Pathoma Acute Renal Failure Flashcards by Jean-Luc Banks

Renal papillary necrosis may be caused by chronic […] abuse

analgesic

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Acute tubular necrosis caused by […] is due to decreased renal blood flow

ischemia

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Renal papillary necrosis may be caused by […] disease or trait

sickle cell

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In early postrenal azotemia, the BUN:creatinine ratio is […] 15

greater than

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Acute tubular necrosis is caused by […] or nephrotoxic injury

ischemic

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One clinical feature of renal failure is […], which is a symptomatic clinical syndrome marked by increased nitrogenous waste products in the blood (azotemia)

uremia

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Renal papillary necrosis presents with gross […]-uria and colicky flank pain

hematuria

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One complication of acute pyelonephritis is renal […] necrosis

papillary

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In addition to hematuria, renal papillary necrosis may also present with […]-uria

proteinuria

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What is the urine osmolality (mOsm/kg) in acute tubular necrosis?

[…]

< 350 mOsm/kg (low)

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[…] is charactized by sloughing of necrotic renal papillae

renal papillary necrosis

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What is the fractional excretion of Na+ (FENa) in early postrenal azotemia?

[>2% or <1%?]

< 1% normal

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What is the most common cause of acute renal failure in hospitalized patients?

[…]

acute tubular necrosis

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Acute interstitial nephritis is less commonly secondary to systemic […] (e.g. mycoplasma)

infections

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Acute interstitial nephritis is associated with hemat-uria and pyruria (classically […])

eosinophils

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Drugs that cause acute interstitial nephritis may be remembered with the 5 “P’s”

Pee (diuretics)
Pain-free (NSAIDS)
Penicillins (and cephalosporins)
Proton pump inhibitors
rifamPin

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The hallmark of acute kidney injury is […], often with oliguria

azotemia

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Acute interstitial nephritis is characterized histologically by
[…] in the connective tissue between renal tubules

inflammatory infiltrate

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Acute tubular necrosis is associated with […] casts in the urine

granular “muddy brown”

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During the recovery phase of acute tubular necrosis, BUN and serum creatinine levels […]

decrease

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What is the effect of postrenal azotemia on GFR?

[…]

decreased GFR

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Acute interstitial nephritis may present with […] and […], days to weeks after starting a drug

fever and rash

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During the recovery phase of acute tubular necrosis, there is increased risk for […]-kalemia and renal wasting of other electrolytes and minerals

hypokalemia

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In prerenal azotemia, the BUN:creatinine ratio is […] 15

greater than 15

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Does the maintenance phase of acute tubular necrosis present with oliguria or polyuria? [...]

- oliguria

Acute tubular necrosis caused by [...] is due to toxic substances

- nephrotoxicity

What acid-base disturbance is associated with the maintenance phase of acute tubular necrosis? [...]

- Metabolic Acidosis

Renal papillary necrosis may be caused by severe acute [...]

- pyelonephritis

Does postrenal azotemia occur with unilateral or bilateral obstruction? [...]

- bilateral

What physical exam finding may be associated with acute interstitial nephritis? [...]

- CVA tenderness

What is the treatment for drug-induced acute interstitial nephritis? [...]

- cessation of the drug

The third (final) stage of acute tubular necrosis is the [...] phase

- recovery

What is the urine osmolality (mOsm/kg) in long-standing postrenal azotemia? [...]

< 350 mOsm/Kg (low)

Acute tubular necrosis may be caused by heavy metals such as [...]

- lead

In long-standing postrenal azotemia, the BUN:creatinine ratio is [...] 15

- less than

What is the effect of prerenal azotemia on GFR? [...]

- decreased GFR

Acute tubular necrosis may be caused by [...]-contrast dyes

- radio

Acute tubular necrosis due to nephrotoxic injury most commonly affects the [...]

- proximal tubule

Acute tubular necrosis is reversible but often requires supportive [...] due to electrolyte imbalances (e.g. hypokalemia)

- dialysis

Acute tubular necrosis is caused by ischemic or [...] injury

- nephrotoxic

Renal papillary necrosis presents with gross hemat-uria and colicky [...] pain

- flank

Acute interstitial nephritis is associated with [...]-uria and pyruria (classically eosinophils)

- hematuria

The hallmark of acute kidney injury is azotemia, often with [urinary change]

- oliguria

[...] is associated with granular "muddy brown" casts in the urine

- acute tubular necrosis

During the recovery phase of acute tubular necrosis, there is increased risk for hypo-kalemia and renal [...] of other electrolytes and minerals

- wasting

What is the urine osmolality (mOsm/kg) in prerenal azotemia? [...]

> 500 mOsm/Kg (normal)

What renal pathology is associated with eosinophils in the urine? [...]

- acute interstitial nephritis

Acute tubular necrosis may be caused by high levels of [...] (e.g. tumor lysis syndrome)

- uric acid

Nephritic syndrome is associated with [...] BUN and creatinine

- increased

What is the effect of acute tubular necrosis on GFR? [...]

- decreased GFR

How does the fractional excretion of Na+ (FENa) change in prerenal azotemia? [...]

- decreased < 1%

Does the recovery phase of acute tubular necrosis present with oliguria or polyuria? [...]

- polyuria

What is the fractional excretion of Na+ (FENa) in long-standing (severe) postrenal azotemia? [>2% or <1%?]

> 2% (elevated)

In acute tubular necrosis, the BUN:creatinine ratio is [...] 15

- less than

During the maintenance phase of acute tubular necrosis, there is increased risk for [...]-kalemia and uremia

- hyperkalemia

What is the fractional excretion of Na+ (FENa) in acute tubular necrosis? [...]

> 2% (elevated)

In prerenal azotemia, there is [...] reabsorption of Na+ and H2O

- increased

What is the urine Na+ (mEq/L) in acute tubular necrosis? [...]

> 40 mEq/L

The second stage of acute tubular necrosis is the [...] phase

- maintenance

[...] azotemia is due to obstruction of the urinary tract downstream from the kidney (e.g. stones, BPH, neoplasia)

- post renal

What is the urine Na+ (mEq/L) in postrenal azotemia? [ >40 or <20?]

> 40

Acute tubular necrosis due to ischemic injury is often preceded by [...]

- prerenal azotemia

Intrarenal azotemia is less commonly due to acute [...] or acute interstitial nephritis

- glomerulonephritis

The first stage of acute tubular necrosis is the [...]

- inciting event

What endocrine pathology may cause renal papillary necrosis? [...]

- diabetes mellitus

Acute interstitial nephritis may progress to renal [...] | necrosis

- papillary

Acute tubular necrosis may be caused by ingestion of [...], which is associated with oxalate crystals in the urine

- ethylene glycyol

What chemotherapeutic agent may cause acute tubular necrosis? [...]

- cisplatin

What is the urine Na+ (mEq/L) in prerenal azotemia? [...]

< 20 mEq/L

Acute interstitial nephritis is less commonly secondary to [...] diseases (e.g. Sjogren syndrome, SLE, sarcoidosis)

- autoimmune

How long does the maintenance phase of acute tubular necrosis last? [...]

1-3 weeks

Acute tubular necrosis may be caused by [...], which can occur with crush injuries

- myoglobinuria

[...] azotemia is due to decreased renal blood flow (e.g. cardiac failure, hypotension)

- prerenal

What is the urine osmolality (mOsm/kg) in early postrenal azotemia? [>500 or <350?]

> 500

What class of anti-microbials is a common cause of acute tubular necrosis? [...]

- aminoglycosides

Acute tubular necrosis is characterized histologically by loss of [...] and detachment of tubular cells from the basement membrane

- nuclei

Intrarenal azotemia is generally due to [...] necrosis or ischemia/toxins

- acute tubular

Acute tubular necrosis due to ischemic injury most commonly affects the [...] and the medullary segment of the thick ascending limb

- proximal tubule

Intrarenal azotemia is less commonly due to acute glomerulonephritis or acute [...]

- interstitial nephritis

Acute tubular necrosis may be caused by ingestion of ethylene glycol, which is associated with [...] crystals in the urine

- oxalate

Prerenal azotemia is due to decreased [...] (e.g. cardiac failure, hypotension)

- renal blood flow

Acute tubular necrosis is characterized histologically by loss of nuclei and [...] of tubular cells from the basement membrane

- detachment

[...] azotemia is generally due to acute tubular necrosis or ischemia/toxins

- intrarenal

Acute tubular necrosis due to ischemic injury most commonly affects the proximal tubule and the medullary segment of the [...]

- thick ascending limb

Azotemia typically refers to an increase in serum [...] and [...]

- BUN | - creatinine

[...] is a drug-induced hypersensitivity reaction involving the interstitium and tubules of the kidney

- acute interstitial nephritis

[...] and allopurinol are used prior to initiation of chemotherapy to decrease risk of urate-induced acute tubular necrosis

- hydration

Acute interstitial nephritis is a drug-induced [...] reaction involving the interstitium and tubules of the kidney

- hypersensitivity

Hydration and [...] are used prior to initiation of chemotherapy to decrease risk of urate-induced acute tubular necrosis

- allopurinol