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Step III

Step III - Renal 1

Hyaline casts, urine osm >500, FeNa <1%, urine Na <20 Pre-renal
What are the causes of pre-renal azotemia HYPO-volemia, HYPO-tn (<90), CHF, constrictive cardx, low onc pressure, renal aa stenosis
Causes of post-renal Strictures, stones, CA bladder/prostate/cervix, neurogenic bladder
Muddy brown/granular casts ATN
Hyaline casts Pre-renal
What are the common causes of ATN Toxic injury and HYPOperfusion
MCC toxin induced renal insufficiency Aminoglycosides, amphotericin, chemo (cisplatin), IV contrast dye
What lab test can help in evalx ATN from contrast Mg
Fever, Rash, Eosinophilia/uria, WBC casts. Exposure to drug or infection AIN
What is the FeNa and urine Osm in AIN FENa >2%, Dilute urine (Osm < 350)
h/o Abx (PCN, ceph, NSAIDs, phenytoin, diuretics, sulfa, quinolones) a/w what type intrarenal renal failure AIN
h/o infection/autoimmune (SS, SLE, sarcoidosis) a/w what type intrarenal renal failure AIN
What is the best initial test for AIN and what does it show UA showing WBCs
Most accurate test for AIN Wright stain OR Hansel’s stain of urine showing eosinophils
Tx for AIN None; resolves on own
What drug causes hemorrhagic cystitis and NOT renal failure Cyclophosphamide
What are some causes of rhabdo that lead to intrarenal failure Seizures, crush injury, immobility in intoxicated pt, low K+ causing muscle necrosis, pt on statin
What is the best initial test for rhabdo induced intrarenal failure UA showing large amounts RBCs but no cells
Most accurate test for rhabdo induced intrarenal failure Urine myoglobin
Decreased bicarb, low Ca2+, incr K+ labs seen in what type of renal failure rhabdo induced intrarenal failure
Tx for rhabdo induced intrarenal failure Bolus nL saline, mannitol diuresis, alkalinization of urine
Pt in case has rhabdomyolysis. Most URGENT step in management and why EKG; rhabdo causes HYPER-kalemia which is risk for arrthymia
Pt intoxicated from suicide attempt w/ antifreeze. What kind of renal failure Crystal induced
What type of crystals are seen in ethylene glycol renal failure and what is the shape Oxalate “envelope” crystals
What is the best initial test for crystal uropathy UA
What is the best initial tx for crystal uropathy Ethanol OR fomepazole w/ dialysis
What kind of crystals are seen in tumor lysis syndrome Urate
Tx for urate crystal renal failure Hydration and allopurinol
What can you give a pt that has DM/HTN who absolutely needs contrast dye Hydrate w/ nL saline + bicarb/N-acetylcysteine
What are some kidney insults resulting from NSAIDs ATN, AIN, nephrotic syndrome, afferent aa vasoconstrx
Red blood cells, red cell casts, proteinuria <2g in 24, edema Glomerulonephritis
Most accurate test for glomerulonephrx Kidney bx
Created by: DrINFJ