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Medicine I > Approach to Patients with Renal Disease and Urinary Abnormalities > Flashcards

Approach to Patients with Renal Disease and Urinary Abnormalities Flashcards

1
Q

What is polyuria, anuria, nonoliguria acute kidney injury, proteinuria, oliguria?

A

Anuria: <150mL/day
Polyuria: >3L/day
Nonoliguria AKI: >0.5mL/kg/hr + azotemia
Proteinuria: >1g protein/day
Oliguria: <0.5mL/kg/hr

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2
Q

What are the diff types of proteinuria?

A

Glomerular Proteinuria
Tubular proteinuria
Overflow proteinuria
Post-renal proteinuria

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3
Q

What type of proteinuria has LMW proteins excreted & not completely reabsorbed in the Proximal tubules?

A

Tubular proteinuria

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4
Q

WHat type of proteinuria has INC excretion of LMW proteins in cases w/ marked overproduction of a specific protein like multiple myeloma?

A

Overflow proteinuria

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5
Q

WHat is the normal level of 24h albumin, albumin:creatinine ratio, & 24h urine protein?

A

24h Albumin: 8-10mg/24h
Albumin: Creatinine ratio: <30mg/g
24-h urine protein: <150mg/24h

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6
Q

What are 2 types of hematuria?

A

Gross & Microscopic Hematuria

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7
Q

What are the causes of hematuria?

A

Glomerular or non-glomerular (post kidneys)

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8
Q

What are the diff types of RBC seen in the urine? Indication?

A

Isomorphic = normal app
Dysmorphic = went through the different tubules of the nephron
RBC case = clustered RBCs = Nephritic syndrome

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9
Q

What can indicate that hematuria is glomerular in nature?

A

Dysmorphic RBC/RBC casts
Protein >500mg/24hr (normally kasi 1g soo dami na niyan)

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10
Q

Where are urinary casts formed?

A

DCT & Collecting duct

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11
Q

WHat are the 2 type sof urinary casts? What are the diff casts under it?

A

Cellular = RTE casts, RBC casts, WBC casts
Non-cellular = Hyaline casts, Granular casts, Fatty casts, Waxy casts

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12
Q

What conditions are indicated in the presence of diff urinary casts?

A

Hyaline/Hyaline-Granular: Normal, Renal Dis
Granular: Renal Dis, Acute Tubular Necrosis
Waxy: Renal Dis w/ function impairment
Fatty: Proteinuria, Nephrotic Syndrome
Myoglobin: Rhabdomyolysis

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13
Q

What is a marker for AKI & what staging is used to diagnose AKI?What is determined for this criteria?

A

Urine output = marker of AKI
Staging = KDIGO staging
Determined = baseline creatinine of px

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14
Q

What are the criteria of each 3 stages of KDIGO staging?

A

Stage 1
Creatinine criteria: 1.5-1.9x baseline OR INC >0.3mg/fL
Urine output: <0.5mL/kg/hr x 6-12hrs

Stage 2
Creatinine criteria: 2-2.9x baseline
Urine output: <0.5mL/kg/hr for 12 hrs

Stage 3
Creatinine criteria: >3x baseline OR >4mg/dL OR initiation of dialysis
Urine output: <0.3mL/kg/hr for >24h, OR Anuria > 12 hrs

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15
Q

What are the indications for dialysis?

A

Intractable metabolic acidosis
Intractablle hyperkalemia
Congestion

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16
Q

What is the hx & PE of px w/ <0.5mg/kg/hr for >6 hrs

A

Orthostatic, HTN

INC Creatinie from baseline of th epx atleast 0.3mg/dL whin 48 hrs

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17
Q

WHAT IS THE PE & LAB TEST RESULT OF SETTING FOR AKI, drug hx, comorbidites

A

Setting for AKI = tachycardia; urinary casts

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18
Q

What are the diff features of prerenal and intrinsic AKI?

A
  1. Hx of poor fluid intake/fluid loss
    DSAINE of volume deption
    Veppiro
  2. NSAIDs, ACEis, ARBs
  3. HF
  4. Evidece of volume depletion
  5. DEC effective circulator vol
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19
Q

How do you classify conditions as chronic renal disease?

A

> 3 months DEC function
GFR = <60mL/min

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20
Q

WHat are the leading causes of CKD in PH?

A

Diabetic nephropathy
Glomerulonephritis
HTN associated CKD
Autosomal polyscystic kidney dis
Other cystic and ubuloointerstitial nephropathy

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21
Q

What is a risk factor for CKD during KDIGO staging?

A

Albuminuria

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22
Q

What are changes brought by diabetic nephropathy?

A

Mesangial expansion & prolfieration
Podocytopathy
Glomerulr BM thickening
Sclerosis

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23
Q

What are the diff clin conditions seen in chronic kidney dis?

A

Na & H2O balance disruption
K balance disruption
Metabolic acidosis
Mineral balance & OSteodystrophy
Neurological , skin changes, GI, repro

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24
Q

What are the stages of CKD?

A

Stage 1: normal, INC GFR, GFR: >90
Stage 2: GFR 60-89
Stage 3: GFR: 30-59
Stage 4: GFR 15-29, renal replacement therapy
Stage: GFR <15/Dialysis

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25
What are the criteria to diagnose Nephrotic syndrome?
Proteinuria Hypoalbuminemia Hypercholsterolemia Edema Hyepertension
26
What are the diff renal diseaes with nephrotic syndrome?
Minimal change dis Focal segmental glomerulosclerosis Membranou GS DIabetic nephropathy AL & AA Amyloidosis
27
What is the most common nephrotic syndrome in pedia?
Minimal change dis
28
What are the pertinent findings in Nephrotic syndrome?
Hx: - Peripheral, periorbital edema - frothy/bubbly urine - recemt drug use - infection (HIV, Hepa B or C) PE: - HTN, volume overload - signs of thromboembolism Labs - DEC albumin, lipid profile - Proteinuria >3.5g in 24h - Fatty casts - Lipiduria
29
What are the criteria of Nephritic syndrome?
Hematuria: RBC casts Oliguria HTN Pyuria Mild-moderate proteinuria
30
What are dis presenting nephritic syndrome?
Subacute bacterial endocarditis IgA nephropathy Henoch-Schonlein purpura Membranoproliferative GN Mesangioproliferative GN
31
What is the most common cause of nephrotic syndrome in PH?
IgA nephropathy
32
What are the pertinent findings in Nephritic syndrome?
Hx - Oliguria - Skin, respi, GIT, infection hx - coca-colla colored urine PE: - HTN - Volume overload (Peropheral/Periorbital edema) Lab: - INC BUN, Creatinine - Hematuria - Proteinuria - (+) RBC cast in urine, Dysmorphic urine RBC
33
What condition presents due to excess crystal-forming substances?
Nephrolithiasis
34
What are contributing factors to Nephrolithiasis?
1. Disturbances in urinary pH 2. Low urine volume 3. DEC fluid intake 4. Dietary factors
35
What other factors in the diet can increase development of Nephrolithiasis?
INC Na intake, Dietary Ca & High acid intake
36
What areas of the kidney can u develop renal stones?
Renal pelvis - asymptomatic Ureter - INC pressure inside urter, nausea/vomiting Bladder - painful urination
37
WHat are the diff types of renal stones? Examples of these?
1. Non-infectious stones: Ca & uric acid stones 2. Infection stones 3. Genetic stones 4. Xanthine stones 5. Silica stones
38
What is themost common form of renal stone?
Ca oxalate
39
What renal stone is formed due to chronic dehydration & INC risk with gout, genetic tendencies, or diet high in CHON?
Uric acid stones
40
What is a renal stone seen in infections? What renal stone is common in caucasians?
Struvite = infections Cystine stones = Caucasians
41
WHat renal stone is caused by an enzyme def that causes building of xanthine deposits?
Xanthine stones
42
What causes formation of Silica stones?
Certain medications or herbal supplements
43
What are symptoms of Nephrolithiasis?
- pain radiates in the flank area - Hematuria - sharp, sudden severe pain - fever, stomach pain, nausea, vomiting, dizziness, backache
44
What should be noted in PE to note Nephrolithiasis?
Flank/Costovertebral angle tenderness
45
What are possible causes of urinary tract obstruction?
neoplasm congeintal anomalies calculi prengncy (gravid uterus) diseases in the prostate
46
what are the different types of osbtruction?
mechanical blockade functional deficits congenital
47
what are the 2 types of mechanical blockade and how do they block the UT?
Intrinsic - within the kidneys ie calculi Extrinsic - outside the kidneys - Gynecologic maglignancies, Pregnancy
48
What are commonly acquired intrinsic defects that causes urinary tract obstruction?
Benign Prostatic hyperplasia Cacner of the prostate, bladder Calculi Diabetic nephropathy Spinal cord disease, anticholinergic drugs, a-adrenergeic antagonists Stricture tumor calculi trauma phimosis
49
What are commonly acquired extrinsic defects that causes urinary tract obstruction?
Pregnant uterus Retroperitoneal fibrosis Aortic aneurysm uterine leiomyomata Carcinoma of the uterus, prostate, bladder, colon, rectum Lymphoma PID, Endomtriosis Carcinoma of the cervix, colon Accidental surgical ligation
50
What is the common cause of urinary obstruction?
Benign prostatic hyperplasia
51
What are symptoms of benign prostatic hyperplasia?
Frequent urination Nocturia Urgency to urinate Dribbling at the end of urination Inability to complete empty the bladder Weak urine stream, difficulty starting urination
52
What are conditions that cause UT obstruction due to functional defects?
Neurogenic bladder/spinal cord problems Diabetic cystopathy
53
What are diff congenital defects that cause UT obstruciton?
Ureteropelvic junction narrowing or obstruction Ureterovesical junctional narrowing or obstruction and reflex Ureterocele Retroocaval ureter Bladder neck obstruction Stricture, Phismosis
54
What condition is the accumulation of urine in the kidneys? What happens if the obstruction is found above or below the level of the bladder?
Hydronephrosis Above the bladder: Unilateral dilation of the ureter & renal system Below the bladder: Bilateral involvement
55
What should be done to determine the site of UT osbtruction?
Insert bladder catheter before dxing --> If urine is excreted after catheter insertion --> obstruction is below the bladder neck If no diuresis after catheter insertion --> ultrasound
56
What is the usual site of UTI?
Ascending from the urethra to the bladder --> Cystitis
57
What are the casues of UTI?
Asymptomatic bacteruria Cystitis - urinary bladder Pyelonephritis - kidneys Prostatitis
58
What is a distinct symptom of mild & severe pyelonephritis?
Mild pyelonephritis - w/ or w/o costovertebral pain Severe pyelonephritis - flank/loin pain
59
What structure of the kidney is affected if there is HTN related vascualr lesions in the kidneys?
Preglomerular arterioles
60
What are pertinent findings of HTN in the kidneys?
hx of HTN Blurring of vision Elevated BP Retinopathy PMI is displaced Macroalbuminuria/Microalbuminaria Casts Elevated Creatinine level
61
What should you do if the px has high BP, what condition could be present? What should be done to confirm this?
Left ventricular hypertrophy 2D echo/ECG
62
Are both micro- and macro-albuminuria seen in urine of px with CKD?
yes
63
What are the 2 types of renal tubular defects and what are its causes?
Primary RTD = affects tubules & interstitium Secondary RTD = dis of glomerulus or its vasculature
64
What are the 2 types of renal tubular defects?
Acute interstitial nephritis Autosomal dominant polycystic kidney disease
65
What are the different causes of acute interstitial nephritis?
Medications: Antibiotics, NSAIDs, Sulfonamides, PPIs, diuretics, etc. Infections Autoimmune dis Idiopathic/emerging
66
What are key clinical features of acute interstitial nephritis?
Fever, eosinophilia Elevated serum creatinine concentration + = WBCs, RBCs, WBC cast
67
What type of renal tubular defect has the progressive formation of epithelial lined cysts in the bilateral kidney?
Autosomal dominant Polycystic kidney dis
68
What are key clinical features of Autosomal Dominant Polycystic kidney dis?
Elevated creatinine level Low urine pH Kidney ultrasound
69
What are the age-related cysts appearance in kidney ultrasound if they have AD polycystic KD?
15-29yo = 2 renal cysts (UNI or BIlateral) 30-59yo = 2 cysts in EACH kidney >60yo = at least 4 cysts in EACH kidney
70
What are important to take down for hx & PE of ADPKD?
Flank pain Fam hx of dis Symptoms of electrolyte imbalance Elevated BP
71
What are important to take note of lab tests to confirm ADPKD?
Subnephrotic proteinuria High urine Na Low urine SG

Medicine I (8 decks)

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