Podcast
Questions and Answers
What is a possible cause of postrenal AKI indicated by palpable flank masses?
What is a possible cause of postrenal AKI indicated by palpable flank masses?
Which of the following imaging studies can help diagnose urinary tract obstruction?
Which of the following imaging studies can help diagnose urinary tract obstruction?
What is a possible cause of postrenal AKI that can be diagnosed by plain X-ray abdomen?
What is a possible cause of postrenal AKI that can be diagnosed by plain X-ray abdomen?
What is a possible indication of urinary tract obstruction on renal ultrasonography?
What is a possible indication of urinary tract obstruction on renal ultrasonography?
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Which of the following is a postrenal cause of AKI that can cause palpable flank masses?
Which of the following is a postrenal cause of AKI that can cause palpable flank masses?
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What is the purpose of retrograde pyelography in the diagnosis of AKI?
What is the purpose of retrograde pyelography in the diagnosis of AKI?
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Which of the following is a postrenal cause of AKI that can cause hydronephrosis on renal ultrasonography?
Which of the following is a postrenal cause of AKI that can cause hydronephrosis on renal ultrasonography?
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What is a possible indication of urinary tract obstruction on imaging studies?
What is a possible indication of urinary tract obstruction on imaging studies?
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Which of the following is a postrenal cause of AKI that can cause flank masses on physical examination?
Which of the following is a postrenal cause of AKI that can cause flank masses on physical examination?
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What is the role of renal ultrasonography in the diagnosis of postrenal AKI?
What is the role of renal ultrasonography in the diagnosis of postrenal AKI?
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Study Notes
TMP-SMX Treatment
- TMP-SMX with one-third of therapeutic dose once daily
Acute Renal Failure (ARF)
- Definition: Rapid and usually reversible decline in renal function leading to retention of nitrogenous waste products and disturbance in water and electrolyte balance
- Etiology:
- Pre-renal causes:
- Dehydration
- Gastroenteritis
- Hemorrhage
- Burns
- Sepsis
- Capillary leak
- Hypoalbuminemia
- Cardiac failure
- Anaphylaxis
- Intrinsic renal causes:
- Glomerulonephritis
- Interstitial nephritis
- Acute tubular necrosis
- Vascular
- Malignancy
- Developmental abnormalities
- Post renal causes:
- Bilateral PU obstruction or unilateral affection of single kidney
- Bladder neck obstruction
- Neurogenic bladder
- Vesico-ureteric reflux
- Posterior urethral valves
- Tumors and other causes of extrinsic compression
- Urolithiasis
- Urethral strictures
- Pre-renal causes:
Clinical Manifestations
- Presenting signs and symptoms may be dominated or modified by the precipitating factor
- C/P related to renal failure: Pallor, oliguria, edema, hypertension, vomiting, and lethargy
- History may be a key for the underlying cause
Urinary Tract Infection (UTI)
- Definition: Actively multiplying organism within the UT with significant bacteriuria that may be symptomatic or not
- Etiology:
- Urinary pathogens
- Route of infection: Ascending infections from fecal flora
- Risk Factors:
- Female gender
- Uncircumcised male
- Vesicoureteral reflux
- Toilet training
- Voiding dysfunction
- Obstructive uropathy
Clinical Manifestations and Classification
- Two basic forms of UTIs: Pyelonephritis and Cystitis
- Cystitis:
- Symptoms: Dysuria, urgency, frequency, suprapubic pain, incontinence, and possibly malodorous urine
- Does not cause high fever and does not result in renal injury
- Pyelonephritis:
- Symptoms: Abdominal, back, or flank pain, fever, malaise, nausea, vomiting, and occasionally diarrhea
- Fever may be the only manifestation
Examination and Lab Findings
- Careful attention to volume status
- Physical examination:
- Tachycardia, dry mucous membranes, and poor peripheral perfusion suggest inadequate circulating volume and possibility of pre-renal AKI
- Hypertension, peripheral edema, rales, and a cardiac gallop suggest volume overload and possibility of intrinsic AKI
- Lab findings:
- Increased blood urea, serum creatinine
- Electrolyte disturbances
- Metabolic acidosis
- May be anemia, leucopenia, and thrombocytopenia
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Description
This quiz covers the causes and complications of acute renal failure, including pre-renal causes, chronic pyelonephritis, and hypertension.
