Acute renal Failure CIS Pales Flashcards
AKI=
Acute kidney injury or acute renal failure
AKI=
Acute kidney injury or acute renal failure
AKI definition
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
Acute vs. Chronic renal failure
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
casts are more likely to be…
acute?
prerenal ua
Normal or hyaline casts
Intrarenal causes of AKI
Tubular cell injury
interstitial nephritis
glomerulonephritis
vascular disorders
tubular cell injury ua
Muddy-brown, granular, epithelial casts
interstitial nephritis ua
Pyuria, hematuria, mild proteinuria, granular and epithelial casts, eosinophils
glomerulonephritis ua
Hematuria, marked proteinuria, red blood cell casts, granular casts
vascular disorders ua
Normal or hematuria, mild proteinuria
postrenal ua
Normal or hematuria, granular casts, pyuria
Pre-renal
FENa
Urine Na
BUN/Creat.Rati0
20:1
ATN
FENa
Urine Na
BUN/Creat.Rati0
> 1%
>20
Toxic Injury
FENa
Urine Na
BUN/Creat.Rati0
> 1%
>20
glomerulonephritis (early)
FENa
Urine Na
BUN/Creat.Rati0
Vascular disorders (early)
FENa
Urine Na
BUN/Creat.Rati0
Fractional Excretion of Na (FENa)
(Urine Na x Plasma Cr x 100)/
Plasma Na x Urine Cr
renal ultrasound
Signs of hydronephrosis Kidneys size PCKD Stones Tumors
What damage does the kidneys sustain with prerenalazothemia?
no damage shown if you biopsy
Causes of pre-renal azothemiaand/or ischemia
Intravascular volume depletion and or hypotension
Decreased effective intravascular volume
Systemic vasodilation/renal vasoconstriction
Large-vessel renal vascular disease
Intravascular volume depletion and or hypotension
Hemorrhage
GI loss: vomiting/diarrhea
Renal loss: diuretics, diabetes (mellitus and incipidus)
Dermal losses (sweating)
Decreased effective intravascular volume
Congestive heart failure
Cirrhosis
Hepatorenalsyndrome,
Peritonitis
Systemic vasodilation/renal vasoconstriction
Sepsis
Hepatorenalsyndrome
What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?
Cyclosporine Tacrolimus ACEIs, ARBs, NSAIDs Radiocontrast agents Diuretics?
What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?
Cyclosporine Tacrolimus ACEIs, ARBs, NSAIDs Radiocontrast agents Diuretics?
AKI definition
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