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medicine > Azotemia > Flashcards

Azotemia Flashcards

1
Q

condition of increased nitrogenous waste

products brought about by a reduction in GFR

A

azotemia

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2
Q
A

creatinine

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3
Q
A 
size
age
sex
underlying renal disease
concurrent illness
true gfr
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4
Q
A

dietary creatine intake
increased creatinine generation (rhabdomyolysis)
Decreased glomerular filtration
reduced tubular secretion

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5
Q

drugs causing reduced tubular secretion

A

trimethoprim and cimetidine

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6
Q

False elevation of creatinine

A

Jaffe assay interference

Enzymatic assay interference

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7
Q

enzymatic assay ibterference

A

high total protein

lidocaine

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8
Q

acute fall/ blunted rise in creatinine

A 
reduced creatinine generation (sepsis)
increased VoD (edematous, acute fluid overload)
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9
Q

chronic elevation of creatinine

A

inc creatinine generation

decreased glomerular filtration

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10
Q

increased creatinine generation

A

muscular body habitus

afro-carribean ethnicity

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11
Q

nephrologic syndrome

A
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12
Q

features of azotemia

A
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13
Q

kidney damage with mild loss of kidney function

A

stage 2 ckd

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14
Q

mild to moderate loss of kidney function

A

stage 3a

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15
Q

kidney damage with normal kidney function

A

stage 1

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16
Q

moderate to severe loss of kidney function

A

stage 3b

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17
Q

kidney failure

A

stage 5

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18
Q

severe loss of kidney fxn

A

stage 4

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19
Q

acute renal failure

A
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20
Q

chronic kidney disease

A
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21
Q

assessment of glomerular filtration rate

A

serum creatinine
UCr/Pcr
24 hr creatinine clearance
egfr

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22
Q

other methods (gfr)

A

inulin clearance
125I-iothalamate
EDTA
Cystatin C

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23
Q

most useful

relates Na clearance to creatinine clearance

A

FENa

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24
Q

FENa is high in ____

A

ischemic ATN

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25
FENa is low in
sepsis, pigment and some form of nephrotoxic ATN
26
In prerenal ARF, FENa may be
>1% among those on diuretics, CKD, salt
27
Less sensitive index for distinguishing prerenal ARF from ischemic and nephrotoxic ARF
UNa
28
is a measure of the extraction of | sodium and water from the glomerular filtrate.
Fractional Excretion of Sodium
29
It can be calculated as the ratio of plasma | creatinine to urine creatinine divided by the ratio of plasma sodium to urine sodium:
FENa
30
Less sensitive index for distinguishing prerenal ARF from ischemic and nephrotoxic ARF
Urine Sodium
31
40-80% reversible
Prerenal azotemia
32
<5%
Postrenal azotemia
33
90%
Acute tubular necrosis
34
stage 1 gfr
>90
35
stage 2 gfr
89-60
36
stage 3a gfr
59-45
37
stage 3b
44-30
38
stage 4
29-25
39
stage 5 gfr
<15
40
CAUSES OF PRE-RENAL AZOTEMIA
``` dec circulating blood volume Sequestration Dec effective arterial volume Reduction in CO from peripheral vasodilation Profound renal vasoconstriction ```
41
Reduction in cardiac output from peripheral | vasodilation
sepsis, drugs
42
causes of profound renal vasoconstriction
hepatorenal syndrome, NSAIDS, severe HF
43
prerenal
Intrarenal vasoconstriction Systemic vasodilation Volume depletion
44
Postrenal
Extrarenal obstruction | Intrarenal obstruction
45
Intrarenal vasoconstriction
46
External obstruction
47
intrarenal obstruction
48
Exogenous toxins
49
Endogenous toxins
50
ischemic ATN
Major surgery, trauma, severe | hypovolemia, sepsis and burns
51
Nephrotoxic ATN causes
o Medications o Intrarenal vasoconstriction, tubule toxicity or obstruction
52
Processes involving tubules and interstitium
Drug-induced interstitial nephritis, severe infections, systemic diseases, infiltrative diseases
53
Occlusion of renal vessels
o Atheroembolic renal failure o Renal Artery thrombosis (mild proteinuria, hematuria) wo Renal Vein thrombosis (heavy proteinuria and hematuria)
54
glomerular diseases
glomerulonephritisor vasculitis
55
Renal microvasculature
o Hemolytic Uremic Syndrome (HUS) o Thrombotic thrombocytopenic purpura (TTP) o Malignant hypertension
56
o 24h urine output of <500ml o Can accompany any cause of acute renal failure
oliguria
57
``` o Complete absence of urine formation o <50 ml/day o Total urinary tract obstruction o Total vessel occlusion o Shock o RPGN, ATN, cortical necrosis ```
Anuria
58
o Urine volume of >3L/day
Polyuria
59
Detects mostly albumin | false positives , ph >7 conc urine or contaminated w blood
60
Glomerular disruption
61
glomerulonephritis
62
2-5 rbcs/ hpf
Hematuria
63
o Formed in concentrated urine from normal constituents of urine o Tamm-Horsfall protein (secreted by epith. cells from the Loop of Henle) o May be seen in any type of renal disease
hyaline casts
64
o May suggest an ischemic or nephrotoxic etiology o May be associated with mild tubular proteinuria ( <1d/d)
fine granular casts
65
o Reflect chronic kidney disease | o Interstitial fibrosis and dilatation of tubules
granular casts
66
o Glomerular injury | o Acute tubulointerstitial nephritis
red blood cell casts
67
o interstitial nephritis o SLE o transplant rejection o Renal infection
white blood cell casts
68
o Seen in concentrated urine of prerenal ARF | o May suggest urate nephropathy
uric acid crystal
69
o Antibiotic induces allergic nephritis | Hansels stain
eosinophiluria
70
o Hippurate crystals (needle shaped) | o Ethylene glycol ingestion and toxicity
oxate crystal
71
a

medicine (14 decks)

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