Renal Failure

Question 1

How is acute kidney injury characterized?

Answer 1

Increase in serum creatinine
Oliguria may be present
AKI results in an inability to maintain acid-base, fluid, and electrolyte balance and to excrete nitrogenous waste

Question 2

How is AKI divided?

Answer 2

Three categories
Prerenal-kidney hypoperfusion
Intrinsic kidney disease
Post renal-obstructive uropathy

Question 3

What is the most common etiology of AKI?

Answer 3

Prerenal 40-80% of cases
If reversed quickly with renal blood flow damage to kidney tissue does not occur

Question 4

How does decreased renal perfusion occur?

Answer 4

Decrease in intravascular volume
-hemorrhage
-Gi losses
-dehydration
-excessive diuresis

Vascular resistance
-sepsis
-anaphylaxis
-anesthesia and other meds

Low cardiac output
-cardiogenic shock
-heart failure
-pulmonary embolism
-pericardial tamponade
-arrhythmia

Question 5

Which cause is least common?

Answer 5

Postrenal with a 5-10%
Important to detect because it is reversible
Causes include
-urethral obstruction
-bladder dysfunction
-obstruction of both ureters
-BPH
-Cancer

Question 6

Which type is in up to 50% of cases?

Answer 6

Intrinsic
Considered after pre and postrenal hve been ruled out.
Sites of injury include
-tubules
-interstitium
-vasculature
-glomeruli

Question 7

What is uremia?

Answer 7

Buildup of waste products causing nonspecific symptoms and signs collectively termed uremia

Question 8

How do you treat prerenal failure?

Answer 8

Depends on the cause
Achieves euvolemia
Restring renal perfusion
Avoiding nephrotoxic drugs

Question 9

How do you treat postrenal failure?

Answer 9

Bladder catheterization
Relieve underlying cause

Question 10

How do you treat intrinsic failure?

Answer 10

Usually self limited
Managed by nephrology

Question 11

Where should you refer these patients?

Answer 11

Pre renal-ER, cardiology, or internal med
Postrenal-urology referral to relieve obstruction
Intrinsic-Nephrologist