ATN

Question 1

RX

Answer 1

1. Remove insult
2. Avoid further insult
3. Hemolytic support
   Diuretics, restrict intake, intake+output=500ml
   Inotropes, adrenaline
4. Treat cx:
   - Restrict K, NA, PO
   -Treat < Ca if symptomatic
   - > K
   Protect heart: Cagluconate
   Shift K in cells: Actrapid + 50% dextrose, NaCHO3, B2 agonsists
   Eliminate K: Kexelate, Dialysis, > urnine flow
   < Intake: stop supplements and ACE-I
   - Metabolic acidosis: HCO3, Cagluconate
   -HPT rx
   -Fluid overload: Lasix

Question 2

Cx

Answer 2

1. Electrolyte abnormalities- > Na, K, PO2 < Ca
2. Metabolic acidosis
3. HPT
4. Fluid Overload
5. Uraemia:
   Pericarditis
   Gastritis
   Encephalopathy
   Coagulopathy

Question 3

CSI

Answer 3

Renal:
1. ECF variable: Contracted, normal, overload
2. U: Cr 1:20
3. < Urine concentration:
U-Na >20
Fe-Na >1%
U0osmol <300
4. Urine: Proteinuria, haematuria, casts

Question 4

Present

Answer 4

Initial phase
- Min/hr/day dependant on severity
Maintainance phase:
- Oligouria <400 ml/day
- Non-oligouria
Recovery phase:
- Polyuria > 3 L per day
- Cr recover 21 d
- Tubular dysfx recover 1 yr
- > Suceptable to insults

Question 5

Path

Answer 5

1. Ischaemic: Hypoperfusion–> Tubular ischamia of prox tube and thick acs loop of Henle–> Tubular necrosis and inflam–> ATN
2. Nephrotoxic: Endo and exotoxins–> ATN
   -Endogenous:
   Myoglobin: Rhabdomyolysis
   Hb: Haemolysis
   Al light chains Meyeloma
   -Exogenous
   NSAIDS
   Aminoglycosides
   Amphotericin B
   Cisplatin
   Radiocontrast

Vasoconstriction: NSAIDS, Radiocontrast
Tubular toxicity: Myoglobin, Aminoglycosides
Tubular obstruction: Myoglobin, Amyloid