robin082006
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Which of the following processes would be most likely to produce this patient's rising serum creatinine
/ A. Benign prostatic hyperplasia
/ B. Drug toxicity causing acute tubular necrosis
/ C. Hypotension
/ D. Post-infectious glomerulonephritis
/ E. Stone impacted in ureter
please explain
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| msyamp
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hmmm good one robin. it is hypotension which causes ARF. none other effect GFR dirctly so..
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| Geroo
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what about acute tubular necrosis ?
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| druas
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i will go with ATN..(B).
prerenal ARF.... Increase BUN,near normal creatinine
post renal....both increases,BUN more than creatinine
Glomerulonephritis......Both increases steadily
ATN......... Both increases,Creatinine more than BUN
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| msyamp
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Harri says:
Serial measurements of serum creatinine can provide useful pointers to the cause of ARF. Prerenal ARF is typified by fluctuating levels that parallel changes in hemodynamic function. Creatinine rises rapidly (within 24 to 48 h) in patients with ARF following renal ischemia, atheroembolization, and radiocontrast exposure. Peak creatinine levels are observed after 3 to 5 days with contrast nephropathy and return to baseline after 5 to 7 days. In contrast, creatinine levels typically peak later (7 to 10 days) in ischemic ARF and atheroembolic disease. The initial rise in serum creatinine is characteristically delayed until the second week of therapy with many tubule epithelial cell toxins (e.g., aminoglycosides, cisplatin) and probably reflects the need for accumulation of these agents within cells before GFR falls.
Copyright© 2001 McGraw-Hill. All rights reserved.
so both are correct. by the way ATN may be mre appropriate here. I dont think druas's concept is really applicable. where is it given so??
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| druas
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mysamp..it was in Q bank explanation
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| robin082006
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no druas,
this is qbank q
msyamp os right, ans is hypotension, a pre-renal renal failure.
A. Benign prostatic hyperplasia / E. Stone impacted in ureter may cause post-renal renal failure
B. Drug toxicity causing acute tubular necrosis and D. Post-infectious glomerulonephritis may cause intra-renal renal failure
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| Geroo
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I remember goljan said that prerenal renal failure causes high BUN with slight increase in creatinine,and the BUN/creatinine ration is increased>15.while in acute tubular necrosis both BUN and creatinine are elevated and the BUN/creatinine ratio is normal.is that correct?
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| robin082006
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Prerenal failure is due to inadequate perfusion of the kidney, and can be seen in settings in which the blood pressure drops to the point of impairing blood flow to individual glomeruli. The tubular network in this setting is still usually functional, and actively reabsorbs sodium and water, producing relatively low values of urine sodium and high osmolarity. Acute tubular necrosis (choice B) and glomerulonephritis (choice D) are causes of intrarenal failure; while stone impaction (choice E, usually bilateral unless only one kidney is functional) and severe benign prostatic hyperplasia (choice A) can cause lower urinary tract obstruction with post-renal failure.
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| msyamp
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interesting!! in exam i would answer hypotension. but if i thought more its difficult to choose between the two hypotension and ATN
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| linaorvos
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??? so what's the answer...
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| kleila
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i go with druas and geroo , ATN , creatinine rises much more in ATN compared with hypotension .
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| docarchana
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acc to qbank, the ans is B. acc to robin & msyamp the ans is C.
very difficult to decide. i go with B.
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