Approach to Patient Flashcards
Epidemiology
- 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
HX
General PV Trunk CV GI Skin GU
- 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
GU Pain
- Dysuria = burning urethritis
- bladder pain
- flank pain
- renal colic
Urination changes
- color
- volume
- Dysuria
- frequency
- hesitancy
- urgency
- hematuria
- Polyuria
- emptying
- leakage
P.E.
- eye = HTN, DM
- CV = volume depletion, HTN
- Abdominal = tenderness, ascites, enlarged kidney, shrunken kidney, palpable bladder, flank tenderness
- Extremities = edema, muscle tenderness
Determining GFR
CREATININE for at least 24 HOURS
- MDRD
- eGFR
Tests to assess
- Urine
- GFR
- Blood
- Imaging
- Biopsy
- Cytology (scrapings)
- Cystoscopy (scope bladder) (bladder is big “cyst”)
Blood tests
- Creatinine
- BUN
- BUN/Creatinine
- Electrolytes
- Blood gas
Serum Creatinine
Serum creatinine = 1 =>GFR 120
1 to 2 = 120 to 60 = biggest jump
Urine tests
- culture
- UA
- Urine Protein to Creatinine Ration (UPCR) = Spot urine
- 24-hour urine = U creatinine, U electrolytes, U albumin
Radionuclide Creatinine Clearance
- more accurate creatinine
* Iothalimate/DTPA, renal plasma flow, function significance
UA
- Color/appearance
- pH
- Odor
- Specific gravity
- Glucose
- Ketones
- Heme
- Nitrite
- Leukocyte Esterase
- Protein
- Bilirubin - urobilinogen
Sediments
- RBCs
- WBCs
- Crystals
- Casts
Imaging
Plain radiography (KUB)
- Kidney shape/size
* Nephrolithiasis (radiopaque) + Nephrocalcinosis
Imaging
Ultrasound
- kidney shape/size
- nephrolithiasis
- Renal mass (cyst vs solid)
- Bladder
Imaging
CT
- kidney shape/size
- obstruction
- nephrolithiasis
- cysts (simple/complex)
- polycystic dz
- renal mass
- bladder (mass/rupture)
Imaging
Intravenous Pyelography
- kidney shape/size
- calyceal anatomy
- internal kidney, papillary abnormalities
- Urinary obstruction location/cause
Imaging
Radionucleotide studies
- urinary obstruction/leak
- renal artery stenosis (screening)
- renal arterial flow (function)
Renal arteriography
- renal artery stenosis
- assessing vasculitis
- vascular vs. solid mass
Imaging
Voiding cystourethrography
*vesticourethral reflux
Imaging
Retrograde/anteriograde Pyelography
- urinary obstruction site
* placement stent
Imaging
MRI
- renal mass
* renal vein thrombosis
Approach to patient
- chronicity
- level/rate of function change (labs)
- prerenal/intrinsic/ postrenal?
- intrinsic = actute tubular, glomerular, vascular, tubuinterstitial
Prerenal
Hypovolemia
CHF
RAAS
Post renal
Prostate enlargement
Obstructing tumor
Nephrolithiasis
Intrarenal
ATN
Renal vascular dz
Tublointerstial dz
Glomerular
