CKD and acute renal failure Flashcards
1
Q
DDx of ARF by category
A
Prerenal
- Hypovolemia
- Decreased cardiac output
- Systemic vasodilation
- Renal vasoconstriction
Intrinsic
- Vascular lesions
- Glomerular lesions
- Interstitial nephritis
- Intra-tubule deposition/obstruction
- ATN
Post-Renal
- Urethral (tumors, calculi, clot, sloughed papillae, retroperitoneal fibrosis, lymphadenopathy)
- Bladder neck (tumors, calculi, prostatic hypertrophy or carcinoma, neurogenic)
- Urethral (stricture, tumors, obstructed indwelling catheters)
2
Q
Most common eti of chronic renal disease
A
- DM
- HTN
- Glomerulonephritis
- Polycystic kidney disease
- Autoimmune disease (SLE)
3
Q
Hx in ARF
A
- Predisposing conditions
- Nephrotoxic drugs
- Systemic disease
- Major causes of CKD
4
Q
PE in ARF
A
- Volume status (height of JVD, measurement of pulse and BP in lying and standing position)
- Palpation and percussion of bladder to recognize bladder distention
- Palpation of prostate
- Determine presence of pulmonary edema, peripheral edema, ascites, signs of heart failure
- Findings consistent with uremia
- Exam for evidence of systemic disease (skin, joints, nails)
5
Q
Potential labs in ARF
A
- Electrolytes, BUN/Cr, calcium, phosphorus
- Urine sodium
- Serum and urine osmolality
- Anion gap
- ABG
- Serum BUN/Cr ratio
- CBC, ferritin
- UA, micro for casts, RBCs, WBCs, and crystals
- Calculating FeNa and ability to distinguish pre-renal from post-renal
- Calculating CrCl with Cockcroft-Gault or MDRD
- Serum parathyroid
- ECG findings of hyperkalemia
- Renal US
6
Q
Counseling in CKD
A
- Dx, Tx, f/u
- Elicit questions
- Counsel on renal diet
