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Renal II Exam 3 > CIS > Flashcards

CIS Flashcards

1
Q

acute kidney injury

A

absolute increase in serum creatinine of .3 mg/dL or

50% increase in serum creatinine or

Reduction in urine output consisting of oliguria of less than .5 mL/kg/hr for longer than 6 hours

Note– BUN is not used in the diagnosis of renal failure

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2
Q

Acute vs. Chronic renal failure

A 
Compare with Creatinine from before
Size of kidneys on US
Sediment on u/a
Stigmata of Chronic Renal Failure:
- Anemia
- Hyperparathyroidism (osteodystrophy)
- A/V fistula
- Hyperphosphatemia
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3
Q

differential for renal acute kidney injury toxins

A

Exogenous: direct and vasoconstriction

Endogenous: myoglobin, hemoglobin, light chAINS, uric acid, calcium

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4
Q

Work-up for AKI. Urinalysis.

A

Prerenal
- Normal or hyaline casts

Intrarenal

  • Tubular cell injury: Muddy-brown, granular, epithelial casts
  • Interstitial nephritis : Pyuria, hematuria, mild proteinuria, granular and epithelial casts, eosinophils
  • Glomerulonephritis: Hematuria, marked proteinuria, red blood cell casts, granular casts
  • Vascular disorders: Normal or hematuria, mild proteinuria

Postrenal
Normal or hematuria, granular casts, pyuria

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5
Q

FeNA, Urine Na and Bun/ Creat Ratio in pre-renal

A

less than 1% FeNa
less than 10 Urine Na
greater than 20:1 BUN Creat Ratio

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6
Q

FeNA, Urine Na and Bun/ Creat Ratio in ATN or toxic injury or early vascular disorders

A

FeNA > 1% , Urine Na > 20, BUN/ Creat Ratio less than 20:1

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7
Q

FeNA, Urine Na and Bun/ Creat Ratio in glomerulonephritis

A

FeNa less than 1%, Urine Na less than 10, BUN/ Creat Ratio less than 20:1

“g-low-merulonephritis,” everything is “low”

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8
Q

Renal Ultrasound

A 
Signs of hydronephrosis
Kidneys size
PCKD
Stones
Tumors
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9
Q

Acute injury, what do you do first before even thinking?

A

give them fluids

If the fluids improve the BUN/ Creatinine ratio, then you know that it was pre-renal (diagnosis by treatment)

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10
Q

What are possible causes of pre-renal azothemia

A

Intravascular volume depletion and or hypotension: Hemorrhage, GI loss: vomiting/diarrhea, Renal loss: diuretics, diabetes (mellitus and incipidus), Dermal losses (sweating)

Decreased effective intravascular volume: Congestive heart failure, Cirrhosis, Hepatorenal syndrome, Peritonitis

Systemic vasodilation/renal vasoconstriction: Sepsis, Hepatorenal syndrome

Large-vessel renal vascular disease: Renal artery thrombosis or embolism, Renal artery stenosis, Cholesterol emboli

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11
Q

What medications make prerenal azothemia worse, and may even push patient into acute tubular necrosis with the same degree of dehydration?

A 
Cyclosporine
Tacrolimus
ACEIs, ARBs, 
NSAIDs
Radiocontrast agents
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12
Q

Why does infection lower albumen?

A

it is an acute phase reaction

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13
Q

Another cause of increased BUN

A

upper GI bleeding– reabsorption of BUN

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14
Q

hyaline casts mean?

A

pre-renal

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15
Q

granular casts mean?

A

ATN

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16
Q

RBC casts mean?

A

glomerulonephrotic

17
Q

what will we see on ultrasound of acute ATN?

A

normal kidneys

18
Q

difference in recovery period between pre-renal and ATN?

A

pre-renal gets better with fluids

ATN will take a week or so to get better because of the necrosis

19
Q

what medications may cause acute renal failure?

A 
Aminoglycosides
Radiocontrast agents
Acyclovir
Cisplatin
Sulfonamides
Methotrexate
Cyclosporine
Tacrolimus
Amphotericin B
Foscarnet
Pentamidine
Ethylene glycol
Toluene
Cocaine
HMG-CoA reductase inhibitors
20
Q

What is the significance of the negative finding for eosinophills. What condition it rules out?

A

acute interstitial nephritis

21
Q

Interstitial Nephritis– meds that make you suspect

A

β-LACTAM ANTIBIOTICS Penicillin Cephalosporins Ampicillin Methicillin Nafcillin

DIURETICS Furosemide Hydrochlorothiazide Triamterene

OTHER ANTIBIOTICS Sulfonamides Vancomycin Rifampin Acyclovir Indinavir

NSAIDS Ibuprofen Naproxen Indomethacin

22
Q

most common side effect of statin?

A

rhabdomyalysis

23
Q

what screams rhabdomyalysis?

A

very positive for blood but very few RBC

24
Q

besides renal failure, 2 other complications of rhabdomyalysis?

A 
compartment syndrome (from swelling)
disseminated intravascular coagulation
25
Q

treat rhabdomyalysis

A

tons of IV fluids
alkalinization of the urine with Na Bicarbonate (thought to decrease precipitation of toxins)
diuretics to increase urine flow (loop and osmotic)
hypocalcemia is not usually treated because calcium would bind with the high phosphorous from the myalysis

26
Q

RBC casts spell

A

glomerulonephritis (many kinds)

27
Q

eosinophils in urine and rash

A

interstitial nephritis

Renal II Exam 3 (15 decks)

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