Renal

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Renal Artery Stenosis S/sx

refractory hypertension, new‐onset hypertension,PE may reveal an audible abdominal bruit

Renal Artery Stenosis Lab findings

w elevated BUN & serum creatinine levels,Abdominal ultrasound,Doppler ultrasonography, CT angiography, magnetic resonance angiography,*RNA

Renal Artery Stenosis Treatment

medical management, angioplasty w/ or w/o stenting, and surgical bypass,Angioplasty

Renal Disease Differential Dx

Oliguria/anuria suggests acute component,Progressive rise > 0.3 to 0.5 mg/dL likely ATN, Slow rise w/ fluctuations likely prerenal

Renal Urinalysis microscopic Exam

muddy brown granular casts and epithelial cell casts suggestive of acute tubular necrosis (ATN,one red cell cast is diagnostic of vasculitis

Acute Renal Failure Definition

Abrupt fall in GFR over a period of minutes to days with rapid & sustained rise in nitrogenous waste products in blood.

Acute Renal Failure Consequences

Volume overload,Hyperkalaemia, Uremia, Metabolic acidosis

Management of Acute Renal Failure

Identify and correct pre-renal and post-renal factors. Stop ACEI, ARBs, NSAIDs,

Prevent AKI/ARF avoidance of nephrotoxins

Aminoglycosides, Amphotericin, Radiocontrast media

AKI/ARF labs & diagnostics

Elevated BUN/Cr, Electrolytes/ECG findings, Hyperkalemia: Peaked T waves‐ PR prolongation wide QRS, Hypocalcemia: long QT

Prerenal Azotemia 3 mechanisms hypoperfusion

Decreased intravascular volume, Change in vascular resistance, Decreased cardiac output

Postrenal Azotemia S/sx

May or may not be anuric, lower abd pain, BPH,Distended bladder

Chronic Kidney Disease S/sx

fatigue, malaise, weakness, pruritis, anorexia, n/v, metallic taste and hiccups are common