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Pre renal/Intra renal/ Post renal FAILURE - step_123
#1
I keep missing questions on these same topics. Anyone has some sort of logical reasoning that works for them ?? I would very much appreciate some help Smile

Thanks in advance!!!
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#2
Pre Renal (ARF) Failure occurs when there is inadequate blood circulation (perfusion) of blood vessels supplying the kidneys. In this situatio,n the kidneys are unable to filter the blood of toxins adequately.

Major causes:
**********
Shock, sepsis
Dehydration,
Severe blood loss
Heart failure
Preexisting atherosclerosis
So, as you see above, all conditions result in reduced blood flow to the kidneys.

BUN /Cr elevated,>20
Ur NA < 20
FENa < 1
No/trace proteinuria
normal or few cells only

Trt is aimed at improving the renal perfusion and by treating the underlying conditions- dramatic improvements with iv fluids.
*********************************************************************************
Intra renal Failure
Intrinsic renal failure is renal failure which is not caused by pre renal or post renal factors. In Intrinsic renal failure there is damage and injury with both kidneys.

Major causes
***********
Vascular-
Glomerulonephritis due to any cause
Renal artery obstruction
Blood disorders- like Anemia, Thrombocytopenia-resulting in necrosis in renal tissues

Diseases of Tubules and renal interstitium
ATN- dueto ischemia, nephrotoxins-causing damge to the renal tubules.
Drug induced allergic interstitial nephritis-commonly by antibiotics,nsaids and chemotherapeutics, radiocontrast dyes.
Also hypercalcemia, myoglobinuria as in rhabdomyolysis,alcohol,cocaine

Urine shows lots of WBCs and RBCs ,casts
BUN/Cr 20
FE Na>1
mild to moderate proteinuria
dark brown casts in urine, eosnophils,WBC and RBC

Blood-hypocalcemia,hyperkalemia, hyperphosphatemia, hypermagnisemia,uremia.
Trt aimed at underlying conditions trt, withdrawal of nephrotoxic drug, glucocorticoids,trt of malignant hypertension, mngmt of acidosis,dialysis when needed.
*******************************************************************************
Post renal Failure
**************
Postrenal ARF is the result of an acute obstruction to the outflow of urine from one or both kidneys. The obstruction results in back pressure

Major causes.
**********
Urinary bladder outlet obstruction- BPH or stones
Renal calculi in one or both ureters
Neurogenic bladder-pt unable to empty the bladder
postrenal injury due to accidents
retroperitoneal fibrosis

BUN/CR -10-15
Ur Na >40
FENa >1
mild to moderate proteins
RBC,WBC ,crystals

Trt of underlying outlet obstruction such as stones,BPH .
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#3
@usmedipro

Thank you thank you thank you !!
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