Renal

Question 0

What are the causes of prerenal renal failure?

Answer 0

Anything that causes decreased flow to the kidneys such as:

1. Cardiac: CHF, MI
2. Volume down: Diarrhea, Diuresis, Diaphoresis, hemorrhage
3. 3rd space: cirrhosis, nephrosis, gastrosis
4. RAS: fibromuscular dysplasia (women), atherosclerosis (men)
   ,

Question 1

What are the three types of acute kidney injury/ renal failure?

Answer 1

1. Pre-renal
2. Intra-renal
3. Post-renal

Question 2

What are the causes of intrarenal renal failure?

Answer 2

1. Glomerulonephritis: RBC casts
2. Acute interstitial nephritis: eosinophils (Infection, drug reaction), WBC casts, WBCs
3. Acute tubular nephrosis: muddy brown casts (IV contrast, myoglobin)

Question 3

What are the causes of post renal renal failure?

Answer 3

Obstruction: Stones, cancer, BPH, Cystocele

Question 4

Patient comes in with an elevated creatinine. How do you assess the patient with elevated creatinine?

Answer 4

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

Question 5

Patient has an elevated creatinine. what lab should you order to assess failure?

Answer 5

U/A
Bun/Cr ratio
FeNa

Question 6

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?

Answer 6

Prerenal

Assess Volume status

If fluid overloaded diurese, if volume down give volume.

Question 7

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?

Answer 7

This is not prerenal disease

Get renal ultrasound to assess for obstruction by looking for hydronephrosis.

If obstructed relieve obstruction. Pass a Foley.

Question 8

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?

Answer 8

This is intrarenal disease.

Do urine studies, get a better history and physical. And patient will likely need biopsy.

Question 9

What is nephritic syndrome?

Answer 9

The nephritic syndrome is characterised by blood in the urine and a decrease in the amount of urine in the presence of hypertension.

Question 10

What is nephrotic syndrome?

Answer 10

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.

Question 11

What are the two broad classes of Glomerulonephritis?

Answer 11

Proliferative and non-proliferative

Question 12

What are the types of nonproliferative glomerulonephritises?

Answer 12

the number of cells is not changed. These forms usually result in the nephrotic syndrome.

1. Minimal change dz
2. Focal segmental glomerulosclerosis
3. Membranous Glomerulonephritis
4. Thin basement membrane dz

Question 13

What is proliferative GN?

Answer 13

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).

Question 14

What are the types of proliferative GN?

Answer 14

1. IgA Nephropathy
2. Post Infectious
3. Membranoproliferative
4. Rapidly progressive GN

Question 15

the most common cause of the nephrotic syndrome in children.

Answer 15

Minimal change dz.
No changes may be visible by light microscopy.
Tx: steroids

Question 16

This form of glomerulonephritis may be associated with conditions such as HIV and heroin abuse, or inherited as Alport syndrome.

Answer 16

Focal Segmental Glomerulosclerosis.

Tx: steroids

Question 17

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.

Answer 17

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

Question 18

a benign condition that causes persistent microscopic hematuria. This also may cause proteinuria which is usually mild and overall prognosis is excellent.

Answer 18

Thin basement membrane dz

Question 19

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.

Answer 19

IgA Nephropathy. Aka Berger’s dz.

Question 20

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.

Answer 20

Post infectious GN. Usually resolves in 1-4 weeks but can be bad if adults get it.

Question 21

Nephrotic syndrome with low complement.

Answer 21

Membranoproliferative GN (MPGN)

Question 22

progressive, rapid deterioration in kidney function. may present with a nephritic syndrome.

Answer 22

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.

Question 23

a life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure

Answer 23

Hepatorenal syndrome.

Must rule out all forms of renal failure.
Tx: liver transplant.

Question 24

A condition where treatment of congestive heart failure is limited by decline in kidney function

Answer 24

Cardiorenal syndrome

Tx: diuretics and adenosine antagonists.

Question 25

A rare medical syndrome involving bleeding in the lungs and kidney damage (glomerulonephritis).

Answer 25

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.

Question 26

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.

Answer 26

Perinephric abscess