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Renal System O1

Anuria/Oliguria Case Closing- Ratliff- 2/1/2013

2 most common causes of chronic kidney disease that predispose to development of acute kidney injury in setting of other exposures Diabetes and hypertension
"I am not making much urine" goes under which section of a note Chief complaint
By which mechanism does an ACE inhibitor increase risk of AKI It blocks the conversion of Angiotensin I to Angiotensin II which inhibits vasoconstriction of the efferent arteriole which is needed to maintain GFR in decreased blood pressure or volume
Effect of NSAID on Renal Blood flow Vasoconstricts afferent arteriole
Effect of ANP on Renal Blood flow Vasodilates afferent arteriole
Effect of Prostaglandin on Renal Blood flow Vasodilates afferent arteriole and vasoconstricts efferent arteriole
Effect of Angiotensin II on Renal Blood flow Vasoconstricts efferent arteriole
Effect of Norepinephrine on Renal Blood flow Vasoconstricts efferent arteriole
Effect of ACE inhibitor on Renal Blood flow Vasodilates efferent arteriole
Rash in a kidney patient can be indicative of Glomerulonephritis or autoimmune (lupis)
Frothy urine is indicative of Proteinuria
Tea colored urine is indicative of Hematuria or rhabdomylosis
Tachycardia, hypotension, reduced skin turgor with tenting and syncope are all findings supporting Volume depletion
Definitive way of diagnosing post-renal causes Ultrasound
Increased Lactic acid levels are due to Ischemia/hypoperfusion
Lack of blood and protein in the urine points to Pre-renal causes
In pre-renal disease, a decreased flow leads to increased reabsorption of BUN
A BUN:CR for pre-renal etiologies >20
Decreased pressure and flow lead to activation of RAAS
Urine sodium levels for pre-renal etiologies <20
Explain why urine sodium levels are low in pre-renal disease In cases of depleted volume, Kidneys will activate RAAS and maximally reabsorb sodium and therefor increasing water retention. This will happen as long as TUBULES ARE INTACT
RBCs or RBC casts are indicative of Intrinsic glomerular disease
"Muddy brown" granular casts are indicative of Intrinsic Tubular disease
WBCs and WBC casts with a negative urine culture are indicative of Intrinsic Interstitial disease
High BUN:CR and Low Na+ points to Pre-renal disease
Low BUN:CR and high Na+ points to Intrinsic renal disease
High BUN:Cr and high Na+ points to Post-renal disease
Pre-renal etiology is due to True volume depletion or medications affecting renal blood flow
Plan for patient with pre-renal causes IV fluid hydration and holding potential offending medications
Anuria Absence of urine formation (<100 ml/day)
Oliguria Scanty urine production (<400-500 ml/day)
Normal urine production >500 ml/day
Nephrotoxic Toxic to renal cells
Nephritic Relating to or suffering from nephritis
Nephritis Inflammation of the kidneys (RBC in urine)
Nephrotic Relating to, caused by, or similar to nephrosis
Nephrosis Damage to renal tubular epithelium/glomerular basement membrane (protein in urine)
General cause of prerenal disease Less fluid is delivered to the kidneys for filtration
General cause of intrinsic renal disease The kidneys are unable to produce urine to due intrinsic disease
General cause of Postrenal disease The kidneys are obstructed and urine cannot be excreted
Nephritic urine sediment suggests Glomerulonephritis
Sterile pyuria suggests Interstitial nephritis
Proteinunuria suggests Intrinsic/Glomerular process
Created by: mcasto