RENAL

Question 1

IF we see an increased Cr by .3 or by 50% within 48 hours – what do you think of? What are the different types?

Answer 1

Acute Kidney Injury

1. Pre-renal
2. Intrinsic
3. Post-Renal

Question 2

Are there any sxs associated with acute kidney injury?

Answer 2

Either Asymptomatic or edema, HTN, fatigue

Question 3

What are the MC causes of pre-renal AKI?

Answer 3

decreased renal perfusion = dehydration, vomiting, diarrhea, CHF

Also, NSAIDs, contrast, and ACE

Question 4

How do you Dx pre-renal AKI?

Answer 4

UA = normal
BUN/Cr >20:1
Urine Na <20
Urine Osmol = increased

Question 5

How do treat pre-renal AKI?

Answer 5

Increase renal perfusion via GIVE FLUIDS!

Question 6

If you see muddy brown casts, tubular cell casts, and dysmorphic RBC’s on UA – Dx?

Answer 6

Intrinsic renal disease

Question 7

What is the MC cause of Intrinsic AKI?

Answer 7

ATN (caused by ischemia secondary to prolonged decreased renal perfusion)

*thrombus, scleroderma, malignant HTN or aminoglycosides and sulfonamides

Question 8

How do you dx intrinsic AKI?

Answer 8

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

Question 9

How do we treat intrinsic AKI?

Answer 9

Treat underlying cause (fluids DO NOT improve ATN)

Question 10

What causes post-renal AKI? Tx?

Answer 10

Due to outflow obstruction

Tx – Cath or remove obstruction

Question 11

What are some life threatening issues associated with AKI?

Answer 11

Hyperkalemia (dialysis for peaked T waves), uremia, and metabolic acidosis

Question 12

What will cause a false-positive for blood in the urine?

Answer 12

Rhabdo from Hyperkalemia

Question 13

If a pts GFR has been decreased over the past 3 months – dx? What is a decrease in GFR?

Answer 13

Chronic renal failure

Less than 60 = decreased GFR

Question 14

What other ways can we see kidney damage?

Answer 14

Protein uria, casts, small echogenic kidneys on U/S

Question 15

So a GFR of 45-59 is known as what?

Answer 15

3A

Question 16

So a GFR of 30-44 is known as what?

Answer 16

3B

Question 17

So a GFR of 15-29 is known as what?

Answer 17

4

Question 18

So a GFR of less than 15 is known as what?

Answer 18

5

Question 19

How do we treat chronic renal failure?

Answer 19

start with protein and sodium restriction

Question 20

If someone has CKD and HTN how do we treat them?

Answer 20

ACE/ARB and loop diuretic

*be careful of hyperkalemia!!

Question 21

When we start an ACE what lab finding do we often see?

Answer 21

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

Question 22

CKD is viewed as an equivalent to what?

Answer 22

Coronary artery disease

Question 23

What are some indications for dialysis?

Answer 23

Uremia, significant bleeding, refractory metabolic acidosis, hyperkalemia, pericarditis, and malnutrition, and GFR of 5!