Acute Renal Failure

Question 1

acute renal failure

Answer 1

Oliguria/anuria, recent onset azotemia, HTN

Question 2

Acute tubulointerstitial nephritis is often a drug hypersensitivity (1) are a common cause) in which numerous (2) are present in the urine as well as in the tissues.

Answer 2

1. penicillins 2. eosinophils

Question 3

Tophi- causes

Answer 3

Gout. tumor lysis syndrome

Question 4

The maintenance phase of ATN:Urine output ____, ____ overload, rising BUN concentrations, ___kalemia, and metabolic acidosis

Answer 4

1) 400 mL/day (oliguria) OR low; salt and water;hyper

Question 5

Acute tubular necrosis: The cells are then sloughed into the tubule, forming (1) which obstruct it, causing back pressure as well as tubuloglomerular feedback, which causes (2).

Answer 5

1. casts 2. afferent arteriolar vasoconstriction and decreased filtration

Question 6

1. ___ is induced experimentally by mixture of aspirin and phenacetin,
2. Analgesic nephropathy may lead to ___

Answer 6

Papillary necrosis;

transitional papillary carcinoma of the renal pelvis, tubulointerstitial nephritis, papillary carcinoma

Question 7

AKI-ATN begins with an initiation phase over the first 36 hours with a decline in (1) and increased (2)

Answer 7

1. urine output 2. BUN

Question 8

(1) can cause what is termed post-renal azotemia which has (2) BUN/creatinine ratio.

Answer 8

1. Obstruction to the urinary tract 2. HIGH

Question 9

(1) can cause pre-renal azotemia, which is generally found with (2) BUN/creatinine ratio.

Answer 9

1. Decreased renal blood flow 2. elevated

Question 10

LOW GFR

Answer 10

increasing BUN

Question 11

Acute renal failure can be a consequence of problems with ?

Answer 11

blood vessels, glomeruli, tubules, or the interstitium.

Question 12

Patients with acute tubulointerstitial nephritis may also have (1)

Answer 12

1. fever, peripheral eosinophila, hematuria, and proteinuria.

Question 13

Acute Tubulointerstitial Nephritis

15 days after drug exposure–> fever, ___, maculopapular rash, hematuria, mild proteinuria, and leukocyturia (often including ___ in urine)

Answer 13

eosinophilia; eosinophils

Question 14

radiographic contrast agents
 heavy metals (mercury)
 organic solvents (carbon tetrachloride).

Answer 14

Nephrotoxic AKI

Question 15

gentamicin and other antibiotics

Answer 15

Nephrotoxic AKI

Question 16

Oliguria, azotemia, proteinuria, HTN, hematuria

Answer 16

Nephritic syndrome

Question 17

In bilateral agenesis, the absence of urine prevents the development of (1) and the subsequent pressure needed for (2) development (this disorder is called (3): they have strange facial development as well, from the loss of amniotic fluid pressure).

Answer 17

1. amniotic fluid 2. lung 3. Potter’s syndrome

Question 18

Bilateral agenesis is a fairly common lethal congenital abnormality which leads to stillborn infants who are born with (1)

Answer 18

1. hypoplastic lungs.

Question 19

___ most frequently occurs with synthetic penicillins
(methicillin, ampicillin), other synthetic antibiotics (rifampin), diuretics (thiazides),
NSAIDs, and miscellaneous drugs (allopurinol, cimetidine).

Answer 19

Acute tubulointerstitial nephritis

Question 20

Acute tubular necrosis: There can also be fluid leakage and inflammation within the interstitium between tubules if

Answer 20

BM is damaged

Question 21

what do these cause?

1. gentamicin and other antibiotics
2. radiographic contrast agents
3. heavy metals (mercury)
4. organic solvents (carbon tetrachloride).
5. mismatched blood transfusions and other hemolysis causing hemoglobinuria
6. skeletal muscle injuries causing myoglobinuria
   characteristic intratubular hemoglobin or myoglobin casts
   toxic iron content of these globin molecules contributes to the AKI

Answer 21

B. Nephrotoxic ATN

Question 22

GFR formula

Answer 22

(urine creatinine X urine volume)/ serum creatinine

Question 23

Recovery phase ATN/AKI

1) in urine volume that may reach up to 3 L/day;

Loss of 2) ;

Hypokalemia, rather than hyperkalemia; ALSO increased risk of 3)

Answer 23

1) Increase;
2) H20, Na, and K
3) INFECTION

Question 24

Most patients recover from ATN/AKI unless ___________

Answer 24

BM is damaged

Question 25

Ischemic acute tubular necrosis; type of necrosis? Inflammation present or absent?

Answer 25

Coagulative with LACK of inflammation

Question 26

If the cause of ATN is reversed or eliminated, then there is a (1) recovery phase, which can have (2)

Answer 26

1. diuretic (high urine output) 2. ery high urine outputs.

Question 27

Ischemic changes

A. reversible injury–> signs?
B. lethal injury–> necrosis and apoptosis

Answer 27

cellular swelling, loss of brush border & polarity, blebbing, cell detachment

Question 28

Acute tubular necrosis: decreased (1) to the (2) produces necrosis of the (3)

Answer 28

1. blood flow or oxygen delivery 2. proximal tubules 3. proximal tubule cells.

Question 29

Acute renal failure due to ethylene glycol (antifreeze) poisoning produces (1) histologically

Answer 29

1. hydropic degeneration of the proximal convoluted tubules.

Question 30

The most common cause of AKI is a pathologic entity known as (1).

Answer 30

1. acute tubular necrosis

Question 31

A maintenance phase follows the initiation phase of ATN/AKI with ?

Answer 31

oliguria, rising BUN, hyperkalemia, and metabolic acidosis (from inability to excrete urea, potassium and acid).

Question 32

Acute renal failure most commonly presents with ?

Answer 32

anuria (complete absence of urine) or oliguria (decreased urine flow), and azotemia (elevated BUN).

Question 33

Although pathologists enjoy looking at glomeruli, we must remind ourselves that (1) can be equally as, or potentially more, important in acute renal failure.

Answer 33

1. tubular defects

Question 34

Because the flow rate is slow, most of the BUN can be reabsorbed, explaining the high ratio (more than 15 Fold) relative to the creatinine.

Answer 34

Pre-renal azotemia

Question 35

Ischemic ATN/AKI etiology:

Severe ___ and ____

Decreased blood flow accompanied by __ and ____

Answer 35

trauma; acute pancreatitis;

marked hypotension and shock

Question 36

Nephrotoxic AKI/ATN

Skeletal muscle injuries causing ___
characteristic ____ casts
toxic iron content of these globin molecules contributes to the ___

Answer 36

myoglobinuria; intratubular hemoglobin or myoglobin;

AKI

Question 37

Glomerular filtration rate can be calculated by determining the (1) clearance, which is equal to (2)

Answer 37

1. creatinine 2. urine creatinine concentration x urine volume, divided by the serum creatinine concentration (UV/P)

Question 38

a decline in urine output with a rise in BUN

Answer 38

Initiation phase (36 hours) of ATN

Question 39

Biochemical changes in ischemia:

1. depletion of ___
2. accumulation of ___
3. activation of proteases (calpain) which cause ____
4. activation of phospholipases, which damage ___
5. generation of reactive oxygen species
6. activation of caspases, which induce apoptotic cell death

Answer 39

ATP;

2) intracellular calcium
3) cytoskeletal disruption
4) membranes

Question 40

1. hyaline CAST is composed of

Answer 40

2. Tamm-Horfstall urinary glycoprotein