Renal 1 Paulson

Question 1

This disease is categorized by a rapid worsening of renal function and a quickly rising BUN/Cr. Happens because all the stuff the kidney is supposed to be filtering concentrates in the blood

Answer 1

Acute Renal Failure (ARF) AKA Acute Kidney Injury (AKI)

Basically kidney failure

Question 2

What is the AKI Criteria? (3)

Answer 2

• *Only need to meet one criteria
  1. Abrupt (within 48 hours) absolute increase in the serum creatinine of ≥0.3 mg/dl above baseline –or-
  2. Serum creatinine increases ≥50% (known or presumed to have occurred in the past 7 days) -or-
  3. Oliguria of <0.5 ml/kg/hour for >6 hours

**need to know patient’s baseline Cr

Question 3

What are some sxs of AKI?

Answer 3

• Weakness, lethargy
• Anorexia
• N/V
• Persistent hiccups
• General malaise

Question 4

What are some signs of AKI?

Answer 4

-usually point towards underlying cause
• Ie: Prerenal, could be tachycardic and hypotensive
• Postrenal: distended bladder, CVA tenderness, enlarged prostate
-anuria/oliguria (pee a lot or little)
-AMS, weight change

Question 5

What is the #1 test to dx AKI?

Answer 5

• BMP

- Also urinalysis & urine microscopy

Question 6

When should you dialyze a patient?

Answer 6

• Serum creatinine >5-10 mg/dl
• Unresponsive acidosis
• Severe electrolyte disorders
• Fluid overload
• Uremic complications

Question 7

What is the most common cause of AKI?

Answer 7

Prerenal failure

**Caused by reduced effecitve blood circulating to the kidney

Question 8

What are some examples of true intravascular volume depletion?

Answer 8

• Traume
• Hemorrhage
• Burns
• Diuretics

Question 9

What are some examples of decreased effective circulating volume? (basically same amt of fluid but in the wrong places)

Answer 9

• CHF
• Cardiac tamponade
• Aortic stenosis

Question 10

What are some examples of impaired renal blood flow?

Answer 10

• ACEI
• NSAIDs
• Renal artery stenosis
• Renal vein thrombosis

Question 11

What are the labs that distinguish prerenal failure?

1. BUN:Cr
2. Urine Sodium
3. FENa
4. Urine specific gravity

Answer 11

• Serum BUN:Cr ratio: ≥20:1
• Urine sodium: <20 meq/L
• Fractional Excretion of Sodium (FENa): <1%
—Measures the percent of sodium fitered by the kidney that is excreted into urine
• Urine specific gravity: >1.020

• Occur because the kidney is responding to prerenal failure by increasing reabsorption

Question 12

What is the treatment for pre-renal failure?

Answer 12

-Correct the underlying cause:
• CHF: Diurese the patient
• Dehydration: IVF
• Hemorrhage: Blood+fluids

Question 13

What are the two mc causes of postrenal failure?

Answer 13

Nephrolithiasis & BPH

**something blocking ureters or bladder and this is backing up into the kidneys

Question 14

Symptoms of postrenal failure?

Answer 14

• Abd or groin pain, bladder discomfort

- mass at flank, suprapubic area or abdomen

Question 15

What diagnostic testing should we order for postrenal failure?

Answer 15

• Post void residual >100 = bladder obstruction

- U/S or IVP (intravenous pyelogram) to use contrast and visualize

Question 16

Treatment for postrenal failure?

Answer 16

Relieve the obstruction

Question 17

This is when one or both kidneys have been damaged and don’t work properly

Answer 17

Intrinsic renal failure

Question 18

Two main causes of intrinsic renal failure?

Answer 18

• ATN (acute tubular necrosis) **MC

- Nephrotoxins (NSAIDs, contrast agents, AGs)

Question 19

Labs that define intrinsic renal failure?

1. BUN:Cr
2. Urine Sodium
3. FENa
4. Urine specific gravity

Answer 19

**the kidney itself is the problem so it lets all of the sodium flow out into the urine

• Serum BUN:Cr ratio: 10-15:1
• Urine Sodium: ≥40 meq/l
• FENa: >2%
• Urine specific gravity: 1.010-1.020

Question 20

This is the mc cause of AKI and is where there is death of the tubular epithelial cells (renal tubules)

Answer 20

Acute Tubular Necrosis (ATN)

Question 21

What are the three major causes of ATN?

Answer 21

1. Renal ischemia
2. Nephrotoxins (AGs, contrast)
3. Sepsis

Question 22

On UA, you will see “Muddy brown granular epithelial cell casts and free renal tubular epithelial cells” in this diagnosis?

Answer 22

Acute tubular necrosis

Question 23

What labs dx ATN?

Answer 23

• FENa, BUN:Cr ratio, urine specific gravity, urine osmolality consistent with
intrinsic AKI
• May also have hyperkalemia and have metabolic acidosis

Question 24

What is the tx/prognosis for ATN?

Answer 24

Hold nephrotoxins (NSAIDs, metformin, AGs, etc)

• Treat underlying cause
• better prognosis if they are nonoliguric

Question 25

This disease is associated with FEM fever, eosinophilia & maculopapular rash

Answer 25

Acute Interstitial Nephritis (AIN)

Question 26

This is an Immune-mediated process of tubulointerstitial injury

Answer 26

Acute Interstitial Nephritis (AIN)

Question 27

On UA, for this disease you will find: WBCs, white cell casts and eosinophils

Answer 27

Acute Interstitial Nephritis (AIN)

Question 28

Treatment for Acute Interstitial Nephritis (AIN)?

Answer 28

Glucocorticoids

Question 29

Gold standard way to dx Acute Interstitial Nephritis (AIN)?

Answer 29

biopsy but usually just labs are done

Question 30

What meds can cause Acute Interstitial Nephritis (AIN)?

Answer 30

Cephalosporins, penicillins, allopurinol, diuretics, NSAIDs, sulfonamides (Catherine puts aloe down new shafts)

Question 31

This disease is when renal glomeruli are damaged by deposition of inmammatory proteins in the glomerular membrane and is caused by weird autoimmune things

Answer 31

Glomerulonephritis

Question 32

These clinical features are a part of what disease?

Hematuria, edema of face/eyes in morning, feet/ankles in evening, HTN common

Answer 32

Glomerulonephritis

Question 33

Diagnostics of glomerulonephritis?

Answer 33

UA and renal bx

Hematuria on UA or teal or cola colored

Question 34

RBCs and RBC casts on UA

Answer 34

Glomerulonephritis

Question 35

Treatment for Glomerulonephritis?

Answer 35

Steroids, immunosuppressants/chemo meds