0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
348 Chronic Renal Failure➣Advanced disease: small shrunken kidneys, increased echo-
genicicty; normal or enlarged kidneys in ADPKD, diabetes HIV
nephropathy: hydronephrosis
■CT/MRI: angiomyolipomas, ADPKD; papillary necrosis
■Voiding cystourethrogram
■Renal Biopsy:
➣Useful when kidneys normal size to make specific diagnosis, e.g.
SLE, glomerulonephritis. When kidneys small (e.g. less (≤9cm)
usual finding is end-stage kidney i.e. global glomerulosclerosis+
tubulointerstitial nephritisdifferential diagnosis
■Chronic renal failure(CRF) symptoms mimicked by systemic
diseases, cancer, wasting illnesses, depression, hypothyroidism,
chronic heart failure, chronic liver disease. Elevated BUN and crea-
tinine point to kidney.Causes of Chronic Renal Failure
■Systemic disease: Diagnosis usually established by history, exam,
sonogram and specific laboratory tests diabetes mellitus, hyperten-
sion, systemic lupus erythematosus, Sjogren’s syndrome, systemic
necrotizing vasculitis, atheromembolic renal disease, myeloma, light
chain deposition disease, amyloidosis, genetic disease e.g. polycys-
tic disease, tuberous sclerosis, cystinosis, Fabry’s disease, sickle cell
disease, CHF, cirrhosis.
■Primary renal and urinary tract disease: Specific glomerular disease
usually requires renal biopsy; obstructive uropathy by sonogram or
CT scan (e.g. retroperitoneal fibrosis), prostate disease, recurrent
UTI or voiding dysfunction (Hx, exam, voiding study).management
What to Do First
■Assess cardiovascular and volume status by physical exam and CXR,
and determine if dialysis is indicated because of:
■a) hypertension and/or pulmonary edema; b) hyperkalemia; c)
pericarditis; d) metabolic acidosis; e) altered MSGeneral Measures
■Dialysis not indicated:
➣Restore volume status