Approach to Patient

Question 1

Epidemiology

Answer 1

• 1% USA = kidney stones
• 10% CKD
• AA more
• Latinos more
• AA die more on dialysis
• AA less common to get transplant (stat includes those who don’t even make it that far)
• whites = baseline number (still terrible)
• 1/2 age 30-64 gets CKD in lifetime
• 1/3 DM = CKD

Question 2

HX

General
PV
Trunk
CV
GI
Skin
GU

Answer 2

• General = fever, fatigue, thirst
• Pain = flank, abdomen, urinary
• PV = edema
• Trunk = flank, renal colic
• CV = HTN, cough, dysnpea
• GI = N/V
• Skin = itching, dryness
• GU = changes in urination

Question 3

GU Pain

Answer 3

• Dysuria = burning urethritis
• bladder pain
• flank pain
• renal colic

Question 4

Urination changes

Answer 4

• color
• volume
• Dysuria
• frequency
• hesitancy
• urgency
• hematuria
• Polyuria
• emptying
• leakage

Question 5

P.E.

Answer 5

• eye = HTN, DM
• CV = volume depletion, HTN
• Abdominal = tenderness, ascites, enlarged kidney, shrunken kidney, palpable bladder, flank tenderness
• Extremities = edema, muscle tenderness

Question 6

Determining GFR

Answer 6

CREATININE for at least 24 HOURS

• MDRD
• eGFR

Question 7

Tests to assess

Answer 7

• Urine
• GFR
• Blood
• Imaging
• Biopsy
• Cytology (scrapings)
• Cystoscopy (scope bladder) (bladder is big “cyst”)

Question 8

Blood tests

Answer 8

• Creatinine
• BUN
• BUN/Creatinine
• Electrolytes
• Blood gas

Question 9

Serum Creatinine

Answer 9

Serum creatinine = 1 =>GFR 120

1 to 2 = 120 to 60 = biggest jump

Question 10

Urine tests

Answer 10

• culture
• UA
• Urine Protein to Creatinine Ration (UPCR) = Spot urine
• 24-hour urine = U creatinine, U electrolytes, U albumin

Question 11

Radionuclide Creatinine Clearance

Answer 11

• more accurate creatinine

* Iothalimate/DTPA, renal plasma flow, function significance

Question 12

UA

Answer 12

• Color/appearance
• pH
• Odor
• Specific gravity
• Glucose
• Ketones
• Heme
• Nitrite
• Leukocyte Esterase
• Protein
• Bilirubin - urobilinogen

Question 13

Sediments

Answer 13

• RBCs
• WBCs
• Crystals
• Casts

Question 14

Imaging

Plain radiography (KUB)

Answer 14

• Kidney shape/size

* Nephrolithiasis (radiopaque) + Nephrocalcinosis

Question 15

Imaging

Ultrasound

Answer 15

• kidney shape/size
• nephrolithiasis
• Renal mass (cyst vs solid)
• Bladder

Question 16

Imaging

CT

Answer 16

• kidney shape/size
• obstruction
• nephrolithiasis
• cysts (simple/complex)
• polycystic dz
• renal mass
• bladder (mass/rupture)

Question 17

Imaging

Intravenous Pyelography

Answer 17

• kidney shape/size
• calyceal anatomy
• internal kidney, papillary abnormalities
• Urinary obstruction location/cause

Question 18

Imaging

Radionucleotide studies

Answer 18

• urinary obstruction/leak
• renal artery stenosis (screening)
• renal arterial flow (function)

Question 19

Renal arteriography

Answer 19

• renal artery stenosis
• assessing vasculitis
• vascular vs. solid mass

Question 20

Imaging

Voiding cystourethrography

Answer 20

*vesticourethral reflux

Question 21

Imaging

Retrograde/anteriograde Pyelography

Answer 21

• urinary obstruction site

* placement stent

Question 22

Imaging

MRI

Answer 22

• renal mass

* renal vein thrombosis

Question 23

Approach to patient

Answer 23

• chronicity
• level/rate of function change (labs)
• prerenal/intrinsic/ postrenal?
• intrinsic = actute tubular, glomerular, vascular, tubuinterstitial

Question 24

Prerenal

Answer 24

Hypovolemia
CHF
RAAS

Question 25

Post renal

Answer 25

Prostate enlargement
Obstructing tumor
Nephrolithiasis

Question 26

Intrarenal

Answer 26

ATN
Renal vascular dz
Tublointerstial dz
Glomerular