Renal Failure Flashcards by Ben Joseph

What is Acute Renal Failure (ARF)?

Occurs rapidly and results in the loss of nephron function; causes the build-up of nitrogenous (azotemia) and non-nitrogenous metabolic waste products

This condition is usually reversible.

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What tests used to determine ARF?

BUN and Creatinine levels

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What are the types ARF?

Pre - renal
Renal
Post Renal

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What is Pre-renal failure?

Due to a decrease in the blood supply to the kidney, resulting from dehydration, trauma, infection, hepatorenal syndrome (compromised liver function), vascular problems (e.g. renal vein thrombosis), or sepsis.

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What is Renal failure?

(intrinsic or intrarenal): Causes of renal failure include toxins or medications, myoglobin (from break-down of muscle, as in blunt trauma), hemolysis, glomerulonephritis, and multiple myeloma.

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What is Post -renal failure?

May result from obstruction in the ureter, bladder, or
urethra; caused by medications that affect the emptying of the bladder or kidney, bladder stones, enlarged prostate, malignancy, or a blocked urinary catheter.

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What is Chronic Kidney Disease (CKD)?

A condition lasting at least 3 months and is caused by an
injury to the kidney or a disease process that results in the decrease in the glomerular filtration rate (GFR) to less than 60/ml/min normalized to the body surface.

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Clinical findings in CKD

abnormalities in imaging studies
urinalysis
blood work

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Precipitating factor to CKD?

  Diabetes mellitus (type 1 and 2) - poor glycemic control
  Systemic lupus
  HIV
  Hepatitis B
  Infection
  Nephropathy
  Hypertension - elevated BP with proteinuria
  Stones
  Cystic disease
  Antibodies
  Anemia

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Outside factors that accelerate CKD

 Smoking (clearly increases the rate of progression of renal disease)
 Age (older age)
 Ethnicity (African American, Native American, Latino, Asian, and Pacific Islander)
 Family History
 Diet
 Exercise
 Body Mass Index

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Optimal level of glycemic control

<7% HbA1C

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Comprehensive assessment goal for CKD

  Distinguish between acute and chronic kidney disease
  Establish the etiology of the disease
  Determine the GFR
  Evaluate the rate of progression
  Analyze cardiovascular risk
  Assess protein excretion
  Gauge reversible damage
  Determine life style risks
  Evaluate dialysis vs. transplant
  Assess medications
  Determine complications of primary disease

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Optimal BP

<130/80 for all CKD patients, diabetic and

nondiabetic, regardless of the level of proteinuria present.

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The drugs of choice for prevention and control of

hypertension in CKD patients with proteinuria?

Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB); with antiproteinuric affects

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Diuretic use in CKD?

Thiazide diuretics - mild CKD when the SCr is 1.8mg/dL

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Glumerular Filtration Rate (GFR)

The rate at which filtrates move through the kidney

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What are the stages of chronic kidney disease?

 Stage 1: Kidney damage with a normal or above normal GFR of >90mL/min/1.73m2
 Stage 2: Kidney damage with mildly lowered GFR of 60-89 mL/min/1.73m2
 Stage 3: Moderate level of damage and a GFR of 30-59 mL/min/1.732
 Stage 4: Severe damage and a GFR of 15-29 mL/min/1.732
 Stage 5: Kidney failure and a GFR of <15 or dialysis

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What are the complications in stage 2 CKD?

 abnormal calcium and phosphate levels
 abnormal parathyroid hormone (PTH) levels
 hypertension

What are the complications in stage 3 CKD?

 abnormal calcium and phosphate levels
 abnormal parathyroid hormone (PTH) levels
 hypertension
 low 25-hydroxy and 1,25-dihydroxycholecalciferol levels
 Anemia, fluid overload

What are the complications in stage 4 CKD?

 abnormal calcium and phosphate levels
 abnormal parathyroid hormone (PTH) levels
 hypertension
 low 25-hydroxy and 1,25-dihydroxycholecalciferol levels
 Anemia, fluid overload
 abnormal potassium, bicarbonate, uric acid and magnesium (electrolyte) levels

What are the complications in stage 5 CKD?

What are the supplemental therapies for CKD?

 Suitable water and sodium intake for regulation of extracellular fluid volume (ECFV)
and plasma osmolality
 Dietary restriction or supplementation for potassium balance
 Phosphate binders (Calcitriol) when indicated for calcium/phosphate balance
 NaHCO3 for acid-base balance
 Avoidance of excess magnesium to maintain magnesium levels
 Calcitriol as needed for activation of 25-hydroxy cholecalciferol
 Angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker
(ARB) for synthesis of renin-angiotensin
 Erythropoietin, or similar, for synthesis of erythropoietin

What is Glumerulonephritis?

Renal disease characterized by inflamation of the small blood vessels(glumeruli) of the kidneys

What diseases causes GN?

Lupus Erythematosus, diabetes nephritis, and Goodpasture syndrome

What is Glumerulosclerosis?

Scarring of the glumeruli, with proteinuria as one of the signs (CHON leak through urine)

What diagnostic choice fo GS?

Kidney biopsy

What treatment for GS?

Immunosupressant, medication for HTN (ACE inhibitors) , low CHON diet, cholesterol lowering method

What is Diabetic Nephropathy (DN)?

An increase blood flow to the kidney, caused by hyperglycemia, resulting to high BP and increasing the work load of glumeruli, then thickens albuminuria occurs

Symptoms of Diabetic Nephropathy (DN)

```  Edema around the eyes upon awakening, progressing to general swelling of the legs and body  Weight gain  Frothy urine  Malaise, fatigue  Nausea and vomiting  Headache  Hiccoughs  Itching  Serum creatinine and BUN levels elevate at this stage. The additional diagnosis of retinopathy may be found. ```

What is PKD?

A genetic disease, Fluid-filled cysts replace normal kidney tissue, as these cysts grow; they crowd the healthy tissue until kidney function deteriorates

Symptoms of PKD?

```  Flank or low-back pain  Urinary tract infections  Hematuria  Severe hypertension  Fatigue  Nausea  Kidney stones with accompanying pain  Increase in abdominal girth  Infection of the kidneys may further weaken the kidneys ability to function  Nephrectomy may be the only option for the painful, chronically infected kidney ```

What is Amyloidosis?

a condition in which proteins (amyloid proteins) have been altered and become insoluble and deposit in various organs eg. kidneys, that causes proteinuria and hypertension

What is Nephrosclerosis?

the hardening of the arterioles of the kidneys caused by uncontrolled high blood pressure, high BP causes the narrowing of preglomerular arteries and arterioles, resulting in poor blood flow to the glomeruli then renin lowers

What is pyelonephritis?

an infection of the kidney and renal pelvis, bacteria, usually from the bowel, ascend through the lower urinary tract, once in the kidney, the infection may lead to fibrosis and scarring

Drug of choice for Pyelonephritis?

Fluoroquinolones (ciprofloxacin), amoxicillin, cephalosporin, and trimethoprim

What is Renal tuberculosis?

Mycobacterium tuberculosis cause renal tuberculosis as a secondary site to the primary lung infection, caseation, in which dead tissue decays and forms a dry mass, occurs in the tubercular lesions; The kidneys are scarred, calcified, and permanently damaged

Symptoms of Renal Tuberculosis (RT)?

dysuria, hematuria, sterile pyuria, albuminuria, and urgency, may complain of suprapubic pain, increased urination, and fever

What are the diagnostic test done for RT?

culture of acid-fast bacillus, cystoscopy, needle biopsy, or imaging

What is Nephrotic Syndrome (NS)?

a myriad of clinical findings that result in massive losses of protein through the kidney due to damaged, leaky glomeruli.

Symptoms of Nephrotic Syndrome(NS)

Edema (puffiness in the periorbital area upon awakening, | abdominal ascites, and pulmonary edema), increased risk for thrombosis and infection

Management of NS?

Dietary recommendations include a low sodium diet, avoidance of saturated fats, monitoring of fluid intake, and increased fruits and vegetables Immunosuppressants, diabetic blood glucose control, and hypertension medications to maintain blood pressure levels

What is ATN?

Acute Tubular nechrosis, to the death of renal tubules with causes:  Hemorrhagic shock from surgery  Trauma  Toxicity due to chemicals or drugs  Sepsis  Cardiovascular system collapse (severe hypotension)  Blood transfusion reaction

What is CPK?

Injured muscle cells release the enzyme creatinine phosphokinase (CPK), which is an indicator of the level of myoglobin in the blood

Symptoms of ATN

``` Symptoms include:  Lethargy  Coma  Decreased urine output  Edema  Nausea  Vomiting ```

Renal Failure Flashcards

To know the different types of renal failure