Large Group 1- Pre-renal Azotemia
What is the BUN:Creatinine ratio in pre-renal azotemia?
> 20
What is azotemia?
A biochemical abnormality that refers to an elevation of nitrogen containing compounds such as urea and creatinine, various waste compounds, and other nitrogen rich compounds in the blood
What is pre-renal azotemia caused by?
A decrease in blood flow to the kidneys without an inherent kidney disease
What is azotemia largely related to?
A decreased GFR
What are conditions where the blood volume is not lost but the heart cannot pump enough blood or blood is pumped at low volume?
Heart failure and shock
What is a normal BUN:Cr ratio?
Less than 15
What is the BUN:Creatinine ration in intra-renal and post-renal ration?
Less than 20
What is the medical management of pre-renal azotemia after blood volume has been restored?
Medications to increase BP and cardiac output
What happens in the proximal tubule of a patient with volume depletion?
Reabsorption resulting in: - Azotemia - Hypernatremia - Elevated calcium - Elevated uric acid - Elevated bicarbonate - Postural tachycardia w/or wo hypotension
What is the main goal in medical management of pre-renal azotemia?
The main goal is to quickly correct the cause of decreased perfusion before the kidney becomes damaged
True or False, pre-renal azotemia is common, especially in people who are in the hospital?
True, it is the most common form of kidney failure in hospitalized patients
Complete reversal of pre-renal azotemia usually occurs in what time frame?
Within 24-48 hrs
Progressive azotemia can lead to end-stage renal disease in what patients?
- Diabetes - Hypertension - Glomerulonephritis - Cystic kidney disease
Pre-renal azotemia can occur following what?
- Hemorrhage - Shock - Volume depletion - CHF - Narrowing of the renal artery
What does pre-renal patients respond to treatment wise?
- IV volume administration or hemodynamic manipulation
What are some caries prevention products for patients with xerostomia?
- Stannous fluoride gel .4% - MI paste
What is the etiology of pre-renal azotemia?
- Any condition that decreases blood flow to the kidney - Conditions where the blood volume is not lost but the heart cannot pump enough blood or blood is pumped at low volume - Conditions where blood flow to the kidney is interrupted
What are some examples of saliva substitutes?
- Aquoral - Caphosol - Moi-Stir - Mouth Kote - Numoisyn - SalivaSure
What are conditions where blood flow to the kidney is interrupted?
- Certain types of surgery - Renal artery embolism or occlusion - Trauma to the kidney
What are conditions that decrease blood flow to the kidney?
- Conditions that allow fluid to escape from the bloodstream - Loss of blood volume - Prolonged vomiting or diarrhea, bleeding
What are some signs and symptoms of pre-renal azotemia?
- Decreased or absent urine - Decreased skin turgor - Asterixis - Fatigue, decreased alertness - Pale skin color - Tachycardia - Xerostomia, thirst - Swelling - Orthostatic hypotension - Uremic frost - Collapsed/flat neck veins
What measure is used to determine the type of azotemia?
BUN to creatinine ratio
Describe the urine of a patient with azotemia and volume depletion
Concentrated urine