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which phase will removal of inciting cause NOT result in immediate return to normal renal function? how long will it take to restore fx?
1-3 weeks
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During maintenance phase, will GFR return to normal if renal blood flow is restored?
no, still remains low
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can a patient in maintenance phase convert from oliguria to polyuria?
yes (this would be better because you can continue fluid therapy w/polyuria)
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during recovery phase, is it possible for BUN/creatine able to return to normal? what about GFR? What about specific gravity?
- possible for BUN/Crea to correct in time
- GFR may remain low
- concentrating defect may persist (low SG)
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what is the definitive test for diagnosing AIRF?
- trick question, there is none
- but history + blood/urine/specific gravity helpful BEFORE starting therapy
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Does AIRF patient usually have longstanding PU/PD issues? weight loss?
- no, this is an acute disease and urine output is variable
- no wt loss (acute) but often dehydrated
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what is renal size in AIRF?
- normal or large
- (small in chronic)
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Chronic, acute or both: uremia? what are signs of uremia?
- both
- uremic breath, oral ulcers, tongue tip necrosis
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chronic, acute or both: pale mucous membrane?
- pallor with chronic (anemia)
- pallor not usually associated with acute unless in shock (peripheral constriction)
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nephrosis or nephritis: hypothermia?
- hypothermia = nephrosis
- hyperthermia = nephritis
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what is potassium status in chronic v. acute?
- acute: hyperK
- chronic: hypoK
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acute, chronic or both: anemia?
- chronic
- (can see regenerative response w/AIRF if recent hemorrhage)
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What is TP in AIRF?
- normal to elevated if dehydrated
- (later samples may appear low TP if overhydrated w/fluids)
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why is lepto associated with thrombocytopenia?
vasculitis --> consumptive thrombocytopenia
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What is definition of isosthenuria? Can this be used to distinguish acute from chronic disease?
- urine concentration = plasma concentration
- no, both have low SG
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can proteinuria be used to distinguish acute from chronic? hematuria? glucosuria?
all yes
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Does absence of casts exclude AIRF?
no, although cylindryuria is common
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what crystals are seen with ethylene glycol?
calcium oxalate
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Increased WBC, RBC and tubular epithelial cells in urine sediment are indicative of what? How does this differ from sediment with WBC and bacteria?
- non-specific reaction to renal injury
- WBC/bacteria more indicative of pyelonephritis (think ascending UTI)
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increased BUN,Creatinine and phosphorus continues to rise with AIRF until which stage? does magnitude of these values distinguish AIRF v. CRF?
- maintenance where it reaches plateau
- No (nor does it tell if pre/post/renal)
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what do you expect blood gas tests to reveal in pt with AIRF in maintenance phase?
moderate/severe metabolic acidosis (more severe than in CRF)
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What ultrasound findings help distinguish acute v chronic RF: brightness, size, corticomedullary junction?
- brightness and size (acute is bright and normal/large)
- not cm-junction
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Can you rule out AIRF if ultrasound findings are normal? Can you determine the cause of AIRF based on US findings?
- no
- no (except possibly ethynol poisoning)
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How can parathyroid gland help distinguish acute from chronic renal failure?
- enlarge with chronic (incr. Ca++)
- normal with acute
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What are two specific infectious causes of AIRF that you can send in serum samples for?
- leptospirosis
- Borrelia (rapid progressive glomerular nephritis)
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will renal biopsy distinguish acute v. chronic? can it distinguish nephritis v. nephrosis?
- yes
- yes
- can also assess for healing potential/prognosis
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Most causes of AIRF are poor to grave prognosis. Which etiology of AIRF has fair to good prognosis?
lepto and bacterial pyelonephritis
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Are patients with baseline azotemia during maintenance phase often successfully managed without dialysis? is hemodialysis or peritoneal dialysis more effective
- NO (80% die even with dialysis)
- hemodialysis more effective (2-3x/wk for months with AIRF)
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Why do animals die with AIRF?
- hyperK
- metabolic acidosis
- severe azotemia (dogs worse off than cats with this)
- (also overhydration/pulmonary edema from vigorous fluids)
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When treating AIRF, how much fluids should be given over 4 hour period?
volume equal to insensible needs plus volume equal to urine output for previous 4 hours
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what are treatments of choice for hyperkalemia?
- insulin + glucose (or glucose alone; NEVER insulin alone)
- Ca gluconate
- if hyperK persists, must proceed to dialysis
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what are some drugs commonly given to treat oliguria? how effective are they?
- furosemide, dopamine, mannitol
- futile effort to try to get kidney to produce urine
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What is special about Sierra brand anti-freeze?
- it's not fatally toxic to animals (but more $$)
- can call illness but usually not fatal
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what are first signs of toxicity with ethylene glycol? when do renal signs appear?
- neurologic ("drunk") within 30-12hr of ingestion
- cardiopulmonary 12-24hr (tachy-)
- renal 24-72hr (PU/PD)***usu.too late if get patient in clinic once azotemic already
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What is most important cause of damage from ethylene glycol? what else is bad?
- metabolite = glycolate (by 12 hours)
- Ca oxalate crystals compressing/blocking tubules
- tubular back leak
- interstitial edema --> compressed renal blood flow
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how can you test for ethylene glycol? what is time for detection post ingestion? what can cause false negatives?
- colorimetric test on whole blood or serum
- undetectable in plasma <30 or >48hr post ingestion
- false from propylene glycol, glycerol, metaldehyde (snail bate)
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what are treatment options for ethylene glycol poisoning?
- ethanol dilute to 20% (will cause CNS depression)
- 4-methyl pyrazole to prevent metabolism (no depression, $$)
- (Ca gluconate for hyperkalemia; Na bicarb for acidosis if fluids don't correct it)
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