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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
Q

What are the three steps involved in the common diagnostic test for AKI?

A
  • UA with microscopy
  • Urine albumin/cr ratio or protein/cr ratio
  • Renal U/S
26
Q

What are the treatments for:

Prerenal AKI:

ATN :

Glomerulonephritis :

AIN :

A

Prerenal AKI: IV fluid

ATN : supportive care

Glomerulonephritis : Immunosuppression/plasmapheresis

AIN : Discontinuationof offending agent

27
Q

Define:

Nephrotic syndrome

A

Proteinuria that is…

>3-3.5 grams/day

28
Q

If ____________ is normal in setting of nephrotic range proteinuria, then patient DOES NOT HAVE true nephrotic syndrome but instead has nephrotic range proteinuria

A

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
Q

What are the 6 most common nephrotic syndrome complications?

A
  • Edema
  • Hyperlipidemia
  • Infection
  • Thrombosis
  • Vitamin D deficiency
  • Anemia
30
Q

What is the classic presentation of nephrotic syndrome?

A
  • New onset HTN
  • New onset Edema
  • Proteinuria
  • Lipiduria
  • Hyperlipidemia
  • Minimal hematuria
31
Q

What are the 5 primary items on your nephrotic syndrome differential?

A
  • Diabetic nephropathy
  • Minimal change disease
  • Focal segmental glomerular sclerosis (FSGS)
  • Membranous nephropathy
  • Monoclonal disease related
32
Q

How would you diagnose nephrotic syndrome?

A
  • 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
Q

What is the general rule to treat nephrotic syndrome?

A

Treat the UNDERLYING etiology

34
Q

Define

Nephritic syndrome

A
  • Low level proteinuria <3.5 grams/day

-Hematuria

  • HTN
  • Renal failure common
35
Q

Key point:

What is usually seen in nephritic syndrome?

A

ACTIVE URINARY SEDIMENT

(i.e., hematuria, dysmorphic RBCs, RBC casts, WBCs, WBC casts, granular casts, etc…)

36
Q

What is the classic presentation of nephritic syndrome?

A
  • New onset hematuria and HTN
  • AKI
  • Low level proteinuria
37
Q

What are (11) potential items on your differential for nephritic syndrome?

A
  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
Q

How would you diagnose nephritic syndrome?

A

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
Q

Urinary pattern = Renal tubular epithelial cells, transitional epithelial cells, granular casts or waxy casts

What kidney disease is suggested by this pattern?

A

ATN

40
Q

Urinary pattern= WBC, WBC cast or urine eosinophils

What kidney disease is suggested by this pattern?

A

AIN

or

Pyelonephritis

41
Q

Urinary pattern= Dysmorphic RBCs, RBC casts

What kidney disease is suggested by this pattern?

A

Vasculitis

or

Glomerulonephritis

42
Q

Urinary pattern= Proteinuria (<3.5g/day), hematuria, dysmorphic RBC and RBC casts

What kidney disease is suggested by this pattern?

A

Nephritic syndrome

43
Q

Urinary pattern= Heavy proteinuria (>3.5g/day), lipiduria, minimal hematuria

What kidney disease is suggested by this pattern?

A

Nephrotic syndrome

44
Q

Urinary pattern= Hyaline cast

What kidney disease is suggested by this pattern?

A

Non-specific, prerenal azotemia

45
Q

Urinary pattern= WBCs, RBCs, bacteria

What kidney disease is suggested by this pattern?

A

Urinary tract infection

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