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Cpr 3 other > (1.1) Approach to Oliguria and Proteinuria [DSA] > Flashcards

(1.1) Approach to Oliguria and Proteinuria [DSA] Flashcards

1
Q

Define:

Anuria

A

UOP < 50-100ml/day

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2
Q

Define:

Oliguria

A

UOP < 400-500 ml/day

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3
Q

Define:

Polyuria

A

UOP > 3,000 ml/day

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4
Q

Define:

Azotemia

A

Elevated blood urea nitrogen (BUN) without symptoms

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5
Q

Define:

Uremia

A

Elevated BUN WITH SYMPTOMS

(N/V, confusion, pruritus, metallic taste in mouth, fatigue, anorexia, etc…)

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6
Q

What are some examples of common questions to ask in patients presenting with oliguria/proteinuria?

A
  • Have you been drinking enough fluids?
  • Are you lightheaded or dizzy w/ position changes?
  • Do you have a hx of HTN/DM?
  • Have you had any recent IV iodine contrast dye?
  • Do you empty bladder completely or feel like you are retaining urine?
  • Any family hx of kidney disease?
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7
Q

What are the (2) criteria that must be present for > 3 months to be considered CKD?

A

Positive markers of kidney damage

Decreased GFR

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8
Q

If a patient has markers of kidney damage AND decreased GFR however this has been occuring for <3 months… what does the patient have?

A

Acute Kidney Injury (AKI)

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9
Q

What are examples of markers of kidney damage?

A

Albuminuria

Urine sediment abnormalities

Electrolyte abnormalities

Histologic changes

Hx. of kidney transplantation

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10
Q

What is considered a decreased GFR?

A

GFR <60ml/min/1.73 m^2

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11
Q

What are the stages of CKD? What do the stages represent?

A

1 - normal/high

2 - mild decrease

3a - mild-moderate decrease

3b - moderate-severe decrease

4 - severe decrease

***Stages refer to the level of GFR decrease. 1 is nearly normal, while 4 is severe stage of CKD.

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12
Q

What is the GFR of a CKD stage 1 pt. ?

A

Greater than, or equal to 90

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13
Q

What is the GFR of a CKD stage 4 pt. ?

A

GFR = 15-29

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14
Q

In the absence of kidney damage, neither GFR category stage ___ or ____ fulfill the criteria for CKD

A

In the absence of kidney damage, neither GFR category stage 1 or 2 fulfill the criteria for CKD

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15
Q

What is the most common cause of CKD?

What is the second most common cause?

A

Most common = Diabetes

Second most common = HTN

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16
Q

What are the signs and symptoms of CKD?

A

-Edema

  • HTN
  • Decrease urine output (UOP)
  • Foamy urine (proteinuria)
  • Uremia
  • Pericardial friction rub
  • Asterixis
  • Uremic frost
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17
Q

What are the 3 simple tests to identify most CKD patients?

A
  • eGFR
  • Urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio
  • Urinalysis
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18
Q

What are the renal ultrasound findings for CKD?

A
  • Atrophic/small kidneys
  • Cortical thinning
  • Increased ecogenicity
  • Elevated resistive indices
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19
Q

What are the indications for dialysis?

A

AEIOU

A = Severe Acidosis

E = Electrolyte imbalance

I = Ingestion (ethylene glycols, methanol, etc…)

O = Volume overload

U = Uremia

20
Q

What are the two lab values that are used to stage AKI?

A

Serum creatinine

OR

Urine output

***Staged based on whichever is worse

21
Q

What are the stages of AKI?

A

Stage 1 (most mild)

Stage 2

Stage 3 (most severe)

22
Q

What are the three potential etiologies of AKI?

A

Prerenal

Intrinsic

Postrenal

23
Q

What is the clinical presentation of AKI?

A
  • Edema
  • HTN
  • Decreased urine output
  • Foamy urine
  • Hematuria
  • SOA
  • Uremia
  • Pericardial friction rub
  • Asterixis
  • Uremic frost
24
Q

What is something you should consider for the clinical presentation of mild AKI?

A

Many pts with mild AKI have NO SYMPTOMS

25
What are the three steps involved in the **common diagnostic test** for **AKI?**
- UA with microscopy - Urine albumin/cr ratio or protein/cr ratio - Renal U/S
26
What are the treatments for: Prerenal AKI: ATN : Glomerulonephritis : AIN :
Prerenal AKI: **IV fluid** ATN : **supportive care** Glomerulonephritis : **Immunosuppression/plasmapheresis** AIN : **Discontinuationof offending agent**
27
# Define: Nephrotic syndrome
Proteinuria that is... \>3-3.5 grams/day
28
If ____________ is normal in setting of nephrotic range proteinuria, then patient **DOES NOT HAVE** true nephrotic syndrome but instead has _nephrotic range proteinuria_
If **serum albumin** is normal in setting of nephrotic range proteinuria, then patient **DOES NOT HAVE** true nephrotic syndrome but instead has _nephrotic range proteinuria_
29
What are the 6 most common **nephrotic syndrome complications?**
- Edema - Hyperlipidemia - Infection - Thrombosis - Vitamin D deficiency - Anemia
30
What is the classic presentation of **nephrotic syndrome?**
- New onset **HTN** - New onset **Edema** - Proteinuria - Lipiduria - Hyperlipidemia - Minimal hematuria
31
What are the 5 primary items on your **nephrotic syndrome differential?**
- Diabetic nephropathy - Minimal change disease - Focal segmental glomerular sclerosis (FSGS) - Membranous nephropathy - Monoclonal disease related
32
How would you diagnose **nephrotic syndrome?**
- Serum creatinine w/ eGFR - UA w/ microscopy - Urine albumin to creatinine ratio, or urine protein to creatinine ratio - 24 hr urine total protein collection - Glomerulonephritis serologic evaluation - Renal biopsy
33
What is the general rule to treat **nephrotic syndrome?**
Treat the UNDERLYING etiology
34
Define Nephritic syndrome
- Low level proteinuria \<3.5 grams/day **-Hematuria** - HTN - Renal failure common
35
Key point: What is usually seen in **nephritic syndrome?**
ACTIVE URINARY SEDIMENT (i.e., hematuria, dysmorphic RBCs, RBC casts, WBCs, WBC casts, granular casts, etc...)
36
What is the classic presentation of **nephritic syndrome?**
- New onset **hematuria** and **HTN** - AKI - Low level proteinuria
37
What are (11) potential items on your differential for **nephritic syndrome?**
1. IgA nephropathy 2. Thin Basement Membrane Nephropathy 3. Alport's Nephropathy 4. Membranoproliferative Glomerulonephritis (MPGN) 5. Lupus 6. Goodpasture's 7. ANCA-associated vasculitis 8. Cryoglobulinemia 9. Thrombotic microangiopathy 10. Post-infectious glomerulonephritis 11. Endocarditis
38
How would you diagnose **nephritic syndrome?**
SAME AS NEPHROTIC SYNDROME! - Serum creatinine w/ eGFR - UA w/ microscopy - Urine albumin-to-creatinine ratio and urine protein-to-creatinine ratio - 24 hr urine total protein collection - Glomerulonephritis serologic evaluation - Renal biopsy
39
**Urinary pattern** = Renal tubular epithelial cells, transitional epithelial cells, granular casts or waxy casts What kidney disease is suggested by this pattern?
ATN
40
**Urinary pattern**= WBC, WBC cast or urine eosinophils What kidney disease is suggested by this pattern?
AIN or Pyelonephritis
41
**Urinary pattern**= Dysmorphic RBCs, RBC casts What kidney disease is suggested by this pattern?
Vasculitis or Glomerulonephritis
42
**Urinary pattern**= Proteinuria (\<3.5g/day), hematuria, dysmorphic RBC and RBC casts What kidney disease is suggested by this pattern?
Nephritic syndrome
43
**Urinary pattern**= Heavy proteinuria (\>3.5g/day), lipiduria, minimal hematuria What kidney disease is suggested by this pattern?
Nephrotic syndrome
44
**Urinary pattern**= Hyaline cast What kidney disease is suggested by this pattern?
Non-specific, prerenal azotemia
45
**Urinary pattern**= WBCs, RBCs, bacteria What kidney disease is suggested by this pattern?
Urinary tract infection

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