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ACUTE RENAL FAILURE

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Side ASide B
What would make you think of Wegener granulomatosis, as acute intrinsic renal failure?
Otitis, Sinusitis, Epistasxis, hemoptysis, or nasal septal ulcers (HONES)
Hemoptysis can be suggestive of what 3 causes of renal failure?
*Goodpasture *Antiglomerular basement membrane disease *Wegener granulomatosis (GAW, you're...
How do you evaluate fluid balance in context of renal failure?
*Orthostatic vital signs *Assessment of skin turgor *Examination of jugular veins
Fluid depletion can indicate what?
Prerenal condition
Fluid overload can indicate what? (2)
Severe intrinsic renal failure or a preenal edematous state, like CHF or cirrhosis
Abdominal bruits suggests?
renovascular disease
Pelvic or rectal examination could be useful why?
Find cause of urinary outflow obstruction, like enlargmed prostate or a pelvic mass
When might be you able to palpate the kidenys, and what would that indicate?
hydronephrosis or polycystic kidney disease (indicates chronic renal failure)
Physical findings of uremic syndrome?

*Pericarditis (cardiac RUB) *Uremic frost (crystals of urea that collect on the skin)  *Asterixis...
DDx of ARF?
CHF, dehydration, intoxication
Dx ARF with what 2 things?
*Elevated BUN *Elevated Creatinine
Monitor ARF how?
Serum electolytes (Na, K, Cl, Bicarb, Ca, Phosphate)
Other tests in ARF with urine?
*Urine sediment  ---RBCs...alone of in casts suggests glomerulus or vascular lesions ---WBCs:...
How do you confrim prerenal failure due to a stimulus to preserve volume via water retention?
High urinary osmolarity (>500mOsm/kg H2O)
Do what if suspect suspect volume deficiency prerenal conditions? For what 2 purposes?
fluid challenge (for Dx and Tx)
If you suspect a glomerular process clinically, what type of disease do you want to look for?...
Look for immune-mediated disease! Measure antinuclear abs, ANCAs (in Wegener granumlomatosis),...
How do you dx and tx postrenal obstruction?
bladder catheterization (large postvoid residual volume --> catheter indicates bladder dysfunction...
What kind of renal imaging can you do and what will it tell you?
*US...tells you kidney size and whether there's hydronephrosis (water inside the kidney) *renal...
What do you do if see hydronephrosis on US indicative of obstruction?
consult urolgoist and do helical CT or retrograde pyelography or cystoscopy to look for precise...
When would you do a renal biopsy?
Not usually needed...done in conjunciton with urologist if dx is uncertain...or if want prognostic...
Basic tx of ARF involves correcting what 2 things?
fluid abormalities, electrolyte abnormalities, underlying case
Avoid which meds in ARF?
nephrotoxic (aminoglycosides, radiocontast dye) or reduce renal blood flow (NSAIDs)
Emergency condition in ARF? And how do you detect it?
*Hyperkalemia! (>6mmol/L or ECG abnormalities)
Tx prerenal axotemia how? (2)
restore intravascular volume and perfusion bp
How do you treat hypovolemia --> prerenal failure?
Depends on mech of fluid loss **Hemorrhage: give saline and red cells! *GI fluid loss: replace...
Tx acute tubular necrosis how?
often caused by nephrotoxic agents, so remove that agent! 
Tx for Wegener's granulomatosis or glomulonephritis?
Immunosuppress with prednisone and cyclophosphamide to prevent irreversible renal damage!...plus...
Tx for postrenal axotemia?
Determine magnitude! Relieve the obstruction of urinary flow. May need to consult. If obstruction...
Long-term managment of pts who have had ARF involves what?
*Monitor for complicatios or renal failiure, maintenance of return of renal fucntion *Adjust...
Which disease--> pts particularly at risk for not recovering sufficiently and needing long-term...
Glomerulonephritis
Start. 5 roles of kidneys?
*maintain water, volume, and electrolyte balance *removal nitrogenous and other metabolic...
time frame for ARF?
hrs to days
3 main etiologies for ARF?
pre-renal (--> overal decrease in renal perfusion) intrinsic renal (conditions affecting...
Pre-renal conditions? (6)
*Hypovolemia (eg from blood loss, dehydration) *Decreased CO (eg during acute myocardial infarction,...
Intrinsic renal conditions? (5)
*Vassculitis or microangiopathy *Glomerulonephritis *Acute tubular necrosis (can be caused...
Postrenal etiologies? (3)
Ureteral obstruction (eg: tumor, retroperitoneal hemorrhage, or nephroliathiasis) Bladder...
In ambulator pts, ARF is more often seen in pts with co-morbid conditions and a debilitated...
-surgery -trauma (hemorrhage, muscle injury) - admin of nephrotoxic drugs (aminoglycoside...
At what % of normal GFR do you normally see symtpoms of ARF?
10-15%
Symtpoms seen in ARF?
Oliguria or anuria Intravascular volume overload (dyspnea, orthopnea, edema) metabolic acidosis...
Hx elements that you should get for ARF?
drugs recent surgery, trauma, infection prior bladder function changes, such as nocturia,...


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