Chronic & Acute Renal Failure Flashcards
Do you need ARF to get CRF?
Nope
if you have CRF does that mean you had to have ARF?
Nope
Renal failure is defined as failure of what?
filtration
ARF reversible?
yes the sooner you treat it the better the outcome
definition of renal failure is how much urine flow per day?
less than 500ml/day
CRF timeline? reversible?
develops over 6 months-years
irreversible
What is normal GFR /min? /day?
125ml/min
180ml/day
GFR at 65? at 80?
65: 100ml/min 144L/day
80: 75ml/min 108L/day
What is considered significant CRF ____ml/min?
<72L per day
loss of GFR is coupled with loss of?
tubular reabsorption/secretion
When do you get endocrine impairment with renal failure?
more so CRF
3 main endocrine impairment with renal failure?
RAS: +++vasocontriction
impaired vitamin D activation
decreased erythropoeitin - anaemia
plasma urea for GFR assessment?
NOPE. crap
what is normal creatinine levels?
50-120uM/L
equation for creatinine clearance?
UV/P = GFR
Normal hydrostatic pressure in glomerulus is?
55mmHg
when do you no longer filter anything in glomerulus?
<40-45mmHg
ARF: What’s more common? oliguria? Anuria?
oliguria
ARF: GFR falls how?
acutely hours/days
3 areas of acute renal failure?
pre-renal
renal
post-renal
what is ATN?
acute tubular necrosis
in pre-renal ARF: what would systemic and Glomerulous pressures be less than?
systemic: <45mmHG
causes of pre-renal ARF? 5 big ones
Shock Sepsis Haemolysis rhabdomyolysis nephrotoxic drugs
3 big causes of renal/intrinsic ARF?
glomerular disease
interstitial nephritis
tubular damage
what can cause glomerular disease?
IgA immune complexes post group A strep infections
interstitial nephritis often related to?
drugs
3 Toxins that can cause tubular damage in ARF?
antibiotics
contrast media
myo/haemoglobin
2 ischemic events that cause tubular damage in ARF? which one is most common?
ATN (most common)
vascular obstruction
how does ATN cause death?
Acidosis, increase in K+ levels: arrythmias
what is a post-renal cause of ARF?
outlet obstruction
stones, clots, tumours
What is uraemia?
CRF
CRF reversible?
Nope
CRF leads to what?
end-stage renal disease
in CRF what happens to remaining nephrons?
hypertrophy
hyperfiltration
What happens in glomerular hyperfiltration in CRF? 3 things
loss of functional reserve
glomerular hypernsion
damage/glomerulosclerosis
What is uraemia exactly beside CRF?
accumulation of urea
when do you get symptoms with uraemia?
<30% normal renal function
fatigue, anorexia, skin pigmentation (lemon)
4 common causes of CRF?
diabetes
high blood pressure
chronic glomerulonephritis
cystic disease
What happens to sodium in glomerular disease?
sodium retention
hypertension
what happens to sodium in tubular disease
sodium wasting
low BP
crappy concentrating ability/polyuria
What happens to [K+] in CRF?
tends to rise in late stage
what happens to pH in CRF?
falls cause it fails to excrete
what happens to PO4 in CRF?
reduced excretion
rise in PO4
reduction in Ca2+
what happens to Ca2+ in CRF?
reduction
rise in PO4
What is renal osteodystrophy?
reduced Vitamin D3 activation: osteomalacia, fractures
why high PTH in CRF?
with less PO4 excretion = increase Ca2+ excretion = increase in PTH to get Ca2+ levels up = hyperparathyroidis (contributes to bone degradation)
Which can be salt and water imbalances in CRF? 1. Sodium retention and hypertension 2. Sodium wasting and low BP 3. Polyuria
?
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
?
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
?
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
?
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
?
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
?
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
?
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
?
Which of the following can cause anuria? 1. Glomerulonephritis 2. Interstitial nephritis 3. Renal artery occlusion 4. Prostatic malignancy
?
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
?
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
?
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
?
Which can be salt and water imbalances in CRF? 1. Sodium retention and hypertension 2. Sodium wasting and low BP 3. Polyuria
?
