Approach to Oliguria and Proteinuria Flashcards
Urine output of:
Anuria
Oliguria
Polyuria
Anuria: <50-100 ml/day
Oliguria: <400-500 ml/day
Polyuria: >3,000 ml/day
To be diagnosed with chronic kidney disease, the patient must have what symptoms?
One of the following: Albuminuria Urine sediment abnormalities Electrolyte abnormalities Histological abnormalities Structural abnormalities History of kidney transplant
AND a GFR <60 ml/min
At what point does AKI become CKD?
If it is less than 3 mo. with GFR < 60 ml/min and/or markers of kidney damage is present, the patient has AKI.
After 3 mo., they have CKD.
What is the GFR in CKD from stages 1 to 5?
Stage 1: >90 Stage 2: 60-89 Stage 3: 30-59 Stage 4: 15-29 Stage 5: <15
Are patients with a stage 1 and stage 2 GFR always considered to have CKD?
No, not unless they have evidence of kidney damage.
What are the top 3 causes of CKD?
- DM
- HTN
- Glomerulonephritis
Signs and symptoms of CKD include:
Edema HTN Low urine output Foamy urine Uremia Pericardial friction rub Asterixis (tremor at wrist) Uremic frost
What is a “poor measure of kidney function”?
Serum creatinine
What are two measurements of GFR?
Estimated GFR (eGFR): done via formula. It is limited in use and is not helpful in settings of rapidly changing creatinine levels.
Measured GFR: most accurate, but is only done at specific institutions.
Creatinine clearance tends to ___________ GFR.
Overestimate GFR
How is proteinuria determined?
Urine albumin to creatinine ration or urine protein to creatinine ratio
What are the “3 simple tests to identify most CKD patients”?
eGFR
Urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio
Urinalysis
What is the most common imaging of the kidney?
Renal ultrasound
What are the renal ultrasound findings for CKD? (4)
Atrophic or small kidneys
Cortical thinning
Increased echogenicity
Elevated resistive indices
What is doppler renal US evaluate?
Renal artery stenosis or renal vein thrombosis or resistant index
What is an abdominal CT used for?
Detecting masses and stones
When is an abdominal MRI used?
To evaluate renal artery stenosis, renal vein thrombosis or renal masses.
What are the complications from CKD? (8)
Proteinuria: low salt diet, BP control.
HTN
Hyperlipidemia: statin therapy.
Anemia
Metabolic acidosis
Hyperkalemia
CKD-BMD, leading to abnormalities in Ca++, phosphorus and vitamin D abnormalities.
Volume overload
What is renal replacement therapy (RRT) include?
Hemodialysis
Peritoneal dialysis
Renal transplant (living or deceased)
What are the indications for dialysis?
A: severe acidosis E: electrolyte disturbance (usually hyperkalemia) I: ingestion O: volume overload U: uremia
What are the 3 common diagnostic tests for AKI?
UA with microscopy**
Urine albumin-to-creatinine ratio or protein-to-creatinine ratio**
Renal US
The following etiologies of AKI are treated with…
Prerenal patients:
Acute tubular necrosis:
GN:
Acute interstitial nephrtitis:
Prerenal patients: IV fluid
Acute tubular necrosis: supportive care
GN: immunosuppression or plasmaphoresis
Acute interstitial nephrtitis: D/C offending agents
Generally, the treatment for AKI is…
Supportive
- avoid HTN
- D/C nephrotoxins
- renal replacement
What is nephrotic syndrome vs. nephrotic range proteinuria?
Nephrotic syndrome occurs if there is low serum albumin, whereas nephrotic range proteinuria has normal serum albumin.
