AKI, CKD + ESRD Flashcards
Renal Anatomy
L renal fein is longer
R kidney is anatomically lower
Kidneys are retroperitoneal (not supported by ligaments/mesentery)
Renal Ultrasonography
Initial testing/MC used
choice for obstructive disease
less sensitive for renal masses
doppler: assesses vascular flow (RAS, RVT)
- MR/CT more sensitive
Computerized Tomography
avoid IV contrast (nephrotoxic)
gold standard for renal stones
locate ureteral obstruction
higher sensitivity for PKD
evaluate tumors
Dx RVT
Radionuclide Scan
preferred in children (reduced radiation)
obstructive vs. nonobstructive hydronephrosis
function of each kidney
Magnetic Resonance Imaging
gold standard for RVT
evaluation of renal masses
EXTREME CAUTION using gadolinium if GFR < 30 (–> nephrogenic system fibrosis)
Renal Arteriography and Venography
more invasive (used less often)
identifies arterial and venous occlusions
preferred test to identify polyarteritis nodosa
Intravenous Pyelogram
aka IV urogram
assess caliceal anatomy, size of kidney, shape of kidney
high sn and sp for stones
substantial radiation and contrast use
Renal Biopsy: indications
nephrotic syndrome: SLE
nephritic syndrome
unexplained AKI
Renal Biopsy: not indicated
isolated glomerular hematuria
low grade proteinuria
Renal Biopsy: types
open
transjugular
percutaneous
Hydronephrosis
U or B edema of collecting system
asymptomatic (pain if obstruction)
possible change in UOP
Hydronephrosis: obstructive
bladder outlet obstruction (GI or GYN masses, stones, BPH)
diagnostic: US
Hydronephrosis: nonobstructive
large diuresis can distend intrarenal collecting system (diabetes insipidus)
CT if US not diagnostic
Hydronephrosis: treatment
relieved by stent
Acute Kidney Injury: definition
precipitous and significant decrease (>50%) in GFR over hrs-days, with accompanying accumulation of nitrogenous wastes in the body and inability to maintain fluid and electrolyte balance
