Renal Flashcards
What are the causes of prerenal renal failure?
Anything that causes decreased flow to the kidneys such as:
- Cardiac: CHF, MI
- Volume down: Diarrhea, Diuresis, Diaphoresis, hemorrhage
- 3rd space: cirrhosis, nephrosis, gastrosis
- RAS: fibromuscular dysplasia (women), atherosclerosis (men)
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What are the three types of acute kidney injury/ renal failure?
- Pre-renal
- Intra-renal
- Post-renal
What are the causes of intrarenal renal failure?
- Glomerulonephritis: RBC casts
- Acute interstitial nephritis: eosinophils (Infection, drug reaction), WBC casts, WBCs
- Acute tubular nephrosis: muddy brown casts (IV contrast, myoglobin)
What are the causes of post renal renal failure?
Obstruction: Stones, cancer, BPH, Cystocele
Patient comes in with an elevated creatinine. How do you assess the patient with elevated creatinine?
Always look at prerenal first. Either labs or volume status.
Then move onto post renal with an ultrasound.
If no etiology is found it’s intrarenal disease and you need to do urine studies
Patient has an elevated creatinine. what lab should you order to assess failure?
U/A
Bun/Cr ratio
FeNa
Patient comes in with elevated creatinine. BUN/Cr ratio is > 20 and FeNa is < 1%. What does this mean? And what do you do next?
Prerenal
Assess Volume status
If fluid overloaded diurese, if volume down give volume.
A patient comes in with elevated creatinine. BUN/Cr is < 20. And FeNa is > 1%. Looks euvolemic. what does this mean and What do you do next?
This is not prerenal disease
Get renal ultrasound to assess for obstruction by looking for hydronephrosis.
If obstructed relieve obstruction. Pass a Foley.
The patient comes in with elevated Cr. BUN/Ce is < 20 and FeNa is > 1%. Renal U/S is negative. What is this and what do you do next?
This is intrarenal disease.
Do urine studies, get a better history and physical. And patient will likely need biopsy.
What is nephritic syndrome?
The nephritic syndrome is characterised by blood in the urine and a decrease in the amount of urine in the presence of hypertension.
What is nephrotic syndrome?
The nephrotic syndrome is characterised by the finding of edema in a patient that has increased protein in the urine and decreased protein in the blood, with increased fat in the blood.
What are the two broad classes of Glomerulonephritis?
Proliferative and non-proliferative
What are the types of nonproliferative glomerulonephritises?
the number of cells is not changed. These forms usually result in the nephrotic syndrome.
- Minimal change dz
- Focal segmental glomerulosclerosis
- Membranous Glomerulonephritis
- Thin basement membrane dz
What is proliferative GN?
increased number of cells in the glomerulus. These forms usually present with a triad of blood in the urine, decreased urine production, and hypertension, the nephritic syndrome. These forms usually progress to end-stage kidney failure (ESKF) over weeks to years (depending on type).
What are the types of proliferative GN?
- IgA Nephropathy
- Post Infectious
- Membranoproliferative
- Rapidly progressive GN
the most common cause of the nephrotic syndrome in children.
Minimal change dz.
No changes may be visible by light microscopy.
Tx: steroids
This form of glomerulonephritis may be associated with conditions such as HIV and heroin abuse, or inherited as Alport syndrome.
Focal Segmental Glomerulosclerosis.
Tx: steroids
This GN may cause either nephrotic or a nephritic picture. About two-thirds are associated with auto-antibodies to phospholipase A2 receptor, but other associations include cancers of the lung and bowel, infections such as hepatitis B and malaria, drugs including penicillamine, and connective tissue diseases such as systemic lupus erythematosus.
Membranous GN Rule of thirds : 1/3 get better 1/3 stay the same 1/3 end stage renal failure
spike and dome
Tx: steroids
a benign condition that causes persistent microscopic hematuria. This also may cause proteinuria which is usually mild and overall prognosis is excellent.
Thin basement membrane dz
self-resolving form of nephrotic syndrome in young adults several days after a respiratory infection. It is characterised by deposits of IgA in the space between glomerular capillaries.
IgA Nephropathy. Aka Berger’s dz.
typically occurs 1–4 weeks after a pharyngeal infection with GAS bacterium, and is likely to present with malaise, a slight fever, nausea and a mild nephritic syndrome of moderately increased blood pressure, gross haematuria, and smoky-brown urine.
Post infectious GN. Usually resolves in 1-4 weeks but can be bad if adults get it.
Nephrotic syndrome with low complement.
Membranoproliferative GN (MPGN)
progressive, rapid deterioration in kidney function. may present with a nephritic syndrome.
Rapidly progressive glomerulonephritis
Type 1. causing a nephritic syndrome and the coughing up of blood. Goodpastures. IgG against basement membrane.
Type 2. Immune complex. associated with systemic lupus erythematosus, post-infective glomerulonephritis, IgA nephropathy, and Henoch-Scholein purpura.
Type 3. Positive ANCA assoc with Wegeners granulomatosis.
a life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure
Hepatorenal syndrome.
Must rule out all forms of renal failure.
Tx: liver transplant.
A condition where treatment of congestive heart failure is limited by decline in kidney function
Cardiorenal syndrome
Tx: diuretics and adenosine antagonists.
A rare medical syndrome involving bleeding in the lungs and kidney damage (glomerulonephritis).
Pulmonary-renal syndrome.
Causes are usually autoimmune.
It is most commonly due to granulomatosis with polyangiitis or Goodpasture’s syndrome.
Other causes include systemic lupus erythematosus and microscopic polyangiitis.
Consider this dx in patients with unilateral flank pain and fever, no response to treatment for acute pyelonephritis, pyrexia of unknown origin, unexplained peritonitis, pelvic abscess, and empyema.
Perinephric abscess
