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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
Q

What are the criteria to diagnose Nephrotic syndrome?

A

Proteinuria
Hypoalbuminemia
Hypercholsterolemia
Edema
Hyepertension

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26
Q

What are the diff renal diseaes with nephrotic syndrome?

A

Minimal change dis
Focal segmental glomerulosclerosis
Membranou GS
DIabetic nephropathy
AL & AA Amyloidosis

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27
Q

What is the most common nephrotic syndrome in pedia?

A

Minimal change dis

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28
Q

What are the pertinent findings in Nephrotic syndrome?

A

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

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29
Q

What are the criteria of Nephritic syndrome?

A

Hematuria: RBC casts
Oliguria
HTN
Pyuria
Mild-moderate proteinuria

30
Q

What are dis presenting nephritic syndrome?

A

Subacute bacterial endocarditis
IgA nephropathy
Henoch-Schonlein purpura
Membranoproliferative GN
Mesangioproliferative GN

31
Q

What is the most common cause of nephrotic syndrome in PH?

A

IgA nephropathy

32
Q

What are the pertinent findings in Nephritic syndrome?

A

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
Q

What condition presents due to excess crystal-forming substances?

A

Nephrolithiasis

34
Q

What are contributing factors to Nephrolithiasis?

A
  1. Disturbances in urinary pH
  2. Low urine volume
  3. DEC fluid intake
  4. Dietary factors
35
Q

What other factors in the diet can increase development of Nephrolithiasis?

A

INC Na intake, Dietary Ca & High acid intake

36
Q

What areas of the kidney can u develop renal stones?

A

Renal pelvis - asymptomatic
Ureter - INC pressure inside urter, nausea/vomiting
Bladder - painful urination

37
Q

WHat are the diff types of renal stones? Examples of these?

A
  1. Non-infectious stones: Ca & uric acid stones
  2. Infection stones
  3. Genetic stones
  4. Xanthine stones
  5. Silica stones
38
Q

What is themost common form of renal stone?

A

Ca oxalate

39
Q

What renal stone is formed due to chronic dehydration & INC risk with gout, genetic tendencies, or diet high in CHON?

A

Uric acid stones

40
Q

What is a renal stone seen in infections? What renal stone is common in caucasians?

A

Struvite = infections
Cystine stones = Caucasians

41
Q

WHat renal stone is caused by an enzyme def that causes building of xanthine deposits?

A

Xanthine stones

42
Q

What causes formation of Silica stones?

A

Certain medications or herbal supplements

43
Q

What are symptoms of Nephrolithiasis?

A
  • pain radiates in the flank area
  • Hematuria
  • sharp, sudden severe pain
  • fever, stomach pain, nausea, vomiting, dizziness, backache
44
Q

What should be noted in PE to note Nephrolithiasis?

A

Flank/Costovertebral angle tenderness

45
Q

What are possible causes of urinary tract obstruction?

A

neoplasm
congeintal anomalies
calculi
prengncy (gravid uterus)
diseases in the prostate

46
Q

what are the different types of osbtruction?

A

mechanical blockade
functional deficits
congenital

47
Q

what are the 2 types of mechanical blockade and how do they block the UT?

A

Intrinsic - within the kidneys ie calculi
Extrinsic - outside the kidneys - Gynecologic maglignancies, Pregnancy

48
Q

What are commonly acquired intrinsic defects that causes urinary tract obstruction?

A

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
Q

What are commonly acquired extrinsic defects that causes urinary tract obstruction?

A

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
Q

What is the common cause of urinary obstruction?

A

Benign prostatic hyperplasia

51
Q

What are symptoms of benign prostatic hyperplasia?

A

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
Q

What are conditions that cause UT obstruction due to functional defects?

A

Neurogenic bladder/spinal cord problems
Diabetic cystopathy

53
Q

What are diff congenital defects that cause UT obstruciton?

A

Ureteropelvic junction narrowing or obstruction
Ureterovesical junctional narrowing or obstruction and reflex
Ureterocele
Retroocaval ureter
Bladder neck obstruction
Stricture, Phismosis

54
Q

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?

A

Hydronephrosis

Above the bladder: Unilateral dilation of the ureter & renal system

Below the bladder: Bilateral involvement

55
Q

What should be done to determine the site of UT osbtruction?

A

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
Q

What is the usual site of UTI?

A

Ascending from the urethra to the bladder –> Cystitis

57
Q

What are the casues of UTI?

A

Asymptomatic bacteruria
Cystitis - urinary bladder
Pyelonephritis - kidneys
Prostatitis

58
Q

What is a distinct symptom of mild & severe pyelonephritis?

A

Mild pyelonephritis - w/ or w/o costovertebral pain

Severe pyelonephritis - flank/loin pain

59
Q

What structure of the kidney is affected if there is HTN related vascualr lesions in the kidneys?

A

Preglomerular arterioles

60
Q

What are pertinent findings of HTN in the kidneys?

A

hx of HTN
Blurring of vision
Elevated BP
Retinopathy
PMI is displaced
Macroalbuminuria/Microalbuminaria
Casts
Elevated Creatinine level

61
Q

What should you do if the px has high BP, what condition could be present? What should be done to confirm this?

A

Left ventricular hypertrophy

2D echo/ECG

62
Q

Are both micro- and macro-albuminuria seen in urine of px with CKD?

A

yes

63
Q

What are the 2 types of renal tubular defects and what are its causes?

A

Primary RTD = affects tubules & interstitium
Secondary RTD = dis of glomerulus or its vasculature

64
Q

What are the 2 types of renal tubular defects?

A

Acute interstitial nephritis
Autosomal dominant polycystic kidney disease

65
Q

What are the different causes of acute interstitial nephritis?

A

Medications: Antibiotics, NSAIDs, Sulfonamides, PPIs, diuretics, etc.

Infections
Autoimmune dis
Idiopathic/emerging

66
Q

What are key clinical features of acute interstitial nephritis?

A

Fever, eosinophilia
Elevated serum creatinine concentration
+ = WBCs, RBCs, WBC cast

67
Q

What type of renal tubular defect has the progressive formation of epithelial lined cysts in the bilateral kidney?

A

Autosomal dominant Polycystic kidney dis

68
Q

What are key clinical features of Autosomal Dominant Polycystic kidney dis?

A

Elevated creatinine level
Low urine pH
Kidney ultrasound

69
Q

What are the age-related cysts appearance in kidney ultrasound if they have AD polycystic KD?

A

15-29yo = 2 renal cysts (UNI or BIlateral)
30-59yo = 2 cysts in EACH kidney
>60yo = at least 4 cysts in EACH kidney

70
Q

What are important to take down for hx & PE of ADPKD?

A

Flank pain
Fam hx of dis
Symptoms of electrolyte imbalance
Elevated BP

71
Q

What are important to take note of lab tests to confirm ADPKD?

A

Subnephrotic proteinuria
High urine Na
Low urine SG

Medicine I (8 decks)

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