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Medicine > Acute Renal Failure and Chronic Kidney Failure > Flashcards

Acute Renal Failure and Chronic Kidney Failure Flashcards

1
Q

Sudden impairment of kidney function

Leads to retention of nitrogenous waste products called

With or without decrease in UO

A

Acute Kidney Injury

Azotemia

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2
Q

UO in AKI

A

Oliguria <400ml/day

Anuria <100ml/day

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3
Q

Increase in Creatinine 0.5mg/dl/day

Increase in BUN 10mg/dl/day over several days

A

AKI

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4
Q

AKI Creatinine value

A

Inc 0.5 mg/dl/day

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5
Q

BUN AKI value

A

Increase 10mg/dl/day over several days

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6
Q

Clinical forms of acute renal failure

A

Prerenal azotemia
Intrinsic renal azotemia
Postrenal azotemia

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7
Q

AKI epidemiology

Complication of hospital and ICU patients

A

5% admission

30% ICU

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8
Q

50-70% of all cases of ARF
Most common form
Due to renal hypoperfusion without compromising the integrity of renal parenchyma

ECF depletion as in hemorrhage or dehydration

A

Prerenal azotemia

Prerenal AKI

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9
Q 
30% of all AKI
due to diseases that involve the renal parenchyma
Mostly triggered by
ischemia (ischemic ARF)
nephrotoxin (nephrotoxic ARF)
acute tubular necrosis (ATN)
A

Renal azotemia

Intrinsic Renal AKI

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10
Q

5-10% of all ARF

Diseases that cause urinary tract obstruction

A

Postrenal azotemia

Postrenal AKI

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11
Q

Most common cause of postrenal azotemia is

A

Bladder neck obstruction from prostatic disease

BPH

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12
Q

ARF Diagnostic procedures

A

Laboratory exams

Urinalysis - casts or proteinuria suggests the specific type of ARF

Fractional excretion of sodium (FeNa) - distinguished prerenal azotemia from other typed

Serial measurements of BUN and Crea

Serum potassium, phosphate, calcium, uric acid, creatine kinase levels - can point to etiology of ARF

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13
Q

BUN/Crea ratio in Pre-Renal

A

> 15

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14
Q

BUN/Crea ratio in Renal

A

<15

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15
Q

AKI Radiographic findings

A

UTZ - useful to exclude obstructive uropathy

CT Scan and MRI - alternative

Pyelography/IVP - to locate obstruction in the urinary tract

Plain film of abdomen can detect nephrolothiasis

Doppler UTZ, MRI, renal angiography

Renal biopsy - for cases where prerenal and postrenal failures are excluded and the cause of intrinsic renal azotemia is still unclear

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16
Q

Encompasses a spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in GFR

Most last >3 months

Irreversible

Small shrunken kidneys

A

Chronic Kidney Disease

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17
Q

CKD Stage 1

A

90 ml/min per 1.73m2

18
Q

CKD Stages 2,3,4 GFR

A

60-89 ml/min per 1.73m2
30-59 ml/min per 1.73m2
15-29 ml/min per 1.73m2

19
Q

CKD RF

A 
Hypertension
Diabetes
Autoimmune
Age
African ancestry
Family history
20
Q

Stage of CKD where anemia is prominent

A

Stage 3 (30-59 ml/kg/min)

21
Q

CKD Etiology and Epidemiology

A

Diabetic glomerular disease
Glomerulonephritis
Hypertensive nephropathy (Primary glomerulopathy with hypertension, Vascular and ischemic renal disease)
Autosominal dominant polycystic kidney disease
Other cystic and tubulointerstitial nephropathy

22
Q

Bone manifestations of CKD

A

High bone turnover - increased PTH
Low bone turnover - decreased or normal PTH level

PTH reabsorbs calcium at PCT, ALOH (physiologic) additionl at DCT and CD

PTH blocks reabsorption of phosphate in PCT
Reduction of phosphate ions result in a more ionized Ca in blood due to lack of phosphate ion-calcium salt formation (insoluble) dec plasma calcium.

23
Q

Cardiovascular manifestation of CKD

A

Vascular calcification
HTN
Heart failure
Pericarditis

24
Q

Calcemic uremic arteriolopathy

A

Calciphylaxis

25
Q

Anemia in CKD

A

Normocytic normochromic anemia
Stage 3
Decreased EPO

26
Q

Neurologic abnormalities in CKD are from

A

retained nitrogenous metabolites
Evident in Stage 3

Early signs include: disturbance in memory, concentration and sleep

Neuromuscular irritability

Periphera neuropathy (Stage 4)

27
Q

GI manifestations in CKD

A

Uremic fetor - urine like odor on breath
Gastritis
Peptic disease
Mucosal ulceration

28
Q

Endocrine metabolic disease in CKD

A

Glucose metabolism impaired

Decreased estrogen and testosterone

29
Q

Dermatologic manifestation in CKD

A

Pruritus

Nephrogenic fibrosing dermopathy

30
Q

Leading cause of ESRD in US

Major cause of morbidity and mortality from persons with either Type 1 DM or Type 2 DM

A

Diabetic nephropathy

31
Q

Edema
Foamy appearance or excessive frothing of urine (proteinuria)
Unintentional weight gain (from fluid accumulation)
Anorexia
Nausea and vomiting
Fatigue

A

Diabetic nephropathy

32
Q

24 h urine collection reveals

Microalbuminuria: 150-300 mg/day
Macroalbuminuria: 300 mg/day

N: <150 mg/day

A

Diabetic nephropathy

33
Q

Diabetic nephropathy pathologic hallmark

A

Kimmelsteil-Wilson lesions (glomerular nodular sclerosis)
Thickening of basement membrane
on light microscopy

34
Q

Diabetic nephropathy Tx

A

Control hyperglycemia
Optimal therapy for diabetic nephropathy

Strict blood pressure control
Uncontrolled hypertension accelerates the rate of decline of renal function

Adequate control of blood presse <130/80 is recommended

35
Q

First line therapy for all patients with DM and HTN

Lowers intraglomerular pressure and posses renoprotective properties

Reduces progression from microalbuminuria to macroalbuminuria

Reduces the decline in GFR

A

ACEI or ARB

36
Q

Alternative in patients who develop ACE inhibitor associated cough and angioedema

A

ARB

37
Q

Cough and angioedema from ACEI use is caused by

A

bradykinin

38
Q

Patchy interstitial suppurative inflammation
Intratubular aggregates of neutrophils
Tubular necrosis

A

Acute Pyelonephritis

39
Q

Complications Acute Pyelonephritis

A

Papillary necrosis
Pyonephrosis
Perinephric abscess

40
Q

Important cause of ESKD in adults and kidney destruction in children with severe lower urinary tract abnormalities

A

Chronic Pyelonephritis

41
Q

Forms of chronic pyelonephritis

A

Reflux nephropathy - most common
Chronic obstructive nephropathy
Xanthogranulomatous pyelonephritis

42
Q

Most common cause of Pyelonephritis

A

E coli 75-90%
S saprophyticus 5-15%

Klebsiella 5-10%
Enterococcus
Proteus - staghorn calculi, alkaline urine from urease
Citrobactee

Medicine (29 decks)

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