"The Practice of Medicine 2 L32: Acute Renal Failure/Mgmt Sriram Narsipur"

Question 1

All oliguria ia considered _____ until proven otherwise

Answer 1

Obstructive

Question 2

Pursue renal parenchymal insufficiency only after what?

Answer 2

After pre-renal and post-renal causes are eliminated

Question 3

What is the most important first step of a work-up of a patient with AKI?

Answer 3

Record review (baseline, events, infections, surgery, hypotension, drugs, volume status)

Question 4

What is the best bedside way to assess volume depletion?

Answer 4

Orthostatic BP measurement

Question 5

A normal urinalysis suggests what source of azotemia?

Answer 5

Pre-renal

dx: volume depletion or decreased effective circulatory volume;
U/A: hyaline casts, FEN 1.020, Osm>500;
studies: response to restoration of renal perfusion

Question 6

What are large vessel causes of AKI?

Answer 6

Renal artery thrombosis;
Atheroembolism;
Renal vein thrombosis

Question 7

Name the dx:
necrosis of renal tubular epithelial cells;
can represent one end of spectrum of prolonged pre-renal azotemia;
most often associated with ischemia and/or nephrotoxins;
Remarkable for propensity to recovery if no further insults

Answer 7

Acute tubular necrosis

Question 8

What is involved in the management of postrenal azotemia?

Answer 8

bladder drainage;
percutaneous nephrostomy drainage vs. stent;
Monitor for post-obstructive diuresis

Question 9

What is involved in the management of pre-renal azotemia?

Answer 9

rx cause of hypoperfusion;
PRBC or isotonic saline;
250 cc - 1000 cc bolus over 20-30 minutes and clinically monitor outcome to guide further rx

Question 10

What are acute di/seases of the tubulointerstitium

Answer 10

Allergic interstitial nephritis;

Acute bilateral pyelonephritis