ARF and CKD

Question 0

Pyuria or pus in urine

Answer 0

Suggests UTI, lower bladder infxn

Question 1

WBC casts + fever

Answer 1

Probably pyelonephritis aka upper UTI

Question 2

WBC in urinalysis, WBC casts, and small amount of proteinuria

Answer 2

Suggests interstitial nephritis

Question 3

Most reliable way to quantify proteinuria

Answer 3

24 hour urine collection

Question 4

How to measure creatinine clearance

Answer 4

Collect 24 hour urine sample and check plasma creatinine on same day

Question 5

Things that elevate creatinine clearance

Answer 5

Ketoacidosis
Drugs

(Cefoxitin, aspirin, bactrim, etc)

Question 6

Things that decrease creatinine clearance

Answer 6

Old
Cachexia
Liver disease

Question 7

Increased BUN

Answer 7

Usually dehydration

Question 8

Reduced BUN

Answer 8

Liver disease

Question 9

Study of choice for PCKD

Answer 9

Ultrasound

Question 10

Contraindications to using IVP

Answer 10

DM w/ Cr >2.0
CKD w/ Cr >5.0
Multiple myeloma

Question 11

Indications for renal biopsy

Answer 11

Unexplained acute renal failure

Question 12

Most common cause of ARF

Answer 12

Prerenal azotemia

• d/t renal HYPOPERFUSION

Question 13

Key to prerenal azotemia

Answer 13

Careful assessment of volume status, drug usage and cardiac function

Question 14

Urine Na is low in volume depletion and high in

Answer 14

Acute tubular necrosis

Question 15

Most important cause of ARF

Answer 15

Post renal azotemia because it is reversible

• it’s the least common cause but most important

Question 16

If you’re thinking post renal azotemia

Answer 16

Do bladder ultrasound or catheterization

Question 17

Must exclude pre and postrenal failure before dx:

Answer 17

Intrinsic renal failure

Question 18

85% of intrinsic renal failure

Answer 18

Acute tubular necrosis

Question 19

Exogenous causes of acute tubular necrosis

Answer 19

Ischemia

Toxin exposure

Question 20

Endogenous causes of acute tubular necrosis

Answer 20

Myoglobinuria after crush injury

Hgb from transfusion rxns

Bence jones proteins from MM

Question 21

Brown urine w/ pigmented granular casts

Maybe hyperkalemia and hyperphos

Answer 21

ARF

Question 22

Peripheral blood eosinophilia

Answer 22

Interstitial nephritis

Also may have fever, rash, arthralgias, WBC, WBC casts, RBC

Question 23

Main cause of interstitial nephritis

Answer 23

Drugs

• PCN, cephs, sulfas, allopurinol, NSAIDs

Question 24

HTN, peri orbital or scrotal edema

Answer 24

Glomerulonephritis

Question 25

Tx with high dose steroids

Answer 25

Glomerulonephritis

Interstitial nephritis

Question 26

Major causes of chronic renal disease

Answer 26

DM

HTN

Question 27

Uremic fetor (fishy smell)

Answer 27

CKD

Question 28

If CKD d/t HTN or CHF

Answer 28

Start ACE inhibitors

They’re renal protective!

Question 29

Bilateral small kidneys in ultrasound

Answer 29

Chronic kidney disease

Question 30

Dialysis when:

Answer 30

Uremic sx appear (confused, n/v) 
Fluid overload and diuretics no help
Refractory hyperkalemia 
Severe met acidosis 
Neurologic sx

Question 31

Urine protein >3.5
Alb <3
Peripheral edema

Answer 31

Nephrotic syndrome

Question 32

If serum alb less than 2 in nephrotic syndrome

Answer 32

May need anticoagulant like warfarin

Bcz losing or not making antithrombin III, protein C or S

Question 33

ALWAYS CHECK DM PATIENTS FOR

Answer 33

MICROALBUMINURIA

To check for diabetic nephropathy
Use ACE inhibitors

Question 34

Usually seen in kids, presents as recurrent UTIs

Answer 34

Vesicoureteral reflux

Question 35

Polyuria, hyperkalemia, hyperchloremic acidosis

Answer 35

Chronic Tubulointerstitial disease

Question 36

Flank pain, strong family hx, can palpate kidneys

Answer 36

PCKD

Question 37

Can clog up kidneys and cause endogenous acute tubular necrosis

Answer 37

Bence jones proteins of multiple myeloma