05 Goldstein Acute Renal Failure

Acute Renal Failure Deb Goldstein Argy Resident September, 2005

Acute Renal Failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Definitions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ARF: Signs and Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Causes of ARF in hospitalized pts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ARF: Focused History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

W/U for ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

FeNa = (urine Na x plasma Cr) (plasma Na x urine Cr) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

More FeNa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Calculating FeNa after pt has gotten Lasix... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

A 22yo male with sickle cell anemia and abdominal pain who has been vomiting nonstop for 2 days. BUN=45, Cr=2.2. ,[object Object],[object Object],[object Object],[object Object]

Prerenal ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prerenal causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Intrinsic ARF ,[object Object],[object Object],[object Object],[object Object]

You evaluate a 57yo man w/ oliguria and rapidly increasing BUN, Cr. ,[object Object],[object Object],[object Object],[object Object]

ATN ,[object Object],[object Object]

ATN Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ATN—What to do ,[object Object],[object Object],[object Object],[object Object],[object Object]

>20:1 10-15:1 BUN/Cr Cr improves with IVF Cr won’t improve much Response to volume Normal epi cells, granular casts UA UNa<20 FeNa<1% UNa>40 FeNa >2% U Na, FeNa increases slower than 0.3 /day increases at 0.3-0.5 /day Cr Prerenal ATN

Which UA is most compatible w/contrast-induced ATN? ,[object Object],[object Object],[object Object],[object Object]

ATN ,[object Object],[object Object],[object Object],[object Object]

56yo woman with previously normal renal function now has BUN=24, Cr 1.8. Which drug is responsible? ,[object Object],[object Object],[object Object],[object Object]

WBC Casts ,[object Object],[object Object],[object Object]

Acute Interstitial Nephritis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

AIN from Drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

AIN Management ,[object Object],[object Object],[object Object],[object Object],[object Object]

You evaluate a 32yo woman with HTN, oliguria, and rapidly increasing Cr, BUN. You spin her urine: ,[object Object],[object Object],[object Object],[object Object]

Acute Glomerulonephritis ,[object Object],[object Object],[object Object],[object Object]

Glomerular Dz ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Rapidly Progressive Glomerulonephritis

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Postinfectious Proliferative Glomerulonephritis

A 19yo woman with Breast Cancer s/p chemo in the ER has weakness, fever, rash. WBC=15.4, Hct 24, Cr 2.9, LDH 600, CK=600. UA=3+ prot, 3+blood, 20 RBC. What next test do you order? What’s her likely dx? ,[object Object],[object Object],[object Object],[object Object],[object Object]

TTP ,[object Object],[object Object],[object Object],[object Object],[object Object]

Microvascular ARF ,[object Object],[object Object],[object Object],[object Object]

Macrovascular ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Your 68yo male inpatient with baseline Cr=1.2 had negative cardiac cath 4 days ago, now Cr=1.8 and blanching rash.

Why do his toes look like this?

Renal Atheroembolic Dz ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Post-Renal ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

“Doc, your pt hasn’t peed in 5 hrs....what do you want to do?” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

You’re called to the ER to see... ,[object Object],[object Object],[object Object]

Indications for acute dialysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object]

Uremia—So what? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

A pt with chronic lung disease has acute pleuritic pain and desats to 92%RA. You want to r/o PE but her Cr=1.4. Can you get a CT with IV contrast? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Contrast-Induced Nephrotoxicity ,[object Object],[object Object],[object Object],[object Object]

Pre-Procedure Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

05 Goldstein Acute Renal Failure

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05 Goldstein Acute Renal Failure

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