The document provides information about acute renal failure (ARF), including: - ARF is the rapid loss of kidney function over hours to days, resulting in failure to excrete waste and electrolyte imbalance. - The main causes of ARF are pre-renal (decreased renal perfusion), intrinsic renal (damage to the kidneys), and post-renal (obstruction of urinary outflow). - Evaluation involves laboratory tests like urinalysis and renal indices to help determine the underlying cause and guide treatment, which depends on the identified etiology. Dialysis may be needed for severe cases.

1. Acute Renal Failure Anthony R Mato, MD

11. THE DIFFERENTIAL DIAGNOSIS

12. Differential Diagnosis

17. Allergic : AIN Allergic reaction in the tubules. IT IS PARAMOUNT TO IDENTIFY THE OFFENDING AGENT AND REMOVE IT. There may be some role for steroids in the case of AIN.

20. Post Renal Causes If we can identify this early, this can be readily reversible. This accounts for fewer than 5% of cases of ARF.

24. Any additional questions?

28. What is your differential?

29. What additional workup do you want to diagnose the etiology of his ARF / abdominal pain?

37. URINE BLING

43. Why is he hyperkalemic? What is the management? Does need dialysis?

54. Why did his renal failure worsen?

61. What is your differential?

64. What additional tests would you like?

65. Multiple Myeloma

67. Sam’s Case 30 year old man with diabetes, hypertension and chronic renal insufficiency (baseline creatinine of 2.5) presents to VA clinic for routine follow-up. His medications are captopril, HCTZ and insulin. Physical exam is unremarkable. Na= 138 , K=5.8 , Cl=110 , HCO3=20 , BUN=30 , Cr=2.4 , Glu=129

68. What is your differential for elevated Potassium?

69. What is your plan management plan?

79. Comparison of Normal Anion-Gap Acidosis Finding Type 1 RTA Type 2 RTA Type 4 RTA GI Bicarbonate Loss Normal anion-gap acidosis Yes Yes Yes Yes Minimum urine pH >5.5 <5.5 <5.5 5 to 6 % Filtered bicarbonate excreted <10 >15 <10 <10 Serum potassium Low Low High Low Fanconi syndrome No Yes No No Stones/nephrocalcinosis Yes No No No Daily acid excretion Low Normal Low High Urine anion gap Positive Positive Positive Negative Daily bicarbonate replacement needs <4 mmol/kg >4 mmol/kg <4 mmol/kg Variable