Chronic & Acute Renal Failure

Question 1

Do you need ARF to get CRF?

Answer 1

Nope

Question 2

if you have CRF does that mean you had to have ARF?

Answer 2

Nope

Question 3

Renal failure is defined as failure of what?

Answer 3

filtration

Question 4

ARF reversible?

Answer 4

yes the sooner you treat it the better the outcome

Question 5

definition of renal failure is how much urine flow per day?

Answer 5

less than 500ml/day

Question 6

CRF timeline? reversible?

Answer 6

develops over 6 months-years

irreversible

Question 7

What is normal GFR /min? /day?

Answer 7

125ml/min

180ml/day

Question 8

GFR at 65? at 80?

Answer 8

65: 100ml/min 144L/day
80: 75ml/min 108L/day

Question 9

What is considered significant CRF ____ml/min?

Answer 9

<72L per day

Question 10

loss of GFR is coupled with loss of?

Answer 10

tubular reabsorption/secretion

Question 11

When do you get endocrine impairment with renal failure?

Answer 11

more so CRF

Question 12

3 main endocrine impairment with renal failure?

Answer 12

RAS: +++vasocontriction
impaired vitamin D activation
decreased erythropoeitin - anaemia

Question 13

plasma urea for GFR assessment?

Answer 13

NOPE. crap

Question 14

what is normal creatinine levels?

Answer 14

50-120uM/L

Question 15

equation for creatinine clearance?

Answer 15

UV/P = GFR

Question 16

Normal hydrostatic pressure in glomerulus is?

Answer 16

55mmHg

Question 17

when do you no longer filter anything in glomerulus?

Answer 17

<40-45mmHg

Question 18

ARF: What’s more common? oliguria? Anuria?

Answer 18

oliguria

Question 19

ARF: GFR falls how?

Answer 19

acutely hours/days

Question 20

3 areas of acute renal failure?

Answer 20

pre-renal
renal
post-renal

Question 21

what is ATN?

Answer 21

acute tubular necrosis

Question 22

in pre-renal ARF: what would systemic and Glomerulous pressures be less than?

Answer 22

systemic: <45mmHG

Question 23

causes of pre-renal ARF? 5 big ones

Answer 23

Shock
Sepsis
Haemolysis
rhabdomyolysis
nephrotoxic drugs

Question 24

3 big causes of renal/intrinsic ARF?

Answer 24

glomerular disease
interstitial nephritis
tubular damage

Question 25

what can cause glomerular disease?

Answer 25

IgA immune complexes post group A strep infections

Question 26

interstitial nephritis often related to?

Answer 26

drugs

Question 27

3 Toxins that can cause tubular damage in ARF?

Answer 27

antibiotics contrast media myo/haemoglobin

Question 28

2 ischemic events that cause tubular damage in ARF? which one is most common?

Answer 28

ATN (most common) | vascular obstruction

Question 29

how does ATN cause death?

Answer 29

Acidosis, increase in K+ levels: arrythmias

Question 30

what is a post-renal cause of ARF?

Answer 30

outlet obstruction | stones, clots, tumours

Question 31

What is uraemia?

Answer 31

CRF

Question 32

CRF reversible?

Answer 32

Nope

Question 33

CRF leads to what?

Answer 33

end-stage renal disease

Question 34

in CRF what happens to remaining nephrons?

Answer 34

hypertrophy | hyperfiltration

Question 35

What happens in glomerular hyperfiltration in CRF? 3 things

Answer 35

loss of functional reserve glomerular hypernsion damage/glomerulosclerosis

Question 36

What is uraemia exactly beside CRF?

Answer 36

accumulation of urea

Question 37

when do you get symptoms with uraemia?

Answer 37

<30% normal renal function | fatigue, anorexia, skin pigmentation (lemon)

Question 38

4 common causes of CRF?

Answer 38

diabetes high blood pressure chronic glomerulonephritis cystic disease

Question 39

What happens to sodium in glomerular disease?

Answer 39

sodium retention | hypertension

Question 40

what happens to sodium in tubular disease

Answer 40

sodium wasting low BP crappy concentrating ability/polyuria

Question 41

What happens to [K+] in CRF?

Answer 41

tends to rise in late stage

Question 42

what happens to pH in CRF?

Answer 42

falls cause it fails to excrete

Question 43

what happens to PO4 in CRF?

Answer 43

reduced excretion rise in PO4 reduction in Ca2+

Question 44

what happens to Ca2+ in CRF?

Answer 44

reduction | rise in PO4

Question 45

What is renal osteodystrophy?

Answer 45

reduced Vitamin D3 activation: osteomalacia, fractures

Question 46

why high PTH in CRF?

Answer 46

with less PO4 excretion = increase Ca2+ excretion = increase in PTH to get Ca2+ levels up = hyperparathyroidis (contributes to bone degradation)

Question 47

``` Which can be salt and water imbalances in CRF? 1. Sodium retention and hypertension 2. Sodium wasting and low BP 3. Polyuria ```

Answer 47

?

Question 48

Impairment of which of the following is the most important in defining renal failure? 1. renal blood flow 2. glomerular filtration rate 3. renal tubular reabsorption 4. renal tubular secretion 5. renal concentrating ability

Answer 48

?

Question 49

``` Predisposition to acute renal failure is seen in which of the following groups? 1. < 5 years of age 2. > 60 years of age 3. vegans 4. obese 5. pre-existing renal disease ```

Answer 49

?

Question 50

``` 28 Which of the following provide a clinical estimate of GFR 1. Plasma sodium concentration 2. Plasma potassium concentration 3. Plasma bicarbonate concentration 4. Plasma pH 5. Plasma urea concentration 6. Plasma creatinine concentration ```

Answer 50

?

Question 51

Which of the following scenarios involving plasma creatinine would worry you? 1. A value of 110 μM/L in a frail old lady 2. A value of 130 μM/L in an elite body builder 3. An increase from 60 to 120 μM/L 4. An increase from 300 to 360 μM/L

Answer 51

?

Question 52

``` Which of the following are true? 1. A urine output of 500 mL per day excludes the presence of renal failure 3. Both 4. Neither ```

Answer 52

?

Question 53

``` Which of the following can cause pre-renal renal failure? (via glomerular filtration driving force) 1. Hemorrhage 2. Hypoalbuminemia 3. Renal artery stenosis 4. NSAIDs 5. ACE inhibitors 6. Cardiac failure ```

Answer 53

?

Question 54

``` The most accurate measure of daily fluid balance is: 1. Hospital admission and careful monitoring of fluid intake and urine volumes 2. Changes in plasma urea 3. Changes in plasma creatinine 4. Jugular venous pressure 5. Daily body weight measurement ```

Answer 54

?

Question 55

``` Which of the following can cause anuria? 1. Glomerulonephritis 2. Interstitial nephritis 3. Renal artery occlusion 4. Prostatic malignancy ```

Answer 55

?

Question 56

``` Which of the following are problems in acute renal failure? 1. Hypokalemia 2. Hypercalcemia 3. Hypophosphatemia 4. Sodium and water retention 5. Acidosis 6. Severe anemia ```

Answer 56

?

Question 57

``` Which of the following are functions of the normal kidney? 1. Maintenance of volume of ECF 2. Maintenance of composition of ECF 3. Vitamin D activation 4. Control of red blood cell production ```

Answer 57

?

Question 58

``` Which of the following would be of benefit to remaining nephrons 1. High protein diet 2. Low protein diet 3. Keeping blood pressure high 4. Keeping blood pressure low ```

Answer 58

?

Question 59

``` Which can be salt and water imbalances in CRF? 1. Sodium retention and hypertension 2. Sodium wasting and low BP 3. Polyuria ```

Answer 59

?