Approach to Renal Complaint

Question 1

What IV contrast can damage the kidney?

Answer 1

Iodine

Question 2

Define uremia?

Answer 2

Increased BUN with symptoms

-look for pericarditis

Question 3

Define Azotemia?

Answer 3

Increased BUN w/o symptoms

Question 4

Define Asterixis?

Answer 4

When pt hyperextends wrist, and it just flaps

Question 5

What is AKI?

Answer 5

If <3 mo of GFR <60ml/min and markers of kidney damage

Question 6

What is Chronic Kidney Disease (CKD)?

Answer 6

> 3mo of:

1. GFR <60ml/min
2. Markers of Kidney damage
   - protein in urine
   - abnormal urine sediment
   - Abnormal kidney biopsy
   - Electrolyte abnormalities

Question 7

CKD Stages?

Answer 7

1->90
2-60-89
3a-45-59
3b-30-44
4-15-29
5-<15

Question 8

Are stages 1 and 2 of CKD considered kidney disease?

Answer 8

Yes, only if kidney damage markers are present

Question 9

What are big risk markers of CKD?

Answer 9

DM
HTN
Cardiovascular Disease
AKI
FH

Question 10

Signs and Sx of CKD

Answer 10

• Edema
• HTN
• Decreased urine output
• proteinuria (foamy urine)
• hematuria
• Uremia
• Pericadial friction rub
• Asterixis
• Uremic Frost

Question 11

What is uremic frost?

Answer 11

Sweating out so much urea that it crystallizes on skin

Question 12

3 simple tests to identify most CKD?

Answer 12

• eGFR
• urine albumin to creatine ratio
• urinalysis

Question 13

What renal findings would be present on ultrasound for CKD?

Answer 13

1. Atrophic or small kidneys
2. Cortical thinning
3. Increased Echogenicity
4. Elevated resistive indices

Question 14

How does kidney function change with age?

Answer 14

GFR declines by 1ml/min/year after age of 30-40

Question 15

Complications of CKD (big 3)

Answer 15

1. Cardiovascular Disease
2. Chronic Kidney Disease Mineral and Bone Disease
   - hypocalcemia and hyper phosphate is and Vit D def (leads to secondary hyperparathyroidism and bone reabsorption)
3. Anemia of CKD
   - decreased EPO

Question 16

Indications for Dialysis? (AEIOU)

Answer 16

A: severe Acidosis
E: Electrolyte disturbance
I: Ingestion (toxic substance)
O: volume Overload
U: Uremia

Question 17

Stages of AKI are based on what?

Answer 17

Based on Serum Creatine or Urine

-whichever is worse

Question 18

Stage 1 of AKI?

Answer 18

Serum Creatine: 1.5-1.9x baseline
Or
Urine: <0.5ml/kg/h for 6-12hr

Question 19

Stage 2 of AKI?

Answer 19

Serum Creatine: 2.0-2.9x baseline
Or
Urine: <0.5ml/kg/hr for >12 hrs

Question 20

AKI Stage 3?

Answer 20

Serum Creatine: 3x baseline
Or
Urine: <0.3ml/kg/h for >24 hrs or anuria for 12 hrs

Question 21

Drugs associated with Acute Interstitial Nephritis (AIN)

Answer 21

Antibiotics
PPIs (rare rash, inconsistent pyuria)
NSAIDs

Question 22

Complications of AKI

Answer 22

1. Development of CKD
2. ESRD
3. Cardiovascular disease

Question 23

Diagnostic Tests of AKI?

Answer 23

UA w microscopy
Urine Albumin/Cr ratio
Renal U/S

Question 24

Urine Microscopy Clues

Answer 24

Renal tubular cells
WBC, WBC Cast
Dysmorphic RBCs
Proteinuria
Hyaline Cast

Question 25

When is FeNa or FeUrea valid?

Answer 25

Only in Oliguric pts! *<400ml/day

Question 26

Etiology of AKI: Prerenal

Answer 26

Hypotension Hypovolemia Reduced CO Systemic Vasodilation

Question 27

Intrisic Etiology of AKI?

Answer 27

``` Tubular Necrosis (ischemia 50% or toxins 35%) Interstitial Nephritis (10%) Glomerulitis (5%) ```

Question 28

Postrenal Etiology of AKI

Answer 28

Bladder obstruction Uteral Obstruction Renal Pelvis

Question 29

What are some major risk factors for AKI?

Answer 29

``` Old Age** Proteinuria CKD HTM DM CVD ```