RENAL Flashcards
IF we see an increased Cr by .3 or by 50% within 48 hours – what do you think of? What are the different types?
Acute Kidney Injury
- Pre-renal
- Intrinsic
- Post-Renal
Are there any sxs associated with acute kidney injury?
Either Asymptomatic or edema, HTN, fatigue
What are the MC causes of pre-renal AKI?
decreased renal perfusion = dehydration, vomiting, diarrhea, CHF
Also, NSAIDs, contrast, and ACE
How do you Dx pre-renal AKI?
UA = normal
BUN/Cr >20:1
Urine Na <20
Urine Osmol = increased
How do treat pre-renal AKI?
Increase renal perfusion via GIVE FLUIDS!
If you see muddy brown casts, tubular cell casts, and dysmorphic RBC’s on UA – Dx?
Intrinsic renal disease
What is the MC cause of Intrinsic AKI?
ATN (caused by ischemia secondary to prolonged decreased renal perfusion)
*thrombus, scleroderma, malignant HTN or aminoglycosides and sulfonamides
How do you dx intrinsic AKI?
UA = granular muddy brown casts, tubular cell casts, dysmorphic RBC’s, hematuria, and/or proteinuria
BUN/Cr 10:1
Urine Na >40
Urine Osmol = decreased
How do we treat intrinsic AKI?
Treat underlying cause (fluids DO NOT improve ATN)
What causes post-renal AKI? Tx?
Due to outflow obstruction
Tx – Cath or remove obstruction
What are some life threatening issues associated with AKI?
Hyperkalemia (dialysis for peaked T waves), uremia, and metabolic acidosis
What will cause a false-positive for blood in the urine?
Rhabdo from Hyperkalemia
If a pts GFR has been decreased over the past 3 months – dx? What is a decrease in GFR?
Chronic renal failure
Less than 60 = decreased GFR
What other ways can we see kidney damage?
Protein uria, casts, small echogenic kidneys on U/S
So a GFR of 45-59 is known as what?
3A
So a GFR of 30-44 is known as what?
3B
So a GFR of 15-29 is known as what?
4
So a GFR of less than 15 is known as what?
5
How do we treat chronic renal failure?
start with protein and sodium restriction
If someone has CKD and HTN how do we treat them?
ACE/ARB and loop diuretic
*be careful of hyperkalemia!!
When we start an ACE what lab finding do we often see?
Transient drop in GFR
*Why you need a baseline Cr and K, followed by a re-check, if Cr increases by over 30% stop ACE
CKD is viewed as an equivalent to what?
Coronary artery disease
What are some indications for dialysis?
Uremia, significant bleeding, refractory metabolic acidosis, hyperkalemia, pericarditis, and malnutrition, and GFR of 5!
