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GU1 - Nephrology > Clin Med - Acute Renal Failure > Flashcards

Clin Med - Acute Renal Failure Flashcards

1
Q

What are the signs of acute renal failure?

A
  • rapid decline in GFR
  • retention of nitrogenous waste

Perturbation (deviation) of homeostasis of:

  • ECF volume
  • electrolytes
  • acid / base
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2
Q

What are the classifications of ARF??

A
  1. Pre-renal
  2. Post-renal
  3. Intrinsic
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3
Q

What are the intrinsic causes of ARF?

A
  • Vascular
  • Glomerular
  • Interstitial (Tubulo-interstitial)
  • Tubular (ATN)
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4
Q

What are the cardiac causes of pre-renal ARF?

A

acute (e.g. MI, arrhythmias, tamponade, acute valvular disease)

chronic (e.g. CHF, valvular disease)

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5
Q

What are the redistribution of ECF causes of pre-renal ARF?

A
  • hypoalbuminemia (e.g. advanced liver disease, nephrotic syndrome, malnutrition)
  • physical causes (e.g. peritonitis, burns, crush injury)
  • peripheral vasodilation (e.g. sepsis, antihypertensive agents).
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6
Q

What is the definition of pre-renal ARF?

A

decreased “effective” intravascular volume/renal perfusion. Genuine volume depletion.

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7
Q

What are the most common causes of post-renal ARF?

A
  • Bilateral obstruction/obstruction of solitary kidney
  • Ureteral and pelvic – intrinsic obstruction (e.g. clots, stones, papillae, fungus ball) and extrinsic obstruction (e.g. malignancy, retroperitoneal fibrosis, inadvertent ligation)
  • Bladder – e.g. clots, stones, prostatic hyperplasia/malignancy, bladder carcinoma, neurogenic.
  • Urethral – e.g. stricture, phimosis
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8
Q

Vasculitis urine sediment findings

A
  • Scant if primarily preglomerular

- RBCs and RBC casts if glomeruli involved

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9
Q

Glomerulonephritis urine sediment findings

A
  • RBCs and RBC casts
  • Lipid casts and lipid bodies
  • Pigmented urine and pigmented casts
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10
Q

Interstitial (tubule-interstitial) nephritis urine sediment findings

A
  • WBCs and WBC casts
  • Renal tubular epithelial cells and RTE casts
  • Eosinophiluria
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11
Q

Acute tubular necrosis (ATN) urine sediment findings

A
  • Renal tubular epithelial cells and RTE casts muddy-brown casts
  • Pigmented granular casts
  • Coarse granular casts
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12
Q

Which urine labs tell you pre-renal AKI?

A

FeNa < 1%

FeUrea < 35%

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13
Q

Which urine labs tell you ATN AKI?

A

FeNa > 1%

FeUrea > 35%

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14
Q

Ischemic causes of ATN

A
  • Severe hypoperfusion +/- additional insult

- NSAIDs (can also cause AIN)

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15
Q

Nephrotoxic causes of ATN

A
  • Antibiotics (aminoglycosides, cephalosporin, ampho B)
  • Can also cause acute interstitial nephritis (“AIN”, penicillin, sulfa, fluoroquinolone)
  • Radiocontrast
  • Chemotherapy
  • Globin pigments
  • Organic solvents/other toxins
  • Anesthetics
  • Heavy metals
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16
Q

General care of patient with AKI

A

The key is to identify the primary cause of AKI and treat that!

17
Q

Volume overload causing AKI

A

Salt and water restriction, diuretics, dialysis

18
Q

Hyponatremia causing AKI

A

Restriction of enteral and parenteral free water

19
Q

Hyperkalemia causing AKI

A

K+ restriction, kayexalate, dialysis

20
Q

Acidosis causing AKI

A

NaHCO3, acetate, dialysis

21
Q

Hyperphosphatemia causing AKI

A

Dietary restriction, binders

22
Q

Hypocalcemia causing AKI

A

Supplement if symptomatic

23
Q

Hypermagnesemia causing AKI

A

D/c Mg2+ containing meds/antacids

24
Q

Nutrition causing AKI

A

Adequate calories, mild protein restriction

25
Q

Dialysis causing AKI

A
  • volume overload, hyperkalemia, acidosis, uremia

- typically simplifies dietary and fluid management

26
Q

Urine volume - anuria

A

obstruction, bilateral vascular occlusion, acute GN, cortical necrosis

27
Q

Urine volume - alternating anuria/polyuria (rare)

A

obstruction

28
Q

Urine volume - oliguria

A

various, but especially pre-renal or ATN

29
Q

Urinalysis - RBCs, RBC casts

A

Glomerular disease - glomerulonephritis, vasculitis

30
Q

Urinalysis - WBCs, WBC casts

A

interstitial disease - infectious, allergic [eosinophils]

31
Q

Urinalysis - brown, muddy, granular casts

A

ATN

32
Q

Urinalysis - epithelial cell casts

A

Interstitial of tubular disease

33
Q

Urinalysis - crystals

A
  • urate (tumor lysis)

- CaOxalate (GI disease, glycol toxicity, congenital hyperoxaluria)

34
Q

What are the indications for dialysis?

A

Patients with volume overload, hyperkalemia, acidosis, uremia

GU1 - Nephrology (16 decks)

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