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nefrologia > 0-30 > Flashcards

0-30 Flashcards

1
Q

Urine formation

A

URINE FORMATION:
**1) GLOMERULAR FILTRATION **

Result:isotonic filtered, protein-free
(this happens in GLOMERULUS)
2) PROXIMAL TUBULAR REABSORPTION

Result: 1/3 of the Glomerular filtrate
[Na] equal to plasma
Zero glucose or amino acids
3) HENLE’S LOOP
Result: hypotonic fluid, hipoosmic
10% of Glomerular filtrate
4) DISTAL CONVOLUTED TUBULE

uptake of Na + on aldosterone secretion of protons, ammonia and potassium
5) DUCT SYSTEM MANIFOLDS
Under the influence of ADH regulates osmolarity

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2
Q

Endocrinal function of kidney

A

ENDOCRINE FUNCTION
ERYTHROPOIETIN
Endothelial peritubular cells
proximal convoluted tubule

** DIHYDROXYCHOLECALCIFEROL 1.25
PROSTAGLANDINS**

KININS
Renin-angiotensin-aldosterone? (RAAS)

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3
Q

Metabolic kidney function

A

METABOLIC FUNCTION
E.g. gluconeogenesis, hormone degradation

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4
Q

what do you have to pay atttention to while examining a patient?

A
  • HISTORY
  • URINARY SIGNS AND SYMPTOMS
  • MEASUREMENT OF RENAL FUNCTIONS
  • URINALYSIS
  • PHYSICAL EXAMINATION
  • INSTRUMENTAL DIAGNOSTICS
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5
Q

Clinical history of nephrological patient

A

CLINICAL HISTORY
• Age, sex
• Places of residence

  • Employment
  • Life habits
  • Power Supply
  • Alcohol
  • Smoke
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6
Q

What to pay attention to clinical history?

A

CLINICAL HISTORY
Evidence of an earlier kidney disease
• Elevated creatinine and Bun in the past
• Proteinuria, hematuria, dark urine, oedema, IVU
• History of Hypertension
• History of diabetes mellitus
• Signs and symptoms of the urinary tract
• Oliguria, polyuria, nocturia
• Collagen diseases: lupus, Scleroderma, Wegener, S-H
• History of hereditary kidney disease: polycystic kidney disease, AlportSyndrome
• Tumours, Amyloidosis

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7
Q

Clinical medication history

A

CLINICAL Medication HISTORY
• NSAID’s
• Penicillin
• Aminoglycosides
• Drug abuse
• Exposure to heavy metals: lead, cadmium, gold
• Medicines that cause worsening of renal function: ACE-I (angiotensin converted enzyme inhibitor), contrast media

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8
Q

Signs and symptoms for nefrology patients

A

SIGNS AND SYMPTOMS
GENERAL: EDEMA, FEVER
URINARY CALCULI:
1) ANOMALIES of URINARY VOLUME
2) URINARY ABNORMALITIES (e.g. MACROSCOPIC URINE)
3) PAIN and COLIC
4) DISORDERS of URINATION

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9
Q

Anuria, oliguria, polyuria

A

Anuria/Oliguria-Polyuria
Normal Urinary volume: 1 ml/min

ANURIA: 100 ml/24 < hours
OLIGURIA: 100-400 ml/24 hours
POLYURIA > 2500 ml/ 24 hours

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10
Q

what is:

Dysuria
pollakiuria
polyuria
nocturia

A
  • *Dysuria** = difficulty urinating
  • *Pollakiuria** = increased urination frequency
  • *Polyuria** = increase volume
  • *Nocturia** = increased and / or prevailing nighttime urination
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11
Q

Renal plasma flow

glomerular filtration rate

A

Renal plasma flow (RPF):
600 ml / min
Glomerular filtration rate (GFR): 125 ml / min x 1.75 m2 body surface area

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12
Q

Clearance, formula, definition

A

CLEARANCE = UXV / P
Where U = urinary concentration in mg / dl
P = plasma concentration in mg / dl
V = urine volume in ml / min
it is THE QUANTITY OF BLOOD THAT IS PURIFIED DATE SUBSTANCE IN UNITY OF TIME

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13
Q

How to measure GFR,

A

For the measurement of Glomerular filtration rate (GFR) using the CLEARANCE Of INSULIN
Molecular weight substance “ESOGENA 5000”
A substance completely filtered, not reabsorbed nor secreted by the tubules.
Shrinks in old age

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14
Q

Creatinine clearance

what it is, where secreted, how much secreted

A

CREATININE CLEARANCE
For clinical purposes you can use the creatinine clearance
ENDOGENOUS substance
originating from muscle creatine and phosphocreatine

Filtered and secreted distal level (10-30)
In urine 20 mg/kg/day in females,

22 in adult males
123 ± 20 ml/min per 1.73 m2 in males 114 ± 6 ml/min per 1.73 m2 in female

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15
Q

Assesment of GFR

A

Assessment of GFR

CREATININE: The assumption is that in an individual production and renal excretion of creatinine is constant in 24h.

 • Easy and widespread use in routine diagnostics.
• It should be used the enzymatic method, much more accurate alkaline picrate.

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16
Q

Creatininemia

A

creatinine
In the male 0.90-1.20 mg / dl
In the female 0.80-1.00 mg / dl
In the newborn 0.30 mg / dl
At 10 years 0.55 mg / dl

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17
Q

GFT formulas, best, not used, etc.

A

Assessment of GFR
FORMULAS

• method of Cockroft-Gault
(best in the IRC Advanced; tends to be obsolete)
(140- age) x weight (kg): 72 x serum creatinine (mg / dl) x 85% in women

• MDRD equation (best in advanced stages in the IRC)

** CKD-EPI Calculator**
(it is the most current, is indicated in the early stages of the IRC).

18
Q

Renal clearance & GFT direct and indirect studies,

advantages and disadvantages

A

Renal clearance & GFR
direct
studies of clearance of exogenous substances (inulin, iohexol, iotamato, Cr51-EDTA)
studies of the clearance of endogenous substances (Ex. Creatinine)

indirect
GFR estimation by anthropometric parameters, anthropological and biochemical

advantages and disadvantages

(varnele) accurate, but
(iksiukas) expensive, long and not applicable to screening

(iksiukas) requires both blood and urine and a racoolta accurate and timed urine
(varnele) very simple and convenient
? accuracy

19
Q

BUN, UREA

A

UREA
UREA = CO(NH)2 PM 60
AZOTEMIA O UREA: 20 – 40 mg/dl
BUN = Blood Urea Nitrogen (Urea Nitrogen): 8–21 mg/dl

BUN
Divide by 2.14 (2 atoms of nitrogen) 60:28 = 2.14

BUN with azotemia multiplies by 2.146

20
Q

The origin, path of urea

A

UREA
Urea originates in the liver from amino acids from muscle tissue from the stomach, the intestines (Krebs-Henseleit cycle)
Urea enters the blood, a part is lost due to extrarenale (e.g. feces, intestinalgases, sweat < of 2 g/day)
The rest get to the kidney where it is filtered and reabsorbed

21
Q

Urea, clearance, GFR

A

UREA
• THE CLEARANCE OF UREA IS APPROXIMATELY HALF THAT OF CREATININE

• MAKE AN AVERAGE BETWEEN THE TWO WHEN THE GFR IS REDUCED
(THAT’S THE CREATININE IS SECRETED, UREA IS REABSORBED)

22
Q

By what UREA and creatinine is influenced

A

UREA is influenced by diet, state of hydration, from catabolism (treatment with diuretics, corticosteroids), intestinal bleeding, liver function
CREATININE is influenced by diet, but it is + constant, and muscle mass, as well as gender and age

23
Q

Fraction of Filtration

A

Fraction of Filtration
GFR: renal plasma flow
125: 654 = 0,192 = 19 X 100
from 654 ml of plasma are formed 125 ml of filtrate that is, 19.2%,
normal values 16-22% increases in heart failure: reduces multiple renal flow that the filtrate

24
Q

Urianalysis

A

The URINALYSIS urine first issued in the morning

MACROSCOPIC EXAMINATION
PHYSICAL TRAITS: APPEARANCE, SMELL, COLOUR

CHEMICAL CHARACTERISTICS: pH, specific gravity, osmolality, glucose, proteinuria, ketones, bilirubin, urobilinogen, nitrite, leukocytes
Or sediment MICROSCOPIC EXAMINATION: red blood cells, leukocytes,epithelial cells, cylinders, microbial flora, crystals, fungi

25
Q

Urine specific gravity, normal value, ???? wtf

A

Urine specific gravity = density/density urinometro water or Refractometer
Normal value = 1001-1030 (1016-1024)

Depends on the number of solutes, weight and temperature.

Osm (mosm/ Kg H2O) = (PS - 1000) x 40000

40 mosm/ Kg = PS 1.001

1200 mosm/ Kg = PS 1.030

Proteins, mannitol, contrast media can elevate the PS without altering the osmolality.
Ph = vn 4.5-6

26
Q

Causes of acidic or alkaline urine

A

CAUSES OF ACIDIC OR ALKALINE URINE
ACIDE: high-protein diet, metabolic or respiratory acidosis, fever, dehydration,potassium depletion, uratica stones, TBC.
ALKALINE: vegetarian diet, contamination or infection with urease + bacteria,metabolic or respiratory alkalosis, water diuresis, renal tubular acidosis,medications (thiazide diuretics, acetazolamide).

27
Q

Microscopic examination

A

MICROSCOPIC EXAMINATION:
sediment, then crystals, cells and cylinders.
White blood cells and red blood cells you receive for HPF (400 x).
Non-refrigerated urine must be analyzed immediately for the degeneration of cells Crystal cylinders.

28
Q

What kind of cylinders are there?

A

CILINDRI
• HYALINE
• GRAINY
• hematic
• CEREI
• LEUCOCYTIC
• TUBULAR

29
Q

Urine acide and urine alkaline crystals??? neisveresta

A

Crystalli

Urine Acide

  • Acido urico (amorfi, romboidi, rosette,

aghiformi)

  • Cistina (esagonali)
  • Ossalato di Calcio (a busta da lettere)
  • Sulfamidici (aghiformi)
  • Mezzi di contrasto (aghiformi)

Urine Alcaline

  • A coperchio di bara (triplofosfato di ammonio e magnesio)
  • Granulari (carbonato di calcio)
  • Giallo-bruni con e senza spine (biurato di ammonio)
30
Q

Changes in sediment

A

CHANGES IN SEDIMENT
PHYSIOLOGICAL
Exercise (microscopic haematuria)
PHARMACOLOGICAL TESTS
Loop diuretics (cylindruria)

31
Q

Alterations of pathognomonic of sediment renal disease?? whatever tai reiskia

A

ALTERATIONS OF PATHOGNOMONIC OF SEDIMENT RENAL DISEASE

1) blood Cylinders x GN, Vasculitis
2) hexagonal Crystals x Cystinuria
3) nuclear Inclusions in cells x CMV
4) oval Bodies x grassosi proteinuria
5) cylinder with leukocytes x pyelonephritis

32
Q

What kind of urine can be?

A

URINE
• SODIURIA
• POTASSIURIA
• CITRATURIA
• OSSALATURIA
• CREATININURIA

33
Q

Instrumental diagnostics

A

INSTRUMENTAL DIAGNOSTICS
• LIVE ABDOMEN
• Ultrasound, +-mz. contr, doppler and renal veins arteries
• SEQUENTIAL SCANS (MAG III X PLASMATIC RENAL FLOW OR DTPA X THEGFR)
• SCINTIGRAFIASTATICA (DMSAXCICATRICI)
• UROGRAPHY (?)
• TACERM (GADOLINIUM?)

34
Q

Ultrasound examination

A

ULTRASOUND
• EXAMINATION OF ELECTION TO EXCLUDE OBSTRUCTION
• CYSTS AND POLYCYSTIC KIDNEY DISEASE
• PYELONEPHRITIS
• RENAL ABSCESS
•DIMENSIONS KIDNEYS

35
Q

Ultrasonography in the diagnosis of kidney stones

A

ULTRASONOGRAPHY IN THE DIAGNOSIS OF KIDNEY STONES:
VERY WELL SITUATED IN THE CALCULATIONS X RENAL PELVIS, FIRST ANDLAST PART THE URETER AND BLADDER
BUT NOT IN THE URETER

36
Q

TAC??? WTF>

A

TAC
• EXAMINATION OF ELECTION (GOLD STANDARD) TAPERED CALCULOSIS(SPIRAL OUT OF MDC)
• RENAL MASS IF NOT a LASTING ECHO (even for a staged K)
• RENAL VEIN THROMBOSIS
• POLYCYSTIC KIDNEY DISEASE

37
Q

MRI

A

MRI
• EXAMINATION OF ELECTION (GOLD STANDARD) FOR RENAL VEINTHROMBOSIS
• RENAL MASS (CARCINOMA)
If TAC contraindicated or not tie-breaking eco and TAC

38
Q

MRI 2, abdomen

A

MRI
• Mra: NEFROVASCOLARE HYPERTENSION
• GADOLINIUM NO PROBLEM = IF GFR < 30
NI = GRF between 30 and 60

LIVE ABDOMEN
• EVIDENZIERA ‘ THE CALCIUM BASED STONES, STRUVITE, CYSTINE
• NOT THOSE OF URIC ACID
• WHILE THE ECHO EVIDENZIERA ‘ ALL CALCULATIONS

39
Q

static scinti, dynamic scinti???

A

STATIC SCINTI (DMSA)
• EXAMINATION OF ELECTION (GOLD STANDARD) FOR SCARS AND REFLUX
DYNAMIC SCINTI
• COARSE MEASURE OF RENAL BLOOD FLOW
• SEPARATE MEASUREMENT Of GFR (DTPA) And The FPR (MAG3)
• GIUNTOPATIE
• HYPERTENSION RENOVASCOLARE (TEST WITH ACE INHIBITOR)

40
Q
A

nefrologia (6 decks)

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