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SBM FEK > 01-09 Clinical Assessment of Renal Fx/Urinalysis > Flashcards

01-09 Clinical Assessment of Renal Fx/Urinalysis Flashcards

1
Q

Remember that patients may present already in chronic renal failure without necessarily knowing it.
—How can you tell if their failure is acute or chronic?

A 
History/Previous blood tests
Kidney size, usually smaller, thin cortex except in:
– Diabetic nephropathy
– amyloidosis
– HIV nephropathy
– Polycystic kidneys
Presence of complications of CKD
– Hyperparathyroidism is first to show up
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2
Q

An 67 y/o man suffered a myocardial infarction and underwent cardiac catheterization with placement of three coronary artery stents. Four days later his serum creatinine has increased from 1.1mg/dl to 3.4mg/dl. He also has chest pain again.

Which is the LEAST likely cause of his recurrent chest pain?

  1. Coronary artery disease
  2. Uremic pericarditis
  3. Dressler’s syndrome
  4. Pulmonary embolism
A
  1. Uremic pericarditis is LEAST likely cause of his recurrent chest pain.
    —hasn’t been enough time
    —this is a very late manifestation of renal failure
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3
Q

An 88 y/o woman weighing 50kg with a serum creatinine of 1.1mg/dl (normal 0.7-1.2mg/dl) has:

  1. normal kidney function
  2. stage 3 CKD
  3. Stage 4 CKD
  4. needs immediate dialysis
A
  1. Stage 4 CKD

—point, have to interpret CrCl w/ pts age, sex and muscles mass in mind!!!

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4
Q

Equation for Creatinine Clearance?

A 
Urine Cr (mg/dl) x 24hr Urine Vol (ml)
------------------------------------------
Serum Cr (mg/dl) x	1440 min

—Use National Kidney Assoc app to get eGFR via
—Cockroft-Gault Equation
—MDRD

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5
Q

Staging of CKD is based on

A

GFR and ?albuminuria

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6
Q

Urine production
—oliguric lower limit
—polyuria upper limit

A

< 500cc/day - oliguria

> 3000cc/day - polyuria

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7
Q

cloudy urine

A

pyuria

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8
Q

foamy urine

A

means high level proteinuria

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9
Q

Coffee/ Coca cola (red/brown) urine

A

GN

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10
Q

Red/brown urine

A

macroscopic hematuria

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11
Q

Particles in urine

A

entero-vesical fistula

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12
Q

black urine

A

melanuria (melanoma)

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13
Q

white urine

A

chyluria (filariosis, tuberculosis, cancer)

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14
Q

orange urine

A

Rifampicin

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15
Q

green urine

A

propofol vs. pseudomonas

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16
Q

red urine

A

hematuria vs. Beeturia

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17
Q

blue urine

A

methylene bleu

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18
Q

Purple urine bag

A

—occurs in people w/ catheters and UTI
—Bacteria produce indoxyl phosphatase: indoxyl sulfate in the urine into the red and blue colored compounds indirubin and indigo.
—most commonly implicated bacteria are Providencia stuartii, Providencia rettgeri, Klebsiella pneumoniae, Proteus mirabilis, Escherichia coli, Morganella morganii, and Pseudomonas aeruginosa.[2]

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19
Q

Leucoesterase (on dipstick)

A

detects esterase, an enzyme released by white blood cells

—good predictor of UTI when combined w/ nitrite

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20
Q

Dipstick: Glucosuria without diabetes

A

Fanconi (reabsorption problem w/ many substances in PT)

21
Q

Dipstick: Weak protein signal despite significant quantity of protein measured in lab:?

A

Bence-Jones Proteins/Paraproteins

—b/c strip only measures [albumin]

22
Q

Dipstick: Heme positive in little stains

A

microscopic hematuria

23
Q

Dipstick: Heme positive homogenously

A

hemoglobinuria vs. myoglobinuria

24
Q

nephritic syndrome

A

HTN, hematuria, edema, flanc pain, increased creatinine
—GN: Mesangial and subendothelial deposits in contact with bloodstream, producing inflammation, proliferation and hematuria

25
Q

nephrotic syndrome

A

Edema, foamy urine (proteinuria), hyperlipidemia, low BP, often normal creatinine
—Lesion of epithelial cells and glomerular basement membrane, not in contact with bloodstream, characterized by heavy proteinuria

26
Q

good estimation of 24hr urine protein

A

spot urine protein/creatinine ratio

27
Q

FENa
—Equation
—Interpretation

A

(U/P) Na
———— x 100
(U/P) Cr

Interpretation
—Normal and prerenal 2%

**Take w/ big grain of salt

28
Q

Urine findings of tubulo-interstitial dz

vs.

Glomerular

A

TUBULO-INTERSTITIAL
—Proteinuria < 3gm/day
—Isostenuria (Urine SG = prot-free plasma SG)
—Glucosuria

GLOMERULAR
—Proteinuria > 3gm/day
—Acanthocytes
—RBC casts
—Lipid casts
29
Q

Tamm-Horsfall Glycoprotein

A

~urinary mucous replacement
—in solution
—prevents UTIs by binding

30
Q

Clear hyaline casts

A

nl finding

31
Q

significance of RBC casts

A

hematuria is of renal origin

32
Q

See acanthocytes and RBCs casts on light microscopy. Dx?

A

GN

33
Q

See granular casts. DX?

A

Granular cast: ATN?

34
Q

Oval fat bodies, fatty casts, cholesterol crystals. Dx?

A

nephrotic syndrome

35
Q

Cystine crystals

A

cystinuria

36
Q

CaOx crystals

A

normal or oxalosis, hyperoxaluria, ethylene glycol ingestion (antifreeze)

37
Q

Maltese cross

A

fat crystals

38
Q

brick dust crystals

A

urate

—no pathology

39
Q

60 year old male with low back pain since 4 months found to have creatinine 2.4mg/dl. His urine dipstick shows trace protein and trace blood. His protein/creatinine ratio is 2.4.

What is his most likely diagnosis?

  1. Membranous nephropathy
  2. Myeloma kidney
  3. Rhabdomyolysis
  4. Diabetic nephropathy
A
  1. myeloma kidney?
40
Q

See small kidney (in adult) on renal U/S?

A

CKD

41
Q

malar rash

A

SLE

—butterfly distribution

42
Q

missing patella

A

nail-patella syndrome

—has renal complications

43
Q

Sinus disease, bloody nasal discharge, saddle nose

A

Wegner’s
—vs. Goodpasture’s
—vs. anti-GBM

44
Q

Post-valsalva periorbital purpura

A

amyloidosis

45
Q

deafness and hematuria

A

Alport’s

46
Q

Ash leaf spots

A

tuberous sclerosis

47
Q

S/Sx of Uremia

A 
SYMPTOMS
Nausea, vomiting: like a nasty hangover
Tiredness: low epo
Weakness: ?anemia, high [K+]
Dyspnea
Edema
Pruritus
Encephalopathy
SIGNS
Foetor uremicus (smell like piss)
Hyperpigmentation
Uremic Frost
Cachexia
Pruritus, scratch marks
Pallor of anemia
Asterixes, confusion, coma
Friction rub/distant cor sounds (uremic pericarditis)
Pulmonary edema
Muscle weakness from hyperkalemia
Cardiac arrythmia from hyperkalemia
48
Q

High total urine protein but negative dipstick?

A

myeloma

—paraproteins don’t show up

SBM FEK (19 decks)

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