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05 Goldstein Acute Renal Failure

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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]
More ATN ,[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]
What are these?
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]

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Pulmonary Function Tests
Pulmonary Function TestsPulmonary Function Tests
Pulmonary Function Tests
 
Oxygenation
OxygenationOxygenation
Oxygenation
 
Hypercapnia On Cerebral Autoregulation
Hypercapnia On Cerebral AutoregulationHypercapnia On Cerebral Autoregulation
Hypercapnia On Cerebral Autoregulation
 
Control%20of%20 Breathing
Control%20of%20 BreathingControl%20of%20 Breathing
Control%20of%20 Breathing
 
Control Of Ventilation
Control Of VentilationControl Of Ventilation
Control Of Ventilation
 
Control Of Respiratory Function
Control Of Respiratory FunctionControl Of Respiratory Function
Control Of Respiratory Function
 

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05 Goldstein Acute Renal Failure

  • 1. Acute Renal Failure Deb Goldstein Argy Resident September, 2005
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  • 21. >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
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  • 40. Why do his toes look like this?
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Editor's Notes

  1. hyaline cast, normal finding, Prerenal.
  2. muddy brown granular casts
  3. epithelial cell cast (cells are larger than WBCs; have nuclei)
  4. WBC cast which drug? gentamicin for SBE, motrin for RA, ASA for CAD,
  5. RBC casts
  6. Another pic of RBC casts; just look different