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Clin Med: GU (block 3) > AKI & CKd > Flashcards

AKI & CKd Flashcards

1
Q

Renal functions

A
  • Waste Removal**
  • Water Management
  • Electrolyte Balance
  • pH Regulation (Acid/Base)
  • Regulation of Blood Pressure
    –> RAAS system
  • Blood Production
    –> Erythropoietin
  • Bone Health
    –> Activation of Vit D
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2
Q

What is most commonly used to assess renal function?

A

Serum Cr

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3
Q

What is creatinine?

A

product of breakdown of Creatinine phosphate

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4
Q

How creatinine excreted & measured?

A
  • excreted by kidneys
  • measured in blood
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5
Q

Does serum creatinine vary based on muscle mass?

A

yes, b/c they are produced by the muscles

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6
Q

What is BUN?

A
  • blood urea nitrogen
  • Comes from PRO waste product after metabolism in the liver
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7
Q

What happens to the BUN levels in renal pts?

A

elevated

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8
Q

What other reasons can elevate BUN be?

A
  • GI bleed
  • Corticosteroid use
  • High PRO diet/parenteral nutrition
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9
Q

What is GFR?

A
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10
Q

Are we able to truly measure GFR? What is closest thing?

A
  • NO
  • Closest equivalent - 24hr Urine CrCl
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11
Q

What must the GFR formula take into account?

A
  • creatinine
  • sex
  • age
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12
Q

What can we used GFR clinically?

A

only is stable renal function

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13
Q

What is most commonly shown on a UA?

A
  • Hematuria*
    –> Blood in urine
  • Proteinuria*
    –> Proteins in urine
  • WBCs w/o other markers of infx
    –> Urine sediment
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14
Q

Different types of Urine Sediments.

A
  • RBCs & RBC Casts
  • WBCs & WBC casts
  • Eosinophiluria
  • Crystalluria
  • (+) blood but no RBCs on microscopic part
  • Bland Sediment (not active)
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15
Q

What condition(s) usually causes RBCs & RBC casts?

A

Glomerulonephritis

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16
Q

What condition(s) usually causes WBCs and WBC casts?

A
  • Pyelonephritis
  • Acute Interstitial Nephritis (also w/ eosinophils)
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17
Q

What condition(s) usually causes Eosinophilia?

A
  • Acute Interstitial Nephritis
  • Cholesterol Emboli
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18
Q

What condition(s) usually causes Cystalluria?

A
  • Uric acid crystals in Tumor Lysis Syndrome
  • Calcium oxalate - ethylene glycol intoxication
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19
Q

What condition(s) usually causes positive blood but no RBCs on microscopic part?

A

Pigmenturia - hemoglobinuria or myoglobinuria; sickle cell crisis, rhabdomyolysis

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20
Q

What condition(s) usually causes Bland Sediment (not active)?

A

Acute Tubular Necrosis
- muddy casts

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21
Q

What two miscellaneous tests are used to differentiate prerenal AKI from ATN?

A
  • BUN/Cr
  • FENa
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22
Q

What are the limitations to a FENa test?

A
  • Multiple causes of low FENa other than prerenal AKI
  • Can’t use in pts w/ salt wasting nephropathy or diuretic use
  • Small sample size of studies supporting its use
23
Q

What imaging can be used for the kidneys?

A
  • renal US
  • CT +/- contrast
  • MRI
24
Q

What is the study of choice for nephrolithiasis?

A

CT w/o contrast

25
When do we used contrasted CT?
RCC staging
26
What is a major complication of doing an MRI in a CKD patient?
Gadolinium based contrast can cause nephrogenic systemic fibrosis
27
Describe when we do a kidney biopsy?
- Last resort - Used when workup either unclear or (-) for etiology of kidney dz - Done outpt setting.
28
Define AKI
Abrupt decr in renal function or filtering ability
29
Describe KDIGO (2012)
- Incr in SCr ≥ 0.3 mg/dL w/n 48 hrs OR Incr in SCr ≥ 1.5 times baseline (known or presumed to have occurred w/n 7 days prior) OR Urine volume < 0.5 mL/kg/h for 6hrs
30
Draw the flow chart of AKI
DONE
31
What can cause hypovolemia seen in AKI?
- Hemorrhage - Cutaneous losses-burns & sweat - GI losses-vomiting & diarrhea - Renal losses-diuretic effect
32
What can cause decr effective blood volume seen in AKI?
- CHF - Cirrhosis - Nephrotic syndrome
33
What can cause change in vascular resistance seen in AKI?
- Bilateral renal artery stenosis (or unilateral in solitary functioning kidney) - NSAIDs
34
In post-renal AKI, what causes an upper tract obstruction?
- Nephro/ureterolithiasis --> Bilateral unless solitary kidney - Malignancy/adenopathy - Retroperitoneal fibrosis
35
In post-renal AKI, what causes an lower tract obstruction?
- BPH - Stricture or phimosis - Neurogenic bladder
36
What are the 3 types of Intrinsic AKI?
- Acute Tubular Necrosis (ATN) - Acute Interstitial Nephritis (AIN) - Acute Glomerulonephritis (GN)
37
Ischemic things that can cause ATN?
- Hypotension -->If prolonged - Hypovolemic shock --> If prolonged - Cardiopulmonary arrest
38
Nephrotoxic things that can cause ATN?
- Drugs (iodinated contrast, aminoglycosides, amphotericin, cisplatin, IV vanc, warfarin, several HIV txs) - Pigment-myoglobinuria (rhabdomyolysis), hemoglobinuria - Crystal-tumor lysis, ethylene glycol, methotrexate - Paraprotein-multiple myeloma
39
List the drugs that can cause Acute Interstitial Nephritis.
-PCNs - Quinolones - -Sulfonamides - PPIs - NSAIDs - Diuretics
40
List the systemic dz that can cause Acute Interstitial Nephritis.
- SLE - Sjögren’s - Sarcoidosis
41
What is Acute Glomerulonephritis?
Broad category of dz that cause damage to the glomerulus
42
Examples of GNs are:
- Post-streptococcal GN - IgA nephropathy (Berger’s dz) - Lupus nephritis - Anti-neutrophilic cytoplasmic - antibody (ANCA) assoc. GN - Anti-GBM GN (Goodpasture’s dz)
43
S/S of Acute GN
- HTN - Edema - Hypercoagulability - Constitutional symptoms - Dz specific symptoms
44
Lab Eval for Acute GN
- Hematuria &/or proteinuria --> RBC cast & pigmented cast - C3 and C4 - ANCAs - Anti-GBM - ANA - Anti-dsDNA - Hep B, Hep C, and HIV - SPEP, FLC, and IFE - +/- renal biopsy
45
Define CKD
- abnormal measurement of the actual or estimated GFR for 3mo or more OR - In situations where GFR is normal but renal pathology exists
46
What are the most common causes of CKD in the US?
DM & HTN
47
Write out the stages of CKD
Stage 1 (eGRF 90 or greater & Mild kidney damage) Stage 2 - (eGFR 60 -90 & mild kidney damage) Stage 3a - (eGFR 45 - 59 & mild to mod kidney damage) Stage 3b - (eGFR 30 - 44 & mild to moderate kidney damage) Stage 4 - (eGFR 15 - 29 & Moderate to severe kidney damage) Stage 5 - (eGFR less than 15 & kidneys are close to failure or have completely failed. Dialysis or kidney transplant)
48
Waste removal in CKD
elevated BUN & serum creatinine
49
Water management in CKD
evidence of volume overload
50
Electrolyte balance in CKD
- hyperK+ - hypoNa+
51
pH regulation in CKD
metabolic alk
52
Blood production in CKD
anemia & poss platelet dysfunction
53
Bone Health in CKD
- hypocalcemia - hyperphosphatemia - secondary hyperparathyroidism/ renal osteodystrophy - osteopenia

Clin Med: GU (block 3) (7 decks)

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