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Patho Final > Renal failure > Flashcards

Renal failure Flashcards

1
Q

Acute renal failure?

A

inability for the kidney to carry out its function

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2
Q

what are some of the main functions of the kidney?

A

ultrafiltrations and reabsorption

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3
Q

Acute?

A

arises abruptly and/or for a short duration

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4
Q

Briefly summarize renal failure.

A

loss of renal function = decrease urine output = azotemia and fluid electrolyte imbalance

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5
Q

Azotemia and electrolyte imbalance can have an impact on other organs of the body. Explain a few organs affected

A
  • waste sent to the brain = encephalopathy

- potassium imbalance = impacts the heart

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6
Q

is acute renal failure and chronic renal failure reversible?

A

Acute renal failure is reversible, chronic is not.

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7
Q

What does GFR require in order to be measured?

A

urine volume + creatinine in blood and creatinine in urine

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8
Q

Oliguria?

A

100-400 mL of urine output per day

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9
Q

Anuria?

A

Less than 100 mL of urine output per day

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10
Q

Etiology of ARF?

A
  • prerenal
  • infrarenal
  • poystrenal
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11
Q

Prerenal?

A

ischemic/circulatory problem preventing proper perfusion to the kidney (HypoTN or hypovolemia)

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12
Q

Intrarenal?

A

problem with the kidney eg. glomerular nephritis

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13
Q

Postrenal?

A

preventing obstruction of urine flow out of the kidney (eg. BPH)

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14
Q

Explain the patho regarding prerenal

A

Eg. hemorrhage -> lose blood volume = inadequate perfusion to glomerulus -> ischemia and ischemic damage -> decreased filtration

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15
Q

examples of intrarenal

A

eg. acute tubular necrosis (ATN) -> nephrotoxic drugs, intratubular obstruction (takes days or weeks to happen).

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16
Q

What are the 3 phases that occur in intrarenal?

A
  1. initiating phase
  2. maintenance phase
  3. recovery phase
17
Q

Initiating phase?

A

(hours-days) Lasts from trauma event to the time that manifestations become apparent

18
Q

Maintenance phase?

A

refers to maintaining the problem, not maintaining the kidney function. Decrease GFR, oliguria, azotemia, fluid retention (HTN, EDEMA, PULMONARY CONGESTION)

19
Q

Recovery phase?

A

offending event that has been addressed (gradual increase in GFR as tissue is repaired)

20
Q

How can BPH cause ARF?

A

BPH -> hydronephrosis -> ARF

21
Q

Manifestations?

A
  • oliguria or anuria
  • fluid-electrolyte imbalance
  • azotemia
  • proteinuria, hematuria
22
Q

Complications?

A

HTN, EDEMA, PULMONARY CONGESTION

23
Q

Diagnostics?

A
  • renal function tests : BUN, Creatinine, GFR
  • RIFLE
  • new early biomarkers (eg. interleukin-18)
24
Q

RIFLE?

A

Risk, injury, failure, loss, end stage renal failure

  • risk = risk of running into renal failure
  • injury = actual damage in the kidney
  • failure = some kind of renal failure has begun
  • loss = loss of renal function (mnfts apparent)
  • E = ESRD -> kidney shuts off and the pt will die
25
Q

What is interleukin 18?

A

a mediator produced together with inflammation in the proximal tubule when there is ischemic damage

26
Q

Which area of the kidney is usually the first to be affected during renal failure?

A

Proximal tubule

27
Q

Treatment?

A
  • reversible but not self-limiting
  • STAT intervention
  • Cautious fluid and electrolyte replacement
  • Diet -> careful protein ingestion
  • dialysis (hemo/peritoneal/intermittent dialysis/CRRT)
28
Q

Why is a protein restricted diet suggestion?

A

protein is broken into ammonia, which is a nitrogenous waste so limiting protein ingestion will help to avoid or decrease azotemia.

29
Q

Hemodialysis?

A

blood is filtered externally from he body through a dialyser which acts as an artificial artery

30
Q

Peritoneal dialysis?

A

dialysate introduced into the peritoneum which acts as a semi-permeable membrane which wastes are filtered through

31
Q

CRRT?

A

continuous renal replacement therapy

32
Q

Chronic RF?

A

progressive, permanent damage

33
Q

List the stages of chronic renal disease.

A
  1. Diminished renal reserve stage
  2. Renal insufficiency
  3. renal failure
34
Q

Diminished renal reserve stage?

A

GFR is less than 50% of normal. GFR is about 60 mL/min which is still adequate for filtration. No signs of decreased renal function.

35
Q

Does the kidney have a large functional reserve?

A

YES

36
Q

Renal insufficiency?

A

GFR is 20-50% of normal (inadequate filtration)

37
Q

Renal failure?

A

GFR is less than 20%. The kidney will shut down once the GFR is <5%

Patho Final (26 decks)

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