Renal Failure

Question 1

Acute renal failure (ARF)

Answer 1

Rapid worsening of renal function
Increase in BUN and creatinine
Hyperkalemia
HTN
Metabolic acidosis

Pre-renal 
-FeNa <1%
-urine osmolality >350 mOsm)
Renal
-FeNa >1%
-urine osm <350 mOsm
Post-renal

Question 2

Causes of intrinsic renal ARF

Answer 2

Acute tubular necrosis
Interstitial nephritis
Hemolytic uremic syndrome
Glomerulonephritis
Nephrotoxic drugs

Question 3

FeNa

Answer 3

= UNa/SNa / UCr/SCr

U=urine

S=serum

Question 4

Acute renal failure treatment

Answer 4

Treat the hyperkalemia and other lyte abnormalities
Correct underlying problem
(Isotonic fluids if prerenal)
Manage HTN
Manage acidosis
Vitamin D supplementation
Proper nutrition and management of fluid intake

Question 5

Nephrotoxic drugs

Answer 5

NSAID
Aspirin
Aminoglycosides
Cyclosporine
Tacrolimus 
Cisplatin
Carboplatin 
Ifosfamide

Question 6

Chronic kidney disease

Answer 6

Usually due to your urologic abnormalities and glomerulopathies

FTT, growth failure
-due to acidosis, nutrition, bone mineralization issues
Anemia (decreased erythropoietin production by kidney). Normocytic
-treat with erythropoietin if Hgb <8
–> side effect can be polycythemia–>HTN and thrombosis
Metabolic acidosis due to bicarbonate loss, decreased acid excretion, decreased bicarbonate production by renal tubules.
Uremia (high BUN)
HTN (salt and H2O retention
Neuro changes, including peripheral neuropathies
Secondary hyperparathyroidism
-kidney stops making 1,25 – dihydroxyvitamin D3–>Decreased calcium absorption (hypocalcemia) –> high PTH
-Hyperphosphatemia –> high PTH
-skin changes: dry skin, pruritus, bruise easily.

Question 7

Chronic kidney disease treatment

Answer 7

Erythropoietin
Restrict protein
Need live immunizations prior to transplant
Dialysis, need hep B titers checked regularly.
Post transplant, growth hormone.

Question 8

Hypertension

Answer 8

BP > 95th %ile for age, sex, and height. x3 separate occasions

POUND HARD

Polycystic kidney disease
O (0) enzyme (11 Hydroxylase deficiency)
Urinary reflux Nephropathy
Neonatal problem (renal artery stenosis)
Neurofibromatosis
Deficiency (17 Hydroxylase deficiency)

Heart (aortic coarctation)
Adrenal (pheochromocytoma)
Rheumatologic (lupus), renal scars
Due to endocrine issues: Cushing’s, hyperparathyroidism.

Question 9

Meds that cause hypertension

Answer 9

Albuterol 
contraceptives 
corticosteroids 
decongestants 
illicit drugs

Question 10

Renal artery stenosis

Answer 10

History of Prematurity
-umbilical catheterization

Confirm diagnosis with renal arteriography with differential central venous renin determination
-renin levels will be higher on the side involved.