseline or ≥ 4mg/dL with acute increase of at least .5 mg/dL

Urine output

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9
Q

True or false- GFR is decreased when there is ARF

A

True

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10
Q

Decreased GFR results in accumulation of ______ _____ which can be tested

A

Nitrogenous waste (BUN and Creatinine)

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11
Q

Azotemia is

A

the laboratory increase in BUN and Creatinine

Uremia- Pathologic . manifestation fo Azotemia (these pts are ill)

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12
Q

3 main categories of classification of Acute Kidney Injury

A

Pre-Renal Azotemia
Intinsic (Intra-renal) Azotemia
Post-Renal Azotemia

pre renal- problem before kidneys such as blood flow

Intrinsic- inside the functional cells of the kidney

Post- down stream things that are prolematic after renal pelvis

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13
Q

Other names for Pre-renal AKI , Intrinsic AKI, and Post-renal AKI

A

Renal hypoperfusion
Direct Renal Organ Damage
Urinary Outflow Obstruction

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14
Q

Pre-Renal Causes are the most common causing what percentage of ARF cases

A

40-80%

Whatever the cause think renal hypoperfusion where the body is unable to maintain adequate blood flow to the kidneys

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15
Q

Causes of Pre-Renal AKF include:

A 
Hypovolemia 
hypotension
ineffective circulation
AAA 
Renal Artery stenosis 
Nearby Neoplasm
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16
Q

Treatment of pre-renal Acute Kidney Injury

A

Dependent on cause
however maintenance of intravascular volume levels
-attention to serum electrolyte imbalances,
-avoidance of nephrotoxic drugs

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17
Q

Intrinsic renal causes are the case in up to ____ percent of ARF

A

50%

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18
Q

Sites of damage with intrinsic Kidney injury include:

A

Glomeruli, the interstitium, and or the tubules

Think direct organ insult

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19
Q

Most common cause of intrinsic Reanal causes

A

Acute Tubular necrosis

Disease that is secondary to ischemia or nephrotoxins

prolonged pre- renal AKI can become intrinsic AKI

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20
Q

Other causes of Intrinsic Renal ARF

A

Acute interstitial Nephritis
Acute Glomeruloephritis

less common but possible- infections like TB or pyelonephritis, vasculitis

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21
Q

Least common category of ARF pertaining approximately 5-10% of the cases

A

Post renal AKF

these are important to detect quickly because of their reversibility.

When thinking of post-renal ARF think Urinary outflow obstruction

22
Q

Azotemia only occurs in what situations

A

if there is outflow obstruction affecting both kidneys.

or if there is only a single functioning kidney .

23
Q

Causes of Post-Renal ARF

A 
Urolithiasis
BPH
Bladder outlet obstruction
Anticholinergic meds
Bladder prostate or cervical cancers
24
Q

Catching Post Renal ARF

A

Post-void bladder scans revealing more than 300 mL residual urine

GU ultrasound revealing hydroureter or hydronephrosis

if the cause is not immediately clear an ABD/Pelvis CT is indicated

25
Q

Treatment of Post-Renal ARF

A

Focused on the cause

Reverse the Obstruction

May include foley or stent placement

*Most azotemia reverses fully with reversal of obstruction

26
Q

Clinical Presentations of ARF

A

If mild / new- may be asymptomatic

if severe / symptomatic might include 
Abnormal urine output
Confusion 
Lethargy/fatigue
anorexia
Nausea and Vomiting 
Wt gain / swelling
27
Q

The clinical presentation of ARF is typically Specific or non-specific?

A

Non-specific

28
Q

The symptoms of shock, nausea, vomiting, acute blood loss may indicate volume depletion and thus what type of ARF

A

Pre-Renal

29
Q

Trauma or prolonged immobilization may indicate __________ thus intrinsic ARF

A

Rhabdomyolysis

30
Q

Fever, maculopapular rash, and arthralgias may suggest a _______ ARF

A

Intrinsic

31
Q

Signs of ARF depend on cause but might include:

A 
Hypervolemia 
hypertension
pericardial effusions
pulmonary edema 
Hypovolemia 
Seizures / coma
Electrolyte disturbances
Oliguria
32
Q

S/S consistent with pre-renal ARF

A

Thirst with reduced fluid intake, nausea / vomiting, diarrhea, acute hemorrhage

33
Q

S/S consistent with Intrinsic ARF

A

Fatigue, anorexia, fevers, foamy urine, blood in urine, myalgias, arthralgias, arthritis, maculopapular rash

34
Q

S/S consistent with post-Renal ARF

A

Urinary urgency or hesitancy, abdominal pain, blood in urine, enlarged prostate, abdominal mass

35
Q

Diagnostic evaluation of ARF

A

important to narrow down the type quickly once suspecting AKI

36
Q

often first helpful step at identifying type of ARF

A

History and physical

37
Q

Laboratory evaluation is an important step for evaluation of ARF…. what should be included

A

Serum Creatinine, Serum BUN, Serum electrolytes, urinalysis with microscopy and a complete blood count

all of this is obtainable by ordering a ( CBC, CMP, nand Urinalysis )

38
Q

Dependent on labs what are other tests wanted with ARF

A

EKG, renal ultrasound, possibly renal biopsy

39
Q

Key to diagnosis of ARF

A

Elevated BUN and Creatinine

you can also see decreased glomerular filtration rate

40
Q

Laboratory clues generally include

A

BUN: Creatinine Ratio
Fractional Excretion of Sodium
Urine Microscopy

41
Q

BUN:Creatinine ratio < 20:1 is more suggestive of _______

A

Intrinsic insult

42
Q

Fractional Excretion of Sodium (FEna) is what

A

the percentage of sodium filtered by the kidneys that is excreted in the urine

43
Q

a FEna below 1% is indicative of

A

Pre-Renal AKF

44
Q

Intrinsic disease has an FEna of what percentage typically

A

2% or greater

45
Q

Urine microscopy revealing in abnormal “sediments” suggest certain renal conditions. What are some of these cells that are utilized to help identify the underlying cause

A

RBC’s
WBC’s
Tubular epithelial cells
Casts

46
Q

Phosphorous needs to be secreted. When kidneys are damaged and this can not happen what is a common result

A

Phosphorus and calcium have a tendency to precipitate in soft tissues causing ectopic calcifications

47
Q

Kidney injury especially in the tubules can result in a decreased ability to manage what

A

Acid-Base balance

48
Q

What is a common result in Acid and base balance from kidney injury

A

Metabolic Acidosis

49
Q

Because electrolytes are often imbalanced in kidney injury we should be cautious to calculate _____

A

Anion gap

50
Q

Management of ARF includes

A

Treatment directed at cause

monitor and adjust fluid and electrolyte balance

Diuretic therapy (reserved for pts with significant symptomatic volume overload)

Renal Replacement Therapy (AKA Dialysis) - emergent when life threatening changes occur

51
Q

Should the pt with Kidney injury be hospitalized or treated out pt

A

if your pt has laboratory findings of AKI that have not resolved or reversed after 1-2 weeks but remain asymptomatic w/o acute uremia then referral to Nephrologist is appropriate

52
Q

When is hospitalization necessary

A

Sudden loss of kidney function resulting n abnormalities that can not be handled expeditiously in outpt setting

Including acute hyperlkalieimia (especially with EKG changes)

May also include other requirements for acute intervention such as emergent urologic intervention or dialysis

Genitourinary (11 decks)

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