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Acute Gero 1 > Renal > Flashcards

Renal Flashcards

1
Q

Prerenal makes up _________ of acute renal failure cases

A

40-80%

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2
Q

what are common causes of prerenal AKI?

A
  • Hypovolemia
  • Hypotension
  • compartment syndrome
  • RAS
  • decrease in cardiac output (CHF)
    Decrease in effective arterial blood volume
  • Cirrhosis
  • CHF
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3
Q

what is the prerenal BUN/Cr ratio:

A

> 20:1

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4
Q

postrenal makes up _______ of AKI cases

A

5-10%

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5
Q

Post renal BUN/Cr ratio:

A

10:1 - 20:1

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6
Q

Post renal AKI is likely due to

A

an obstruction in lower urinary tract

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7
Q

Intrarenal causes of AKI are

A
  • renal ischemia
  • nephrotoxic injury
  • intrarenal failure can lead to ischemic injury when MAP < 65 or circulation is interrupted for 30 min
  • Acute Tubular Injury (ATI or ATN)
  • Ischemia (50%)
  • Toxins (35%): aminoglycosides, myoglobin, radiocontrast
    agents
  • Interstitial (10%) (AIN)
  • Vascular and Glomerular (5%)
  • Renal artery occlusion, cholesterol emboli
  • GN, thrombotic microangiopathy
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8
Q

Intrarenal BUN/Cr ratio:

A

< 10:1

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9
Q

Imaging of kidneys to evaluate for obstruction
(hydronephrosis)

A

– US Renal or CT A&P

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10
Q

Evaluation of Patients with Acute Increase
in Creatinine:

A

Urinalysis (structure)
–Macroscopic: protein, blood, WBC’s, RBC’s
–Microscopic: cells, casts, crystals
* Urine chemistries (response to stimuli-function)
– osmolality (ADH action)
–fractional excretion of Na+ (FeNa+) or urea
* Blood chemistries: BUN, creatinine

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11
Q

Causes of Low-Perfusion States

A
  • Hypovolemia
    – Blood, GI, Renal, Skin
    – 3rd Space (bowel, pancreatitis, edema
  • Cardiovascular: low cardiac output
    – Cardiorenal Syndrome type 1
  • Distributive (decreased SVR)
    – Sepsis
    – Hepatorenal
    – Vasodilators
  • Renal
    – Renal artery stenosis
    – Drugs (ACE inhibitors, non-steroidal)
    – Rapid lowering of BP in severe hypertension
  • Abdominal Compartment Syndrome
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12
Q

Normally, GFR is
maintained until MAP
is

A

<80mm

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13
Q

NSAID’s, ACEi/ARB,
vascular disease,
CKD, chronically
elevated BP can

A

impair GFR autoregulation

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14
Q

GFR falls when MAP
falls below limits of

A

60

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15
Q

Clinical Diagnosis of ATN/AKI

A
  • History and physical exam: use of
    aminoglycosides, radiocontrast, trauma, shock
  • Urinalysis: mild proteinuria (< 1gram/day), tubular
    cells, granular casts
  • Urine chemistries: osmolality <350 mosm/kg
    (inability to concentrate), urine Na+ >40 (inability to
    conserve Na+), FeNa+>2% despite hypotension or
    hypovolemia
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16
Q

what are Indications for dialysis?

A
  • Hyperkalemia
  • Fluid Overload
  • Acidosis
  • Uremic conditions
  • Pericarditis
  • Encephalopathy
17
Q

persistent abuminuria with normal or increased GFR
GFR: > 90

A

stage 1 renal failure

18
Q

persistent abuminuria with mild decrease in GFR
GFR: 60-89

A

stage 2 renal failure

19
Q

moderate decrease in GFR, start preparing for dialysis
GFR: 30-59

A

stage 3 renal failure

20
Q

Severe decrease in GFR
GFR: 15-29

A

stage 4 renal failure

21
Q

Kidney failure requirement dialysis or translation.
<15

A

stage 5 renal failure

22
Q

which of following is the best indicator of BPH?

A

a digital exam with findings consistent with BPH

23
Q

In case of nephrolithiasis with stones of diameter <6 mm that are producing symptoms including nausea and vomiting, the indicated treatment is…

A

pain control and IV fluid

24
Q

Prerenal failure is likely caused by ?

A

A. CHF
B. Glomerulornephritis
C. Prostate hypertrophy
D. The use us contrast dyes

25
Q

who is at greatest risk for having renal complications associated w/ contrast dye?

A

an 86 yr old female who has been NPO for 12 hrs

26
Q

which of the following constitutes a surgical emergency

A

Testicular torsion

27
Q

patients with chronic renal disease typically have anemia related to

A

a decrease in erythropeietin production

  • because they are needed to create RBC and thee are created by the kidneys
28
Q

which diet is contraindicated in a patient with chronic renal disease?

A

high protein diet

29
Q

BPH can precipitate which type of renal failure?

A

post renal

30
Q

The gold standard diagnostic study of choice for nephrolithiasis is a

A

CT scan of the Abdomen without contrast

31
Q

nephrolithiasis is also known as

A

kidney stones or renal calculi

32
Q

what are the 4 types of kidney stones

A

calcium
uric acid
struvite
cystine

33
Q

clinical presentation of nephrolithiasis

A
  • cosyovertebral or flank pain
  • hematuria

complicated
- Possible UTI
- anuric

34
Q

management of calcium nephrolithiasis

A
  • low Na+ diet
  • pain management
  • treat symptoms
  • strain urine
35
Q
A
36
Q
A

Acute Gero 1 (8 decks)

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