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Renal Exam III > Acute renal Failure CIS Pales > Flashcards

Acute renal Failure CIS Pales Flashcards

1
Q

AKI=

A

Acute kidney injury or acute renal failure

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2
Q

AKI=

A

Acute kidney injury or acute renal failure

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3
Q

AKI definition

A

Absolute increase in serum creatinine of 0.3 mg/dL
or
50% increase in serum Creatinine
or
Reduction in urine output consisting of oliguria of less than 0.5 mL/kg/hr for longer than 6 hours

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4
Q

Acute vs. Chronic renal failure

A 
Compare with Creatinine from before
Size of kidneys on US
Sediment on u/a
Stigmata of Chronic Renal Failure
   Anemia
   Hyperparathyroidism (osteodystrophy)
   A/V fistula
   Hyperphosphatemia
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5
Q

casts are more likely to be…

A

acute?

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6
Q

prerenal ua

A

Normal or hyaline casts

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7
Q

Intrarenal causes of AKI

A

Tubular cell injury
interstitial nephritis
glomerulonephritis
vascular disorders

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8
Q

tubular cell injury ua

A

Muddy-brown, granular, epithelial casts

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9
Q

interstitial nephritis ua

A

Pyuria, hematuria, mild proteinuria, granular and epithelial casts, eosinophils

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10
Q

glomerulonephritis ua

A

Hematuria, marked proteinuria, red blood cell casts, granular casts

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11
Q

vascular disorders ua

A

Normal or hematuria, mild proteinuria

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12
Q

postrenal ua

A

Normal or hematuria, granular casts, pyuria

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13
Q

Pre-renal

FENa
Urine Na
BUN/Creat.Rati0

A

20:1

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14
Q

ATN

FENa
Urine Na
BUN/Creat.Rati0

A

> 1%

>20

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15
Q

Toxic Injury

FENa
Urine Na
BUN/Creat.Rati0

A

> 1%

>20

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16
Q

glomerulonephritis (early)

FENa
Urine Na
BUN/Creat.Rati0

A
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17
Q

Vascular disorders (early)

FENa
Urine Na
BUN/Creat.Rati0

A
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18
Q

Fractional Excretion of Na (FENa)

A

(Urine Na x Plasma Cr x 100)/

Plasma Na x Urine Cr

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19
Q

renal ultrasound

A 
Signs of hydronephrosis
Kidneys size
PCKD
Stones
Tumors
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20
Q

What damage does the kidneys sustain with prerenalazothemia?

A

no damage shown if you biopsy

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21
Q

Causes of pre-renal azothemiaand/or ischemia

A

Intravascular volume depletion and or hypotension
Decreased effective intravascular volume
Systemic vasodilation/renal vasoconstriction
Large-vessel renal vascular disease

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22
Q

Intravascular volume depletion and or hypotension

A

Hemorrhage
GI loss: vomiting/diarrhea
Renal loss: diuretics, diabetes (mellitus and incipidus)
Dermal losses (sweating)

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23
Q

Decreased effective intravascular volume

A

Congestive heart failure
Cirrhosis
Hepatorenalsyndrome,
Peritonitis

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24
Q

Systemic vasodilation/renal vasoconstriction

A

Sepsis

Hepatorenalsyndrome

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25
Q

What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?

A 
Cyclosporine
Tacrolimus
ACEIs, ARBs,
NSAIDs
Radiocontrast agents
Diuretics?
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26
Q

What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?

A 
Cyclosporine
Tacrolimus
ACEIs, ARBs,
NSAIDs
Radiocontrast agents
Diuretics?
How well did you know this?
1
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27
Q

AKI definition

A

Absolute increase in serum creatinine of 0.3 mg/dL
or
50% increase in serum Creatinine
or
Reduction in urine output consisting of oliguria of less than 0.5 mL/kg/hr for longer than 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Acute vs. Chronic renal failure

A 
Compare with Creatinine from before
Size of kidneys on US
Sediment on u/a
Stigmata of Chronic Renal Failure
   Anemia
   Hyperparathyroidism (osteodystrophy)
   A/V fistula
   Hyperphosphatemia
29
Q

casts are more likely to be…

30
Q

extension gfr low/falling

A

cellular apoptosis/necrosis>disrupstion of normal epithelial integrity abrnomal tubular function (filtrasion/clearance)

cellular sloughing>luminal obstruction

inglammation> capillary sludging and worsening ischemia

31
Q

Intrarenal causes of AKI

A

Tubular cell injury
interstitial nephritis
glomerulonephritis
vascular disorders

32
Q

tubular cell injury ua

A

Muddy-brown, granular, epithelial casts

33
Q

interstitial nephritis ua

A

Pyuria, hematuria, mild proteinuria, granular and epithelial casts, eosinophils

34
Q

glomerulonephritis ua

A

Hematuria, marked proteinuria, red blood cell casts, granular casts

35
Q

vascular disorders ua

A

Normal or hematuria, mild proteinuria

36
Q

postrenal ua

A

Normal or hematuria, granular casts, pyuria

37
Q

Pre-renal

FENa
Urine Na
BUN/Creat.Rati0

38
Q

ATN

FENa
Urine Na
BUN/Creat.Rati0

39
Q

Toxic Injury

FENa
Urine Na
BUN/Creat.Rati0

40
Q

glomerulonephritis (early)

FENa
Urine Na
BUN/Creat.Rati0

41
Q

Vascular disorders (early)

FENa
Urine Na
BUN/Creat.Rati0

42
Q

Fractional Excretion of Na (FENa)

A

(Urine Na x Plasma Cr x 100)/

Plasma Na x Urine Cr

43
Q

renal ultrasound

A 
Signs of hydronephrosis
Kidneys size
PCKD
Stones
Tumors
44
Q

What damage does the kidneys sustain with prerenalazothemia?

A

no damage shown if you biopsy

45
Q

Causes of pre-renal azothemiaand/or ischemia

A

Intravascular volume depletion and or hypotension
Decreased effective intravascular volume
Systemic vasodilation/renal vasoconstriction
Large-vessel renal vascular disease

46
Q

Intravascular volume depletion and or hypotension

A

Hemorrhage
GI loss: vomiting/diarrhea
Renal loss: diuretics, diabetes (mellitus and incipidus)
Dermal losses (sweating)

47
Q

Decreased effective intravascular volume

A

Congestive heart failure
Cirrhosis
Hepatorenalsyndrome,
Peritonitis

48
Q

Systemic vasodilation/renal vasoconstriction

A

Sepsis

Hepatorenalsyndrome

49
Q

Large-vessel renal vascular disease

A

Renal artery thrombosis or embolism
Renal artery stenosis
Cholesterol emboli

50
Q

What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?

A 
Cyclosporine
Tacrolimus
ACEIs, ARBs,
NSAIDs
Radiocontrast agents
Diuretics?
51
Q

What findings do you expect to see on the u/a of patient with pre-renal azothemia?

A

hyaline casts

sodium less than ten

52
Q

upper gi bleeding,

A

bc it is reabsorbed and causes an increase in bun,

53
Q

giving fluids to renal problems

A

atn takes longer

prerenal is better right away

54
Q

initiation gfr falling

A 
prolonged prerenal state
hemorrhage
sepsis
vascular disrupstion (trauma, coronary artery bypass, aortic crossclamp)
nephrtoxins

these all lead to ischemia

55
Q

extension gfr low/falling

A

cellular apoptosis/necrosis>disrupstion of normal epithelial integrity abrnomal tubular function (filtrasion/clearance)

cellular sloughing>luminal obstruction

inglammation> capillary sludging and worsening ischemia

56
Q

maintenance gfr stable/low

A

cellular dedifferentiation and proliferation>reestablishment of tubular epithelium

57
Q

Recovers GFR rising

A

Cellular repolarization> reestablishment of normal tubular function (filtration/clearance)

58
Q

what percentage of atn pts get better

59
Q

obstruction causing hydronephrosis

A

catheter to release the kidney out

unilateral does not cause renal failure

this case is bilateral

60
Q

What medications may cause acute renal failure?

A 
Aminoglycosides
Radiocontrastagents
Acyclovir
Cisplatin
Sulfonamides
Methotrexate
Cyclosporine
Tacrolimus
AmphotericinB
Foscarnet
Pentamidine
Ethylene glycol
Toluene
Cocaine
HMG-CoAreductaseinhibitors
61
Q

acute interstitial nephritis recovery?

A

acute interstitial nephritis, never fully recover

if contrast nephropathy fully recover, causes vasospasm so you decrease flow to kidneys

62
Q

What is the significance of the negative finding for eosinophills. What condition it rules out?

A

acute interstitial nephritis

63
Q

Interstitial Nephritis

β-LACTAM ANTIBIOTICS

A

PenicillinCephalosporinsAmpicillinMethicillinNafcillin

64
Q

Interstitial Nephritis

diuretics

A

DIURETICSFurosemideHydrochlorothiazideTriamterene

65
Q

Interstitial Nephritis

other antibiotics

A

SulfonamidesVancomycinRifampinAcyclovirIndinavir

66
Q

Interstitial nephritis nsaids

A

IbuprofenNaproxenIndomethacin

67
Q

What is the significance of RBC casts?

A

glomerulonephritis

68
Q

What is the differential for glomerulonephritisand what tests should we order?

A

goodpastures anti gbm

wgeners panca

ana acuet lupus nephritis

69
Q

Go over powerpoint and chart in back

Renal Exam III (17 decks)

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