Day 6 - Urinary Flashcards
1
Q
Acute renal failure - division
A
- Haemodynamic (prerenal)
- Nephrotoxic (renal)
- Urinary tract obstruction (postrenal)
2
Q
ARF - Haemodynamic
A
- Decreased cardiac output and/or increased renal vascular resistance, decr. GFR
- Diarrhoea, endotoxaemia, septicaemia, acute blood loss, dehydration, colic, myositis, thrombosis, anaesthesia
- Hypotension & release of pressor agents
3
Q
ARF - Nephrotoxic
A
- Drugs: Aminoglycosides, tetracyclines, sulfonamides, NSAIDs, vitamin K3, vitamin D
- Organic metals: Mercury, arsenic, cadmium
- Oxalic acid: Pigweed, budding oak leaves, acorns
- Pigment nephropathies: Myoglobinuria, haemoglobinuria
4
Q
ARF - CS
A
- Depression, anorexia, Dehydration
- Mild colic, abdominal pain
- Signs of primary disorder
- e.g. diarrhoea, septic shock, myositis
- Oliguria (anuria is uncommon)
5
Q
ARF - Clinical pathology
A
- Creatinine increased with low SG (<1.020)
- Prerenal azotaemia: SG>1.025
- Urine casts: Granular leukocytes, tubular epithelial cells, pigments, hyaline (non-cellular)
- Fractional excretion: Na: >1%, Phosphate: >1.2%
- Hypo –> Na, Cl, Ca
- Microscopic hematuria
6
Q
Fractional excretion
A
- Na: 0.03-0.5%
- K: 15-70%
- Cl: 0.2-1.7%
- Ca: <7%
- PO4: <0.5%
- Mg: <15%
7
Q
ARF - Dx
A
- History, clinical signs, lab findings
- Ultrasound, biopsy
- FE
- Pathology
Tubular necrosis, interstitial oedema, infiltration, Intratubular casts, dilation, collapse, Vascular thrombosis
8
Q
ARF - Tx
A
Restore fluid loss, GFR
If still oliguric: Furosemide/Mannitol
- K+ supplementation
- Bicarbonate replacement
- Anti-ulcer medication
- Nutritional support
- Peritoneal dialysis
9
Q
CRF - contributing factors (5)
A
- Systemic hypertension
- Cytokines & growth factors
- Ca2+ and PO43- deposition
- Lipid abnormalities
- Intrarenal vascular changes
10
Q
Stages of CRF
A
- Loss of nephrons < 65%: Subclinical CRF
- Loss of nephrons > 65%: Compensated CRF
- End-stage kidney: Non-compensated
11
Q
Causes of CRF
Tubulointerstitial causes
Glomerular causes
A
Tubulointerstitial causes
* Vascular, septic and toxic causes of ARF
* Chronic or intermittent obstruction
* Chronic pyelonephritis
* Granulomatous infiltrate
* Neoplasia
* NSAIDs
* Renal dysplasia
Glomerular causes
* Renal hypoplasia
* Amyloidosis
* Glomerulonephritis
12
Q
Etiologies of CRF
A
- Toxic nephrosis
Drugs (e.g. aminoglycosides, NSAIDs)
Mercury, arsenic, oxalic acid - Chronic pyelonephritis
Actinobacillus equuli, Streptococci, E. coli - Proliferative glomerulonephritis
EIA, strangles, herpesvirus infections
13
Q
CRF - CS
A
- Weight loss, depression, PU/PD, Dysuria
- Ventral oedema from hypoproteinaemia
- Haematuria, pyuria
- Dental tartar, melaena or ulceration
- Small & irregular kidney, +/- painful
Hypo; Na, P, Proteins
Hyper; K, Ca, Crea/Urea
Metabolic acidosis (End stage)
* Isosthenuria (SG 1.008 to 1.014)
* Proteinuria
14
Q
CRF - Dx
A
- History
- Physical examination
- Rectal palpation
- Laboratory findings: Azotaemia, Isosthenuria
- Ultrasound examination: Increased echogenicity, fibrosis
- Biopsy
- Confirm fibrosis & aetiology
15
Q
CRF - Tx (6)
A
- Supportive care
- Correct pre- and post-renal factors first
- Vitamin B complex
- Iron
- Antibiotics
- Nephrectomy
