Approach to Oliguria/Proteinuria DSA Flashcards
The following are defined as:
Anuria
Oliguria
Polyuria
Anuria: less than 50-100 mL/day
Oliguria: less than 400-500 mL/day
Polyuria: more than 3,000 mL/day
What is the difference between azotemia and uremia?
- Azotemia: High BUN w/o symptoms
- Uremia: High BUN with symotoms (N/V, confusion, pruritis, metabolic tast in mouth, fatigue, anorexia)
The kidney can maximally concentrate ______.
~1200 mOsm/L
If a person consumes 600mOsm/day, what is the minimal urine output?
600/1200=
0.5 L/day
If a patient is experiencing oliguria and proteinuria, what are the 3 DDx if a cardiac problem?
- Cardiorenal syndrome (systolic/diastolic HF)
- starves the kidney of blood
- Cor pulmonale
- Valvular abnormalities
Other: constrictive pericarditis, pericardial effusion/ cardiac tamponade
If a patient is experiencing oliguria and proteinuria, what are the 2 DDx if a pulmonary problem?
- ANCA-vasculitis
- Anti-GBM syndrome (Goodpastures)
If a patient is experiencing oliguria and proteinuria, what are the 4 DDx if a renal problem?
- 1. Prerenal azotemia
- 2. Acute kidney injury (AKI)
- 3. Chronic kidney injury (CKD)
- 4. ESRD
What is a normal fluid intake?
What fluids does this include?
1.5 -2 L/day (50-60 oz)
Includes ALL fluids (water, coffee, tea, soda, etc)
What are commmon questions to ask patients with oliguria or proteinuria?
- Have you been drinking enough fluids? (all fluids)
- Do you get lightheaded or dizzy when you change postions?
- Do you have a history of HTN, DB and if so, for how long?
- Do you use certain meds, like nephrotoxins (NSAIDS, recent abx or PPIs)?
- Have you had any recent IV iodine contrast?
- Do you empty bladder completely or do you feel like you are retaining urine?
- Do you have a history of kidney disease?
Patients with oliguria/proteinuria can present with symptoms that related to volume status?
- JVD or flat veins
- Oral mucosa (dry, moist)
- Capillary refill (NL is less than 3 seconds)
- Skin tenting)
- S3
- Crackles
- Ascities
- LE pitting edema
- Sacral edema
Patients with oliguria/proteinuria can present with symptoms that related to HEENT?
- Retinopathy (could mean HTN or DB)
- Nasal ulcers (ANCA vascultis)
- Tonsilar exudates (post-infectious GN)
- Oral ulcers (autoimmune)
Patients with oliguria/proteinuria can present with symptoms that related to cardiac?
- S3 (HF)
- Heart rhythm
Patients with oliguria/proteinuria can present with symptoms that related to lungs?
- Crackles (pulmonary edema or ILD)
- Pleural effusions (systemic diseases. CHF)
Patients with oliguria/proteinuria can present with symptoms that related to abdominal exam?
- Bruits
- Palpable kidneys
- Tense abdomen (abdominal compartment syndrome)
Patients with oliguria/proteinuria can present with symptoms that related to skin?
- Malar rash (SLE)
- Palpable purpura (vasculitis)
- Non-blanching purpura (thrombocytopenia)
- Buttock and leg purpura (HSP)
Patients with oliguria/proteinuria can present with symptoms that related to MSK?
- Synovitis
- Myalgia
- CVA tenderness
CKD diagnosis criteria
Patient must have [marker for kidney damage or a decreased GFR] for more than 3 months.
-
Marker for kidney damage (one or more) (7)
-
Albuminuria
- =/> 30 mg/24 hours
- Albumin- to- creatinine ratio (=/> 30mg/g or 3mg/mmol)
- Abnormalities in urine sediment
- Abnormalities in electrolytes due to tubular disorders
- Abnormalities detected by histology
- Structural abnormalities detected by imaging
- History of kidney transplant
-
Albuminuria
-
Decreased GFR
- Less than 60 mL/min
When is a patient diagnosed with AKI?
- GFR below 60mL/min
- Markers of kidney damage
for less than 3 months
After 3 months => CKD
Describe the stages of CKD (1-5)
-
CKD stage 1
- GFR is 90 or above
-
CKD stage 2
- GFR (60-89)
-
CKD stage 3a
- GFR (45-59)
-
CKD stage 3b
- GFR (30-44)
-
CKD stage 4
- GFR (15-29)
-
CKD stage 5/ESRD
- GFR (<15)

Without evidence of kidney damage, Stage 1 or stage 2 does not meet the full criteria of CKD.
The vast majority of CKD is caused by what, in order of predominance
DM & HTN
- 1. DM (38%)
- 2. HTN (26%)
- Glomerulonephrrtis
Clinical presentation of CKD is ___________, depending on ___________.
- variable
- the severity
Many patients with CKD are _________, thus, we find out they have CKD via what?
- Asymptomatic
- Lab testing (abnormal Cr; ↓GFR)
Signs and symptom of CKD include what? (8)
- Edema
- HTN
- Decrease UO
- Foamy urine
- Uremia
- Pericardial friction rub (pericarditis & pericardial effusion)
- Asterixis
- Uremic frost
___________ is a sign of CKD where when you fully extend the wrist and it flaps (flexes forward).
Asterixis
