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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
Q

What are 4 renal ultrasound findings for CKD?

A

Atrophic or small kidneys

Cortical thinning

Increased echogenicity

Elevated resistive indices

26
Q

How do you treat proteinuria?

A

Low salt diet

BP control

ACEi, ARBs, aldosterone antagonist, renin inhibitor, non-dihydropyridine CCB

27
Q

What is the goal BP for a person with CKD with proteinuria? Without?

A

With proteinuria: Goal BP is <130/80

Without: BP <140/90

28
Q

How do you treat a patient with CKD and anemia?

A

Oral or IV iron

EPO stimulating agents (ESA)

29
Q

How do you treat a person with CKD and metabolic acidosis?

A

Bicarbonate supplementation if HCO3- is <22 mEq/L

30
Q

How do you treat a person with CKD and hyperkalemia?

A

Renal failure diet (low salt, potassium, and phosphorus)

Diuretics

Sodium polystyrene sulfonate or Patiromer

31
Q

How do you treat a person with CKD and CKD-BMD (secondary hyperparathyroidism)?

A

Renal failure diet (low salt, potassium, and phosphorus)

Phosphorus binder

Vitamin D supplementation (Lowers PTH)

Calcimimetics (lowers PTH)

Dialysis

32
Q

What are 5 indications for dialysis?

A

A- severe acidosis

E - electrolyte disturbance (usually hyperkalemia)

I - ingestion (e.g. ethylene glycols, methanol)

O - Volume overload

U - uremia

33
Q

Do you diagnose the stage of AKI based on serum creatinine or urine output?

A

Staged based on whichever is worse

34
Q

What is stage 1 of AKI?

A

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
Q

What is stage 2 of AKI?

A

Serum creatinine: 2.0-2.9x baseline

Urine output: <0.5 mL/kg/h for 12+ hours

36
Q

What is stage 3 of AKI?

A

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
Q

What are 4 prerenal causes of AKI?

A

Hypotension

Hypovolemia

Reduced cardiac output (HF, tamponade, massive PE)

Systemic vasodilation (sepsis, SIRS, hepatorenal syndrome)

38
Q

What are 3 intrinsic causes of AKI?

A

Glomerulonephritis

Interstitial nephritis

Tubular necrosis (ischemia (50% of cases) or toxins (35% of cases))

39
Q

What are 3 postrenal causes of AKI?

A

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
Q

What are 3 common diagnostic tests for the diagnosis of AKI?

A

UA with microscopy

Urine albumin/cr ratio or protein/cr ratio

Renal ultrasound

41
Q

What is the main method of treating AKI (aside from treating the etiology)?

A

Mostly supportive

42
Q

What is the definition of nephrotic syndrome?

A

Proteinuria with 3-3.5 gm/day

Hypoalbuminemia

Peripheral edema

Hyperlipidemia

Lipiduria

43
Q

Why do people with nephrotic syndrome have edema?

A

Low serum albumin, but more likely increased urinary sodium retention

Which leads to increased TBW and Na+

44
Q

Why are nephrotic syndrome patients more susceptible to infection?

A

There is urinary loss of IgG

45
Q

What is the DDx for nephrotic syndrome?

A

Diabetic nephropathy, minimal change disease, FSGS, Membranous nephropathy, monoclonal disease related (multiple myeloma, amyloidosis)

46
Q

What is the definition of nephritic syndrome?

A

Proteinuria (usually <3.5 gm/day)

Hematuria

HTN

Renal failure is common

[** usually have active urinary sediment whereas nephrotic has “bland” urinary sediment**]

47
Q

DDx for nephritic syndrome?

A

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
Q

What complement levels are low in nephritic syndrome?

A

C3 and C4

49
Q

What disease is suggested by urinary microscopy if you see renal tubular epithelial, transitional epithelial cells, granular casts, or waxy casts?

A

Acute tubular necrosis

50
Q

What disease is suggested by urinary microscopy if you see WBC, WBC casts, or urine eosinophils?

A

Acute interstitial nephritis or pyelonephritis

51
Q

What disease is suggested by urinary microscopy if you see dysmorphic RBCs, rBC casts?

A

Vasculitis or glomerulonephritis

52
Q

What disease is suggested by urinary microscopy if you see proteinuria (<3.5 gm/day), hematuria, dysmorphic RBC and RBC casts?

A

Nephritic syndrome

53
Q

What disease is suggested by urinary microscopy if you see heavy proteinuria (>3.5 gm/day), lipiduria, minimal hematuria?

A

Nephrotic syndrome

54
Q

What disease is suggested by urinary microscopy if you see hyaline casts?

A

Non-specific, prerenal azotemia

55
Q

What disease is suggested by urinary microscopy if you see WBCs, RBCs, and bacteria?

A

UTI

CPR Exam 3 (4 decks)

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