Acute Renal Failure

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trbowers1@gmail.com

par trevor bowers

Winter 2015 Pathophys Concept Map

par Jennifer Ashley O

ANTIBIOTICS

par Nik Qabila

Meningococcal Infection

par Brooklyn Bakker

Acute Renal Failure

Thrombotic microangiopathies

TTP

Purpura

Fever

CNS problems

Women

HUS

E.coli (Hemorrhagic)

Hamburger

Most recover

Some develop CRF

Triad

Thrombocytopenia

Uremia

Hemolysis

Children

DIC

Bilateral renal coritcal necrosis

This is possible

Prognosis is bad

Toxemia of pregnancy

Abruptio placentae

Bactermia

Crescentic GN

Immune complex Dz

anti-GBM

Goodpasture's

P-ANCA

Microscopic PAN

Myeloma kidney (Cast Nephropathy)

30% have severe ARF

Concomitant amyloidosis (15%)

Multinucleated giant cells surround casts

Hard, brittle, bright, eosinophilic cast in tubules

Bence-Jones protein

Transplant rejection

Earliest is 3rd-7th day (wks to mos)

Acute

Edema, hemorrhage, parenchymal necrosis

Vascular

Micro: endovasculitis

Edema, renal function normal after steroids

Cellular (interstitial)

W/in Hours

Hyperacute

Cyanotic, soft

Pre-existing Ab to HLA/ABO Ag

TIN

Tubulointerstitial nephritis (TIN)

aka

Acute interstitial nephritis

aka

Drug-induced ____

Allergic ___

Prednisone (part. benefit)

Deal w/ the Source

Clinical

Eosinophilia (50%)

Allergy

Infection

Other

Rapid Review:

LSE

Pb poisoning

Urate nephropathy

Multiple myeloma

Drugs

Antibiotics

Sulfonamide

Penicillin

Diuretics

NSAIDs

Acute pyelonephritis

ATN

Most important

Most common

Prognosis

Rx:

Rx

Dialysis

Peritoneal

Hemo-

Water/Electrolytes

Toxic ATN

Organic compounds

CCL4

Heavy Metals

Arsenic

Mercuric chloride

Aminoglycoside

Gentamicin

Ischemic ATN

Causes

Reduced renal perfusion

Leads to prerenal azotemia --> hence, elevated BUN & Cr

Renal vasoconstriction

Shock

Hypovolemia

Lab Values

Oliguria 50%

Cr

BUN

LM

NO DIFFUSE NECROSIS of tubular epithelial cells

Gross

Cortex pale, medulla dark

Cortex bulging out of capsule

Swollen