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CPR Exam 3 > Approach To Oliguria And/or Proteinuria > Flashcards

Approach To Oliguria And/or Proteinuria Flashcards

1
Q

What is the definition of anuria?

A

UOP <50-100 mL/day

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2
Q

What is the definition of Oliguria?

A

UOP <400-500 mL/day

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3
Q

What is the definition of polyuria?

A

UOP > 3000 mL/day

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4
Q

What is the definition of azotemia?

A

Elevated BUN w/o sx

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5
Q

What is the definition of uremia?

A

Elevated BUN with sx

Note: sx of uremia are non-specific

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6
Q

What are 5 possible cardiac DDx for oliguria/proteinuria?

A

Cardiorenal syndrome (systolic/diastolic HF)

Pulmonary HTN

Valvular disease (stenosis/regurg)

Pericarditis

Pericardial effusion/Cardiac tamponade

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7
Q

What are pulmonary DDx for oliguria/proteinuria?

A

ANCA-vasculitis (MPO, PR3, Churg-Strauss)

Anti-GBM disease (Goodpasture’s)

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8
Q

What other disease/system (besides cardiopulmonary-renal) can be a DDx for oliguria/proteinuria?

A

Hepatorenal syndrome (Cirrhosis)

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9
Q

What are renal DDx for oliguria/proteinuria?

A

Prerenal azotemia (hypovolemic, cardiogenic, neurogenic, or septic shock)

AKI (acute tubular necrosis, interstitial nephritis, glomerulonephritis (nephrotic vs nephritic), postrenal obstruction)

CKD (due to HTN, DM, AKI)

ESRD

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10
Q

What is a normal amount of fluid intake?

A

1.5-2 L/day (50-60oz/day)

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11
Q

What studies involve IV iodine contrast dye?

A

Cardiac cath and CT scans

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12
Q

What are important abdominal exam findings that present with oliguria/proteinuria?

A

Abdominal bruits (RAS, AAA, iliac arteries)

Palpable kidneys (ADPKD or kidney transplant)

Tense abd (abdominal compartment syndrome?)

Ascites

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13
Q

What are important skin exam findings in patients presenting with oliguria/proteinuria

A

Malar rash (SLE)

Palpable purpura (vasculitis)

Non-blanching purpura (thrombocytopenia)

Buttock and leg purpura (HSP)

Livedo reticularis (SLE, cryoglobulinemia, hypercoaguable states, vasculitis)

Emboli (septic or thrombotic)

Drug rash

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14
Q

What is the definition of AKI?

A

<3 months with GFR <60 mL/min and/or markers of kidney damage present

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15
Q

What is the definition of CKD?

A

3+ months of GFR <60 mL/min and/or markers of kidney damage

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16
Q

Can you diagnosis Stage 1 or 2 CKD if there is no evidence of kidney damage?

A

Noooooooooooooooo, duh

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17
Q

What GFR and description is Stage 1?

A

> or equal to 90 mL/min

Considered to be normal or high

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18
Q

What GFR and description is Stage 2?

A

60-89 mL/min

Mild decrease

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19
Q

What GFR and description is Stage 3a?

A

45-59

Mild to moderate decrease

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20
Q

What GFR and description is Stage 3b?

A

30-44

Moderate to severe decrease

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21
Q

What GFR and description is Stage 4?

A

15-29

Severe decrease

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22
Q

What are main etiologies of the vast majority of CKD

A

DM or HTN

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23
Q

What are 8 signs and sx of CKD?

A 
Edema
HTN
Decrease UOP 
Proteinuria
Uremia
Pericardial friction rub
Asterixis
Uremic fros t
24
Q

What are 3 simple tests to identify most CKD patients?

A

Urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio

eGFR

Urinalysis

25
What are 4 renal ultrasound findings for CKD?
Atrophic or small kidneys Cortical thinning Increased echogenicity Elevated resistive indices
26
How do you treat proteinuria?
Low salt diet BP control ACEi, ARBs, aldosterone antagonist, renin inhibitor, non-dihydropyridine CCB
27
What is the goal BP for a person with CKD with proteinuria? Without?
With proteinuria: Goal BP is <130/80 Without: BP <140/90
28
How do you treat a patient with CKD and anemia?
Oral or IV iron EPO stimulating agents (ESA)
29
How do you treat a person with CKD and metabolic acidosis?
Bicarbonate supplementation if HCO3- is <22 mEq/L
30
How do you treat a person with CKD and hyperkalemia?
Renal failure diet (low salt, potassium, and phosphorus) Diuretics Sodium polystyrene sulfonate or Patiromer
31
How do you treat a person with CKD and CKD-BMD (secondary hyperparathyroidism)?
Renal failure diet (low salt, potassium, and phosphorus) Phosphorus binder Vitamin D supplementation (Lowers PTH) Calcimimetics (lowers PTH) Dialysis
32
What are 5 indications for dialysis?
A- severe acidosis E - electrolyte disturbance (usually hyperkalemia) I - ingestion (e.g. ethylene glycols, methanol) O - Volume overload U - uremia
33
Do you diagnose the stage of AKI based on serum creatinine or urine output?
Staged based on whichever is worse
34
What is stage 1 of AKI?
Serum creatinine: 1.5-1.9x baseline OR > 0.3 mg/dl increase Urine output: <0.5 mL/kg/h for 6-12 hours
35
What is stage 2 of AKI?
Serum creatinine: 2.0-2.9x baseline Urine output: <0.5 mL/kg/h for 12+ hours
36
What is stage 3 of AKI?
Serum creatinine: 3x baseline OR increase to >4 mg/dl OR initiation of renal replacement therapy OR in patients <18 years, decrease in eGFR to <35 mL/min Urine output: <0.3 ml/kg/h for >24 hours OR anuria for >12 hours
37
What are 4 prerenal causes of AKI?
Hypotension Hypovolemia Reduced cardiac output (HF, tamponade, massive PE) Systemic vasodilation (sepsis, SIRS, hepatorenal syndrome)
38
What are 3 intrinsic causes of AKI?
Glomerulonephritis Interstitial nephritis Tubular necrosis (ischemia (50% of cases) or toxins (35% of cases))
39
What are 3 postrenal causes of AKI?
Bladder outlet obstruction (BPH, cancer, strictures, blood clots) Ureteral obstruction (bilat obstruction, unilateral obstruction with one kidney, stones, malignancy, retroperitoneal fibrosis) Renal pelvis (papillary necrosis (NSAIDs), stones)
40
What are 3 common diagnostic tests for the diagnosis of AKI?
UA with microscopy Urine albumin/cr ratio or protein/cr ratio Renal ultrasound
41
What is the main method of treating AKI (aside from treating the etiology)?
Mostly supportive
42
What is the definition of nephrotic syndrome?
Proteinuria with 3-3.5 gm/day Hypoalbuminemia Peripheral edema Hyperlipidemia Lipiduria
43
Why do people with nephrotic syndrome have edema?
Low serum albumin, but more likely increased urinary sodium retention Which leads to increased TBW and Na+
44
Why are nephrotic syndrome patients more susceptible to infection?
There is urinary loss of IgG
45
What is the DDx for nephrotic syndrome?
Diabetic nephropathy, minimal change disease, FSGS, Membranous nephropathy, monoclonal disease related (multiple myeloma, amyloidosis)
46
What is the definition of nephritic syndrome?
Proteinuria (usually <3.5 gm/day) Hematuria HTN Renal failure is common [** usually have active urinary sediment whereas nephrotic has “bland” urinary sediment**]
47
DDx for nephritic syndrome?
IgA nephropathy, Thin basement membrane nephropathy, Alport’s nephropathy, MPGN, lupus nephritis, Anti-GBM antibody disease, ANCA-associated vasculitis, cryoglobulinemia, Thrombotic microangiopathy, post-infectious glomerulonephritis, endocarditis
48
What complement levels are low in nephritic syndrome?
C3 and C4
49
What disease is suggested by urinary microscopy if you see renal tubular epithelial, transitional epithelial cells, granular casts, or waxy casts?
Acute tubular necrosis
50
What disease is suggested by urinary microscopy if you see WBC, WBC casts, or urine eosinophils?
Acute interstitial nephritis or pyelonephritis
51
What disease is suggested by urinary microscopy if you see dysmorphic RBCs, rBC casts?
Vasculitis or glomerulonephritis
52
What disease is suggested by urinary microscopy if you see proteinuria (<3.5 gm/day), hematuria, dysmorphic RBC and RBC casts?
Nephritic syndrome
53
What disease is suggested by urinary microscopy if you see heavy proteinuria (>3.5 gm/day), lipiduria, minimal hematuria?
Nephrotic syndrome
54
What disease is suggested by urinary microscopy if you see hyaline casts?
Non-specific, prerenal azotemia
55
What disease is suggested by urinary microscopy if you see WBCs, RBCs, and bacteria?
UTI

CPR Exam 3 (4 decks)

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