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Acute Renal Failure
Overview
41
Audiology
4th Grade
10/19/2013

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Term
Glomerular filtration rate
Definition
~150 L/day
Term
critical for potassium homeostasis
Definition
Aldosterone
Term
% normal GFR
Definition
1/serum creatinine
Term
main causes of acute renal failure
Definition
pre-renal, intrinsic renal, or post-renal
Term
causes serious cardiac arrhythmias
Definition
hyperkalemia
Term
has relatively low blood flow and high metabolism thus particularly susceptible to ischemic injury
Definition
medulla
Term
peritubular capillaries encircling all nephron sections
Definition
cortical nephrons (85%)
Term
some peritubular capillaries and vascular loops which surround loop of henle which descend into medulla
Definition
juxtamedullary nephrons
Term
critical determiant of potassium regulation
Definition
distal tubular flow rate
Term
water channels in the collecting tubules
Definition
aquaporins
Term
distal delivery of tubular sodium
Definition
important in regulating potassium homeostasis
Term
presence of sodium
Definition
dictates the loss of potassium
Term
someone on a loop and thiazide diuretic:
Definition
keeps sodium from being absorbed into tubules --> accumulates in distal tubule further downstream and pushes potassium out --> become hypokalemic
Term
Low perfusion
Definition
results in afferent arteriolar vasodilation and efferent arteriolar vasoconstriction
Term
dilates the incoming pipe
Definition
prostaglandin
Term
causes constriction of outgoing pipe
Definition
angiotensin II
Term
causes constriction of the incoming pipe
Definition
ibuprofen
Term
causes dilation of outgoing pipe
Definition
lisinopril
Term
Macula Densa
Definition
sodium concentration
Term
Juxtaglomerular apparatus
Definition
renin release and AT-II production; direct vasoconstriction; aldosterone secretion
Term
Aldosterone secretion
Definition
sodium retention
Term
Vasopressin
Definition
enhanced water resorption at the collecting ducts
Term
Macula Densa
Definition
sodium concentration
Term
Juxtaglomerular apparatus
Definition
renin release and AT-II production; direct vasoconstriction; aldosterone secretion
Term
Aldosterone secretion
Definition
sodium retention
Term
Vasopressin
Definition
enhanced water resorption at the collecting ducts
Term
kidney calcium metabolism
Definition
formation of the active form 1,25-OH vitamin D (required for calcium absorption from intestines); site of parathyroid hormone actions (calcium retention and phosphate wasting)
Term
stimulates bone marrow production and maturation of RBCs
Definition
Erythropoietin
Term
Ace inhibitor effect
Definition
in diabetes there is scarring of glomerulus; this helps with the filtration-- good for diabetic patients
Term
Every time the serum creatinine doubles
Definition
the creatinine clearance drops by 50%
Term
a clinical syndrome characterized by an abrupt decline in GFR and a rise in BUN and Cr; occurs over days to weeks
Definition
Acute Renal Failure
Term
non-dialysis ARF: complication- intravascular volume overload
Definition
restrict salt (1-2 g/day) and water (<1L/day); Diuretics (usually loop +/- thiazide)
Term
non-dialysis ARF: complication- hyponatremia
Definition
restrict enteral water intake (<1L/day); avoid hypotonic IV solutions including dextrose
Term
non-dialysis ARF: complication- hyperkalemia
Definition
restrict dietary potassium intake; eliminate K supplements and K sparing diuretics; potassium-binding ion-exchange resins (sodium polystyrene sulfonate); glucose and insulin; sodium bicarbonate; albuterol; calcium gluconate
Term
non-dialysis ARF: complication- metabolic acidosis
Definition
restrict dietary protein; sodium bicarbonate
Term
non-dialysis ARF: complication- hyperphosphatemia
Definition
restrict dietary phosphate intake; phosphate binding agents (calcium carbonate, etc)
Term
non-dialysis ARF: complication-- hypermagnesemia
Definition
discontinue MG2 containing antacids
Term
non-dialysis ARF: complication-- hyperuricemia
Definition
treatment usually not necessary
Term
non-dialysis ARF: complication-- nutrition
Definition
restrict dietary protein; if not catabolic carbohydrate (~100g/day); enteral or parenteral nutrition
Term
If hyperkalemia persists....
Definition
kayexylate (k-binding resin)
Term
indications for dialysis therapy
Definition
acidosis, electrolytes, ingestions, overload, uremia
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