Acute Renal Failure

Question 1

What is the def of ARF? it can be separated into ___ and ___

Answer 1

Deterioration of renal function over a period of hours to days resulting in failure of kidneys to excrete nitrogenous waste products
Increase in serum creatinine of more than 0.5
50% decrease in creatinine clearance
it can be oliguric or non-oliguric

Question 2

Oliguria:

Answer 2

UOP less than 400 mL per day or 0.5 mL/kg/hr for 6 hours

Question 3

Risk factors for ARF:

Answer 3

Co existing renal disease
Advanced age
Major operative procedures

Question 4

Normal BUN

Answer 4

10-20 mg/dL

Question 5

Normal creatinine:

Answer 5

0.5-1.5 mg/dL

Question 6

Creatinine clearance:

Answer 6

85-125 mL/min women and 95-140 for men

Question 7

Specific gravity:

Answer 7

1.002-1.030

Question 8

Prerenal vs renal: UOP

Answer 8

UOP for renal and pre-reanl: both less than 0.5 (cc/kg/hr)

Question 9

Urine sodium in renal vs pre-renal ARF

Answer 9

prerenal: <25
renal: >35

Question 10

FENA in pre-renal vs renal ARF

Answer 10

pre-renal: <1

Renal: >1

Question 11

Urine osmolality in pre-renal vs renal ARF:

Answer 11

pre: >500
Renal: <350

Question 12

BUN/CR ratio in pre-renal vs renal ARF:

Answer 12

Pre: >20:1
Renal: <10: 1

Question 13

What to do for acute renal failure that you think is an issue with the actual kidney?

Answer 13

check urine for blood or myoglobin 
check the electrolytes 
check BUN/Cr
Check FeNA 
send blood and urine for sodium, osmolality, creatinine, and urea 
d/c nephrotoxic drugs

Question 14

What can you give to maintain UOP in ARF pts?

Answer 14

Mannitol/dopamine/furosemide HD as needed