Renal Flashcards
Types of renal failure
Prereanal
Renal: glomerular/tubular
Post renal
Falsely elevated BUN
High protein diet
Blood in git
Falsely low BUN
Liver ds
Malnutrition
SIADH
How is GFR measured??
Creatinine clearance
Product of skeletal muscle
Slighlty overestimates the GFR because it is secreted
Even if person is anuric , the rate of rise in creatinine ll be
0.5 to 1.0 /day
The rise ll be faster if the body muscle mass ll be more
Cause of prerenal azotemia
Due to any cause
- hypovolemia
- hypotension
- third spacing of fluids
- addisons ds(low aldosterone)
Blood pressure in systemic and renal artery
Systemic- high( due to aldosterone)
Renal - low (kidney perceive as systemic hypotension)
Parameters to find out the cause of oliguria
FeNa BUN/Cr ratio UOSm Urine Na Urinanalysis
What ll happen to the parameters in prerenal azotemia
FeNa. -less than 1%
BUN/Cr ratio - > 15:1
UNa. - less than 20 mEq/L
UOsm - more than 500
Urinanalysis - normal
What ll happen to parameters in post renal azotemia
UNa - more than 40
uOsm - less than 350
FeNa - more than 2%
BUN/Cr ratio -
diagnosis of hepatorenal syndrome
exclude intrinsic renal ds first . no improvement in renal failure after 1.5 L of colloid.
Rx of liver ds
Rx liver ds . Midodrine ( alpha agonist) . octreotide . liver transplantation.
best Rx in hepatorenal syn
liver transplantation
angiotensin acts on
constricts efferent normally
role of PGs in kidney
dilates afferent( inhibited by NSAIDS)
how do ACEI prevent renal failure
for short term : increase bun/ creatinine by dec GFR in long term: dec intraglomerular pressure
can there be renal failure with obstruction in one kidney
no
cause of postrenal azotemia
obstruction in both kidneys/ in bladder
retroperitoneal fibrosis caused by which drugs
bleomycin, methotrexate ,methylsurgide
MCC of neurogenic bladder
diabetes and multiple sclerosis
most serious complication of postoliguric phase
hypokalemia
ATN types
ischemic and toxic
phases of ATN
Prodromal oliguric postoliguric
Rx of ATN
no specific Rx
hydration to rx prerenal component
no effect of diuretics , mannitol or dopamine
clinical features of AIN
fever
rash
joint pain
drugs responsible for Skin rash due to allergy
penecillins cephalosporins sulfa allopurinol rifampin quinolones
causes of AIN
drugs mainly
infections
autoimmune
lab findings in AIN
eosinophilia eosinophiluria(many people have this) hematuria proteinuria inc Ige
