Exam 3- Acute Renal Failure Pales Flashcards
elevated creatinine is indicative of
renal failure
how do you know if renal failure is acute or chronic
compare to creatinine from before
size of kidneys on US
sediment on U/A
stigmata of chronic renal failure
anemia
hyperparathyroidism
A/V fistula
hyperphosphatemia
sediment on UA is indicative of acute or chronic renal failure
acute
What are the 2 tests you must order for kidney failure
Ultrasound
UA
What is indicatice of pre-renal damage on UA
normal or hyaline casts
What does muddy brown, granular epithelial casts mean on UA
tubular cell injury
pyuria, hematuria, mild proteinuira, granular and epithelial casts with eosinophils is indicative of what on UA
interstitial nephritis
hematuria, marked proteinuria, RBC casts and granular casts are indicative of what on UA
glomerulonephritis
normal or hematrual and mild proteinuria are indicative of what infrarenal acture kidney injury
vascular disorders
what does a post renal AKI UA look like
normal or hematuria, granular casts, pyuria
if fractional excretion Na is less than 1% what is location of AKI
pre renal
glomerulonephritis or vascular disorders
if urine Na is less than 10 what is location of AKI
pre-renal
if urine Na is more than 20 what is location of AKI
ATN, toxic injury
intrarenal
What can you see on renal ultrasound
hydronephrosis, stones, kidney size, PCKD, tumors
If Normal saline corrects BUN and creatinine, what does that tell you about the injury
pre-renal
what damage do kidneys get from pre-renal damage
none
why can albumin decrease in pre-renal AKI
because is an acute phase reactant
changes composition under certain stressors
what are causes of pre-renal azothemia
intravascular volume depletion decreased effective intravascular volume (cirrhosis, CHFm peritonitis) systemic vasodilation (sepsis, hepatorenal syndrome) large vessel renal vascular disease
What meds make prerenal AKI worse
NSAIDs ACEI cyclosporine tacrolimus radiocontrast dyes
ulnar deviation of wrist and fingers is indicative of what
rheumatoid arthritis
what is the hypersensitivty reaction to med causing renal issues called
acute interstitial nephritis
What can cause an extreme high BUN in an intra renal caused AKI
GI bleed
ulcer
What would US look like from intrarenal ATN
looks normal
Why would creatinine go up after a surgery for GI ulcer and dehydrated man suffering from acute interstitial nephritis that was just reperfused
part of the maintenance phase of kidney recovery from AKI
what are the phases of recovery in AKI
initiation, extension, maintenance, recovery
how do you Tx post renal ARF from obstruction
remove obstruction
What is DIC
increased coagulopaty
more Hb etc..
When giving fluids over period of time and shows worsening renal conditions what must you look at
intake and output of fluids each day
what are some nephrotoxic medications
radiocontrast dye acyclovir sulfonamides methotrexate cyclosprine tacrolimus amphotericin B aminoglycosides cisplatin pentamidine ethylene glycol toluene cocaine HMG-CoA reductase inhibirors
what is prognosis of radiocontrast related nephropathy
gets better with time
patient with purpura on skin and URI that won’t go away with hemoptysis
scan shows lung nodules
3-5 days at hospital, creatinine increased and patient had swelling and hyperkalemia (on acute dialysis)
US normal, UA negative for eosinophils
pre? intra? post renal?
intrarenal
no eosinophils- not acute interstitial nephritis
RBC casts are indicative of what
glomerulonephropathy
what GN involves lungs too
goodpastures and wegeners
final step to Dx acute renal failure if blood tests and everythin unremarkable
biopsy
