OMED Renal Flashcards
Big picture concept: pre-renal AKI is a problem with…
perfusion:
a) the pump: MI, CHF
b) leaky pipes: 3rd spacing of fluid, anything causing albumin to go down (nephrotic syndrome, cirrhosis, proteinopathies, malnutrition etc)
c) holes in the pipes (the 3 Ds) diuresis, diarrhea, dehydration, and hemorrhaging
d) clog: fibromuscular dysplasia, renal artery stenosis
Big picture concept: post renal AKI is a problem with…
obstruction: stones, cancer, BPH, neurogenic bladder
Big picture concept: intra-renal AKI is a problem with…
a. glomerulus- glomerulonephritis b. tubules: Acute Tubular necrosis c. interstitium: Acute interstitial nephritis
Glomerulonephritis
RBC casts, but must rule out nephrotic syndrome
AIN
white blood cell casts + eosinophils caused by infections and drug reactions (antibiotics like sulfa, cephalosporins and penicillins)
ATN
muddy brown casts think ischemia or exposure to toxins (IV contrast and myoglobin in particular)
three phases of ATN
ATN is a COP
- prodrome - creatine rises
- oliguric phases - urine output declines
- polyuric phases - urine output excessive
elevated creatinine: first step
rule out pre-renal causes
urine sodium < 10% FeNa < 1% Fe Uria < 35 %
Pre-renal AKI if Bun/Cr is also > 20 give IV fluid if fluid down, refrain IV fluid if too much fluid
elevated creatinine: second step
if no pre-renal–> rule out post renal with U/S or CT scan to look for hydroureter or hydronephrosis
elevated creatinine: third step
pre-renal and post-renal ruled out. treat as intra-renal even though only biopsy confirms order U/A
Indications for Dialysis
AEIOU
- Acidosis
- Electrolytes (Na/K)
- Ingestion (toxins)
- overload (CHF/edema)
- uremia (pericarditis)
CKD stage 1 GFR and action
above 90, prevent their progression
CKD II GFR and action
60-89, prevent progression
CKD stage III GFR and action
30-59, complication management
