Acute Renal Failure
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Created by:
Nygrl89 on March 22, 2011
Subjects:
comprehensive disease management 2
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62 terms
Terms | Definitions |
|---|---|
 Kidneys | Are responsible for the maintenance of body composition, regulation of body volume, osmolarity, electrolytes, and pH of the blood through regulation of excretion and water and ions. Excretion of metabolic end products and foreign substances |
| Endocrine | the E____ functions of the kidney include the production of RENIN and ERYTHROPOETIN |
| d3, Gluconeogensis, CYP | The Kidney performs some metabolic activity such as the activation of vitamin D#, Gluco_______, and even has some ___ activity, like the liver |
| acute renal failure, HOURS, WEEKS | IS THE SIGNIFICANT, ABRUPT, DETERIORATION IN GFR OVER A SHORT PERIOD OF TIME (H___ TO W___). NO CONSISTENT APPROACH. TIME DIFFERENTIATES FROM CHRONIC RENAL FAILURE |
| 0.5 MG/DL, doubling | ARF is shown by an increase of Scr of #.# __/__ in 24 hours, a ______ing of the SERUM CREATININE in 24-48 hours |
| Acute Renal Failure, 50, 30, insufficiency | In _____ ______ _____ There is an increase in serum creatinine by 1.0 mg/dl in 24 hours, and increase of SrCr of more than ##% in 24 hours with normal renal function. Also an increase of SrCr of greater than ##% in patients with renal i______ |
| urine output | assessment of ___ ____ for the prognosis of ARF particularly in hospitalized patients where anuric or oligouric patients have a significantly higher mortality rate than similar arf patients with non-oligouria |
| < 50 ml | Anuria is (use sign) ## (units) per DAY! |
| Oliguria | 50-500 ml per day |
| 500 | NON-Oligouria is greater than ### ml of urine a day |
| Renal dysfunction, nephrotoxic, dehydration, ICU | Risk Factors for ACUTE RENAL FAILURE include pre-existing r_____ D______, N__________ drugs (Abx, antivirals, ARBs, NSAIDs, ACEi). D________ (lack of fluids) and Being in the ___ (hospital care) |
| sepsis, cardiac output, male | Risk factor for ARF would be certain risk factors in hospitalization such as DECREASED renal perfusion secondary to S____, decreased c____ O______, surgery, overidiuresis, drug induced, m___ over 60 years old, acute infection, pre-existing comorbidities. being in the ICU also is a risk factor for ARF |
| volume expansion, electrolyte, acid-base, uremic | ARF quickly leads to potentially life threatening complications including v_____ e______, e______ abnormalities, a___-_____ disorders and u_____ complications |
| Edema, urine, pain, | SUBJECTIVE ARF s(x) an signs include decreased urine output, thirst, dizziness, orthostasis in patients with volume depletion. Increase in e_____, changes in _______ine (blood, darker appearance), P___ with voiding, symptoms related to E- abnormablities |
| Hypotension, Hypertension, JVD, BUN, electrolytes | OBJECTIVE measurement of ARF would be the measured urine output, h______ in those with FLUID DEPLETION. H________ in those with VOLUME OVERLOAD. Signs of fluid overload such as rales in the lungs or increased ___ (Physical Assessment), increased SCr and ___ and increased _____ such as potassium, phosphorus and magnesium) |
| kidney injury, cause, drug-induced, worsen | Assessment for ARF should be focused on establishing the type of k____ I______ and id-ing the C_____. Assess the extent of kidney injury and complications present. As a Rph, pay attention to d____-______ causes and drugs that can w_____ kidney injury even if they are not the cause of ARF |
| MDRD, 60 | Which equation is used to estimate GFR? It is used in early recognition and monitoring of patients with decreased renal function. Those patients with a Creatinine Clearance of above ## ml/min SHOULD NOT USE MDRD but the C-G equation |
| Cockcroft-Gault | Estimation of CrCL or the ?-? equation is the guide for drug dose adjustments in the presence of renal dysfunction. Those with a ABW of more than or equal to 30% of their IBW, liver disease, preggos or acute SCr changes, kids, old (not accurate) |
| 4.5-7.8 | pH of urine |
| Glucose | Should be negative, only positive in diabetes hyperglycemia |
| Ketones | Should not be present in urine, for ARF only positive in diabetic ketoacidosis |
| nitrite | should be negative, positive in UTIs |
| Leukocyte esterase | Released from lysed granulocytes, presence suggests UTI |
| Heme | Positive Test without the presence of RBC suggests red blood cell hemolysis or rhabdomyolysis |
| Protein or Albumin | SHOULD BE LESS THAN 30 MG/Day in the urine. Prescence indicates chronic and persistent elevations (principal markers of kidney damage) |
| Specific Gravity | 1.003-1.030, Used to assess urine concentrating ability should be interpreted along with hydration status and plasma osmolality |
| Microscopic examination | M_________ E_______, the presence of RBC, WBC, various casts and crystals assists in the diagnosis of UTI, type and etiology of acute renal failure |
| 10-15:1 | BUN to SrCr ratio #-#:# , elevated BUN to SrCr ratio is suggestive of volume depletion (kidney compensates by re-absorption of water and urea) and often is present in pre-renal azotemia |
| 0.5-1.5 | #-## (normal) SrCr, but determined by race, age, sex, muscle mass. Elevation are typically the first indicator of renal damage |
| Pre-Renal | Hypoperfusion of kidney insufficient plasma volume or cardiac output. Vessel occlusion. |
| Pre-Renal, renal artery stenosis, ACEi, NSAIDS | Chronic/acute blood loss overdiuresis, dehydration, heart failure (reduced cardiac output), vomiting or diarrhea, R_____ A_____ S_____ (reduction in lumen size from artherosclerosis or complete occlusion due to a embolism). Also Caused by exacerbating medications such as ____, arbs, and _____s (pain) |
| orthostatic hypotension, dry, increased, decreased | PRE-RENAL O_______ h_________ D__ Mucous membranes _______ HR ________ BP |
| 20:1, decreased | (Pre-Renal) BUN:SCr>##:#, _________ urine output, Electrolytes (chem7) |
| Concentrated, hyaline | Pre-RENAL C_______ urine with bland sediment H______ casts. |
| Fractional Excretion of Sodium | May not be useful in patients on diuretics; fractional excretion of urea can then be calculated (FEurea is less than 35% correlates to FEna less than 1%) |
| Glomerular Damage | In intrinsic G______ D_____ (5%) Capillary bed is used to filter fluid and solute. Damage is caused via inflammation, thromboemboli, immune mediated injury (may specific causes) |
| ATN (Acute Tubular Necrosis), Drug | ??? Tubular damage is a form of instrinsic kidney disorders. Ischemic etiology as a result of prolonged pre-renal failure. D___/Toxin Induced |
| Interstitial Nephritis, fibrosis | Most Commonly caused by medications or infections (bacterial and viral) it is an intrinsic form of ARF and has immunologic causes. Characterized by lesions comprised of monocytes, macrophages, B-CElls, and T-Cells. If the cause is not removed can cause f_______ of the tubules via inflammation |
| 10:1 | in INTRINSIC ARF (exposure to toxins resulting in acute tubular nephritis or acute interstitial nephritis. Glomerularnephritis, renal vasculature damage. The BUN SCr level should be ##:# |
| degree of insult | in INTRINSIC ARF, the d____ o_ ins____ is the main determinant. OLIGURIA has POORER prognosis than non-oliguric. ANURIA frequent |
| Post-Renal, nephrolithiasis, anticholingerics | ___-_____al Obstruction BELOW THE BLADDER OUTLET. Drug induced causes are uncommon but can include crystal formation and ? or kidney stones. Also A_______ Contributing to lack of voiding or neurogenic bladder |
| Post-Renal | In ? ? ARF, ranges from no abnormalities to a Palpable bladder, enlarged Prostate, and abdominal or pelvic masses with the inability to void. |
| 20:1 | Post-Renal, the BUN:SCr ratio may be greater than ##:#, ISNT SPECIFIC OR SENSITIVE in this case. Shows Anuria to Polyuria. (waxing and waning urine volumes) |
| Pre-Renal, 20 | ? ARF Urine sediment shows Concentrated urine with bland sediment and HYALINE casts. Urine Sodium is less than ## mEq/L |
| 40, 1 | PRE-RENAL ARF, THE URINE/SCr is greater than ## and the FEna is LESS THAN #% |
| glomerularnephritis, interstitial, tubular necrosis | ****IN INTRINSIC ARF RBC Casts indicate ? ? WBC Casts indicate ? Nephritis MUDDY BROWN Granular Casts indicate A____ T______ ______ Biopsy may prove helpful in pinpointing the intrarenal process |
| 40, 20, greater | In INTRINSIC ARF, Urine sodium is GREATER THAN ## mEq/L, URINE/SERUM CR is LESS THAN ## and the Fraction of Sodium is (less/greater) than 1%!!! |
| Post-Renal | isosomotic, isothernuiric (normal specific gravity) with NO casts but POSSIBLY WBC or RBC from STONES or INFECTION |
| hydronephrosis | Post-Renal diagnosis of ARF is confirmed if a Renal Ultrasound shows that the marked dilation of the collecting system or _________isis is present |
| urea, sodium | Fractional excretion of sodium may not be useful in patients on diuretics, fractional excretion of sodium can then be calculated. FE _____ 35% is equal to Fe____ of LESS than 1 percent |
| SNS, ADH, dilation, constriction | Compensatory response for LOW renal perfusion includes the activation of the ____, the activation of the Renin-Angiotensin-Aldosterone system, Release of A__. TO Maintain renal perfusion and GFR, you need the _______ of the afferent arteriole and the ______ of the efferent! |
| ACEi, ARB | In order for the kidney to use compensatory mechanisms such as Afferent arteriole dilation, efferent arteriole constriction ____ and _R__s should be avoided along with NSAIDS if evidence of ARF |
| Beta Blockers, Ace Inhibitors | In order for a succesfully compensatory response to occur, the activation of SNS, RAAS, ADH to maintain blood pressure via vasoconstriction, thirst stimulation and water retention, drugs such as ______ b_____, A_____ I_______ and ARBs should be held in suspected case of ARF |
| ischemia, interstital | Pre- and post renal causes are often easily corrected if ID early. Prolonged Pre-renal state can result in kidney is______a and i_____tial kidney injury. Intra-renal failure may be treatable depending on etiology |
| Acute Tubular Necrosis, necrosis, hypoxia | (? ? ? ) Tubular damage (85%) leading to epithelial cell n______ and APOPTOSIS leading to extension phase with continued h_____ and inflammation that may involve interstitium onset of days to weeks |
| tubular pressure, GFR, urine | IN ATN dead cells slough off into tubular lumen with debris, causing increased t______ p_________ and reduced ___ as well as disregulation of fluid and electrolyte transfer across the tubules and the ability to concentrate u___ is reduced |
| cortical necrosis | Continued Kidney hypoxia or exposure to toxins after initial injury will propogate inflammation and delay recovery. May lead to c______tical ne_____ preventing tubular cells re-growth |
| 2-3, epithelial, diuresis | Upon removal of the toxins/hypoxia in ATN, there is a maintence phase of #-# weeks that is followed by the recovery phase (#-# same) during which new tubular e_______ial cells are generated. Recovery phase is accompained by extensive _____ NEED TO INSURE PROPER FLUID BALANCE |
| normovolemia, cardiac, nephrotoxins, kidney function | Avoid injury to the kidneys, PREVENTION IS THE BEST TREATMENT FOR ARF, Maintain n_________ and urine output. Treat C_____ Problems, Avoid Nep______ins if possible, if not dose according to k____ f_____ |
| Pre-Renal, decrease renal perfusion | In ? ? ARF Hydration in fluid depletion, gentle hydration and diuresis in cases of edema and intravascular depletion associated with heart failure. Diuresis in cases of heart failure exacerbations with fluid overload. HOLD MEDS THAT CAN D______ Re____ P______ such as ACEI, ARB, NSAID, DIURETICS |
| Intrinsic | What type of ARF? You want to ID and D/C nephrotoxin and supportive measures along with immunosuppression are used in AIN. |
| Post-Renal | IN ___-_____ ARF need to clear obstruction, insert a catheter, passing and management of kidney stones and management of prostatic disease |
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