Kidney

Question 1

what classified acute renal failure

Answer 1

0.5 mg/dL rise in serum creatinine from normal
>1 mg/dL rise in serum creatinine w/ CKD
Daily urine output (prognosis) - < 0.5ml/kg/hr for >6 consecutive hours

Question 2

AKI stage 1
AKI stage 2
AKI stage 3

Answer 2

creatinine increase to >150-200% baseline
>200-300%
>300 % or >4.0 mg/dl

Question 3

oliguric renal failure

Answer 3

urine output < 400ml/24hr

more common with obstruction, prerenal azotemia

Question 4

anuric renal failure

Answer 4

urine output < 100ml/24hr.

Suggests complete obstruction, major vascular catastrophy, or more commonly severe acute tubular necrosis (ATN)

Question 5

nonoliguric renal failure

Answer 5

Urine output >400ml/24hr

intrarenal causes – nephrotoxic ATN, acute glomerulonephritis, acute interstitial nephritis

Question 6

which drugs can induce acute renal failure?

Answer 6

• NSAIDs
• anbx (sulfonamides, aminoglycosides, PCNs, quinolones)
• amphotericin, acyclovir, foscarnet
• chemo
• TB

Question 7

these drugs reduce renal perfusion through alteration of intra-renal hemodynamics

Answer 7

• NSAIDs
• ACE I
• cyclosporine/tacrolimus/IL-2
• amphotericin
• contrast

Question 8

these drugs are directly nephrotoxic

Answer 8

• aminoglycosides
• MTX
• cyclosporine/tacrolimus
• amphotericin
• IV IG
• contrast

Question 9

these drugs cause heme-pigment induced nephotoxicity (rhabdo)

Answer 9

• cocaine
• ethanol
• statins

Question 10

intratubular obstruction by precipitation of the agent or its metabolites

Answer 10

• acyclovir
• sulfonamides
• chemo/MTX

Question 11

these drugs can cause allergic interstitial nephritis

Answer 11

• anbx
• NSAIDS
• diuretics
• phenytoin
• allopurinol

Question 12

these drugs can cause HUS

Answer 12

• cyclosporine/tacrolimus
• mitomycin
• cocaine
• quinine

Question 13

how to assess contrast induced nephropathy

Answer 13

eGFR <30 – Hospital admission, Nephrology consult, Dialysis planning, renal protection
eGFR 30-59 – Discontinue NSAIDs, IV volume expansion, Intra-arterial: isoosmolar, Intra-venous: iso-osmolar or low osmolar contrast; limit contrast volume
eGFR >60, Discontinue metformin

Question 14

how to tx CIN

Answer 14

volume expansion with normal saline

Question 15

Progressive (over >3 months) tissue destruction with permanent loss of nephrons and renal function

Answer 15

chronic renal failure

Question 16

chronic renal failure staging

Answer 16

Stage 1 	       ≥ 90
Stage 2 	       60 – 89
Stage 3 	       30 – 59
Stage 4 	       15 – 29
Stage 5 	        < 15

Question 17

CKD tx

Answer 17

1st- Iron supplementation
2nd - Epoetin alfa (Epogen Procrit), Darbepoetin alfa (Aranesp)
3rd – RBC transfusions

Question 18

how much Fe should be supplemented?

Answer 18

Recommended initial dose is 200mg elemental/day (2-3 tabs)

Question 19

Fe OD tx

Answer 19

Deferoxamine

Question 20

phosphate binding agents

Answer 20

Calcium carbonate, calcium acetate

sevelamer (lowers LDL and raises HDL)

Question 21

what else do CKD pts need

Answer 21

• Vit D

- Calcium (Cinacalcet-Acts on the calcium-sensing receptor of the parathyroid gland reducing PTH secretion)

Question 22

indication for renal replacement

Answer 22

acidosis-metabolic
electrolyte imbalance
intoxication-rhabdo
overload-fluid
uremia