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32 Cards in this Set
- Front
- Back
describe the general process in pre-renal, intrinsic, and post renal failure
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pre: decreased perfusion
intrinsic: pathologic changes within the kidney post: obstruction to urinary outflow |
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most common cause of intrinsic renal failure?
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ischemic ARF
traditionally known as acute tubular necrosis and now called acute kidney injury |
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what type of renal failure does this describe:
thirst, orthostatic light-headedness, and decreasing urine output |
Pre-renal
|
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cardiac arrest, severe sepsis, or other causes of systemic hypotension lead to?
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Ischemic acute kidney injury
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flank pain and hematuria likely is what kind of nephropathy?
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crystal induced
aka nephrolithiasis papillary necrosis can present this way too |
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rhabdomyolisis (myalgais, recent coma, seizures, recreational intoxication, excessive exercise) and hemolysis (recent blood transfusion) can have what type of ARF?
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pigment induced
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darkening urine and edema with or without constitutional symptoms such as fever, malaise and rash should raise suspicion for?
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acute glomerulonephritis
preceded by pharyngitis or cutaneous infection |
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fever, arthralgia, and rash are common with what?
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acute interstitial nephritis
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Cough, dyspnea, hemopytsis can raise the suspicion for what renal syndromes?
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Goodpasture
or Wegener |
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what GFR typically indicates kidney failure?
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<15
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give a dd of prerenal failure
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Hypovolemia (GI, diruetics, burns)
Hypotension (septic, hemorrhage, decreased CO) Renal artery and small vessel dz (embolism, thrombosis) |
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Significant permanent loss of renal function occurs over the course of how many days in the setting of complete obstruction?
** |
10-14 days
the risk of permanent RF increases significantly if obstruction is complicated by UTI |
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Most common cause of in-hospital ARF?
** |
Radiocontrast-induced nephropathy
IV contrast |
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elevated uric acid levels causes crystal induced nephropathy...this can be caused by medications including?
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acyclovir, sulfonamides, indinavir, triamterene
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ARF in the setting of ACE inhibitor initiation should prompt consideration of?
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bilateral renal artery stenosis
maintenance of GFR is depended on postglomerular arteriole vasoconstriction |
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how do NSAIDs lead to ARF?
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decreased prostaglandins
results in decreased GFR and renal blood flow |
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what class of abx can cause direct tubular toxicity?
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Aminoglycosides
|
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In patients with no renal function (GFR=0) serum Cr levels increase how?
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1--3 mg/dL a day
|
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In the setting of prerenal failure, the serum ratio of BUN to Cr is?
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typically >20
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what renal lab can be increased in the setting of protein loading, GI bleed, or trauma?
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BUN
|
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FeNA=?
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UNa/PNa / UCr/Pcr
u=urine P=plasma |
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Give the urine osmolality and FeNa% for the following:
Prerenal azotemia |
Osmol >500
FeNa < 1% |
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Give the urine osmolality and FeNa% for the following:
Renal azotemia (tubular injury, ischemia, nephrotoxins) |
Osmol < 350
FeNa >1% |
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Give the urine osmolality and FeNa% for the following:
Postrenal azotemia |
Osmol >500
FeNa >1% |
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Osmol >500
FeNa >1% general cause of ARF? |
Post renal
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Osmol >500
FeNa < 1% general cause of ARF? |
Pre renal
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Osmol < 350
FeNa >1% general cause of ARF? |
intrinsic renal failure
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in intermittent or partial obstruction, hydronephrosis may NOT be present and it may even be ABSENT in complete obstruction in the setting of what problem?
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retroperitoneal fibrosis
|
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Test of choice for urologic imaging in the setting of ARF?
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Renal US
has 90% sensitivity and specificity for detecting hydronophrosis due to mechanical obstruction |
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Indications for emergent dialysis?
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AEIOU
Acidosis (resistant to NaHCO3) Electrolytes (hyper K>6.5, Na <115 or >165) Ingestion/Intox (lithium, aspirin, mehanol, ethylene glycol, theophylline) Overload Uremia (pericarditis, encephalopathy, asterixis, seizure, bleeding) |
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Radiocontrast induced nephropathy begins to be significant concern when GFR is ?
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<60
CKD 3 |
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Gadolinium based contrast for MRI should not be given if GFR is < __?__
due to the risk of what? |
<30
CKD 4 risk of nephrogenic systemic fibrosis |