ARF and CKD Exam Questions with Complete Solutions
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ARF
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ARF
BUN): The BUN will also filter through normally. However, it will not get reabsorbed as it
usually does under normal circumstances because there is damage to the renal tubules.
Therefore, some of it is excreted. Note that in intrinsic renal failure, the BUN and creatinine
will still be elevated ...
ARF and CKD Exam Questions with
Complete Solutions
(BUN): The BUN will also filter through normally. However, it will not get reabsorbed as it
usually does under normal circumstances because there is damage to the renal tubules.
Therefore, some of it is excreted. Note that in intrinsic renal failure, the BUN and creatinine
will still be elevated but there will not be the significant difference in terms of elevation
between the BUN and creatinine. The ratio will be less than the ratio seen in pre-renal failure.
This is all due to the lack of reabsorption of the BUN due to the damaged renal tubules. The
typical BUN/Creatinine ratio of intrinsic failure is <15:1 and in pre-renal failure, the ratio is 20:1
One of the best ways to differentiate between pre-renal and intrinsic renal failure is to
examine the ratio difference between the BUN and creatinine.
Urine: The urine will be dilute because it is not being absorbed by the tubules.
Therefore, sodium and water excretion are increased which leads to a dilute urine.
post-renal failure - ANSWER damage occurs in the collecting ducts or even further down
into the ureter, bladder or urethra due to some type of obstruction, that include stones and
strictures
post-renal failure causes: - ANSWER Unilateral obstruction- is obstruction in one kidney but
not the other.
Ureter obstruction: due to stone, stricture, and fibrosis.
, Bladder obstruction: due to neurogenic bladder.
Bladder neck obstruction: due to benign prostatic hyperplasia (BPH) and prostate cancer.
Urethra: stricture, tumor, and phimosis.
common issues that require management are: - ANSWER Volume overload (furosemide is
prescribed). The patient has a good prognosis for recovery if the kidneys respond to furosemide
by increasing urine output.
Hyperkalemia should be managed. It occurs because the patient cannot secrete potassium
(patient is maintained on restricted potassium diet; potassium binding drugs are often given
like insulin, dextrose and beta-agonists that all drive potassium back into the cell). Finally,
dialysis becomes the option when supportive measures are unable to reverse the acute renal
failure.
A healthy 26-year-old female was in a car accident where she sustained a crushing injury to her
left lower extremity. She was taken to surgery upon arrival to the emergency department for
pinning and reconstructive surgery. On the second day post-op, the NP noticed an increase in
the patient's creatinine from 0.7 to 2.0 mg/dL. Her urine output also decreased to 25 mL/hr. A
creatine kinase is 3300 u/L. - ANSWER Because of the acute change in the patient's serum
creatinine and urine output, the NP suspects acute renal failure. Next, the NP considers
whether it is a pre-renal, intrinsic, or post-renal cause. In this patient's case, the elevated
creatine kinase is a big clue. It suggests rhabdomyolysis, which commonly occurs after a
crushing injury where myoglobin is released into the blood stream. From there, it precipitates
in the renal tubules. Because the injury is inside the kidney, the cause of her acute renal failure
is an intrinsic cause. The cause is unlikely a pre-renal cause because the patient is healthy with
no history of diseases that cause hypoperfusion such as heart failure and myocardial
infarction. Also, she has not experienced any shock symptoms as a result of her injury.
One of the issues that requires management of a patient with acute renal failure
is hypokalemia.
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