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ECOS2 Exam 1 > Approach To Renal Complaint > Flashcards

Approach To Renal Complaint Flashcards

1
Q

Most renal failures happen due to

A

Vascular problems since most of kidneys is vasculated (20% of CO)

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2
Q

Proteinuria

A

Protein in urine

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3
Q

Dysuria

Polyuria

A

Painful ruination

Frequent urination

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4
Q

Uremia

A

Elevated BUN (Blood Urea Nitrogen)

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5
Q

BUN

A

Urea nitrogen is waste from liver making protein
Goes to kidney to be peed out
test levels by blood test
HIGH : decreased kidney function, something causing retention of waste

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6
Q

Cr

A

Creatinine
Waste product from muscles
Goes to kidney to be peed out
Test blood for this also

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7
Q

Nitrates in urine can mean

A

bacteria , UTI

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8
Q

Leukocyte Esterase in urine can mean

A

Enzyme made by WBC

UTI or inflammation of GU tract

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9
Q

What should you never see in the urine

A

Bilirubin
Glucose
Protein

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10
Q

AKI

A

Impaired renal filtration and excretion for days, weeks
Retention of waste
transient (no electrolyte abnormality), Severe (require dialysis, pH and electrolytes off)
*for 3 months

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11
Q

what happens if AKI doesn’t get revered or resolved and in how long

A

After 3 months or elevated wastes all nephrons cant go back to normal function
= CKD (Chronic Kidney Disorder)

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12
Q

Risk for AKI

A 
Old age
CKD
HTN
Diabetes 
NSAIDS, Abs
Fluid overload (heart failure)
Trauma
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13
Q

3 categories of AKI

A
  1. Pre-Renal AKI : injury or upstream kidney, blood supply, fluid (Hypotension)
  2. Intrinsic AKI : injury at level of kidney (Glomerulonephritis)
  3. Post -Renal AKI : injury downstream to kidney (Bladder outlet obstruction), urethra, bladder (stones)
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14
Q

4 things to ask for Pre-Renal AKI

A
  1. History of fluid loss or poor fluid intake (V,D, hemorrhage)
  2. History of low circulatory v, (Hearst Failure =low blood to kidneys)
  3. History of new Mx (NSAIDs, BP meds)
  4. V depletion on PE (dry mucus membranes, tachycardia, HypOtention, poor skin turgor)
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15
Q

Risk factor for Intrinsic AKI

A 
History of URI, CKD, Diabetes, HTN
New Mx
Autoimmune (fever, chills, abd pain, CP, SOB)
Recent strep throat
Protein or blood in urine
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16
Q

Post -Renal AKI what 4 questions should I ask

A
  1. History of Kidney stones (flank pain + Hematuria)
  2. History of Prostate issues (urination probs,elderly)
  3. History of Pelvic Neoplasm (NOT uptodate on cervical/prostate cancer screening)
  4. History of Foley Catheter (acute or chronic)
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17
Q

Renal ROS

A 
Foamy urine
Polyuria, Dysuria
Color of urine
Smell of urine
Kidney stone History
Flank pain
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18
Q

Renal GU Exam

VOLUME STATUS

A 
Jugular Venous pressure (flat or distended, esp subclavicular notch)
Oral mucosa
Cap refill
ASCITES
Edema 
Skin turgor
Skin tenting
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19
Q

Renal GU Exam

LUNGS

A 
Crackles = pulmonary edema
Effusions = heart failure
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20
Q

Renal GU Exam

ABD

A 
ABD bruits (Renal A stenosis, abd aortic aneurysms)
Palpable kidney
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21
Q

Renal GU Exam

MSK

A

Constovertebral angle pain or tenderness

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22
Q

Renal GU Exam

NEURO

A

Alert + oriented x3 (person, place, time)

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23
Q

What should I order definitely for AKI

A
  1. BMP
    (Look at Cr, and BuN)
  2. Uralysis and urine microscopy
    (look and protein, blood, glucose in urine)
24
Q

some other AKI tests I could order

A

Renal US

Renal Biopsy

25
Q

Don’t prescribe what to those with AKI or kidney problems

A

NSAIDS
ABs
BP meds (or anything causing HypOtention)

26
Q

how to treat most pre-renal AKI patients

A

They need IV fluids

27
Q

Chronic Kidney Disease

3 things that can diagnose this

A
  1. GFR ,60ml/min/1.73m2
  2. Kidney damage shown by : proteinuria
  3. Kidney damage shown by : abnormal urinary sediment (RBC, WBC)
    * EITHER HAS TO BE LONGER THEN 3 MONTHS
28
Q

CKD stage 1 and stage 5 GFR

A

> 90

<15 (ESRD, kidney failure, dialysis)

29
Q

Risk factors for CKD

MAJOR 4

A

DM
CVD (cardiovascular Disease)
HTN
AKI (especially glomerulonephritis)

30
Q

What should you ask fro CKD

A

Symptoms of UREMIA
N,V, confusion metallic taste, fatigue
Asterixis : extend arms AND close eyes, they cant keep them straight
Uremic frost : so much urea in body you sweat it out

31
Q

Differences between GFR and eGFR

A

eGFR is estimated GFR with calculations

32
Q

limitations to eGFR

A

NOT RELIABLE WHEN

  1. GFR > 60
  2. AKI (Cr changes rapidly)
  3. Low muscle mass
33
Q

How do I measure proteinuria

A

Urine albumin: creatinine
Urine Protein : creatinine
Cr. Doesn’t change as much over time so its constant

34
Q

Complications of CKD

Not really need to memorize

A 
CVD
CKD-Mineral Bone Disease
Anemia
Electrolyte abnormalities 
Acidosis
Uremia
HTN
Volume overload
35
Q

Tx for CKD

A

Renal Replacement Therapy:
Hemodialysis
Peritoneal Dialysis
Renal Transplant

36
Q

INDICATIONS FOR DIALYSIS

A
  1. A : Severe Acidosis
  2. E : Electrolyte disturbance (hyperkalemia)
  3. I : Ingestion (methanol, ethylene glycols….)
  4. O : Volume Overload
  5. U : Uremia
37
Q

UTI 4 types

A
  1. Asymptomatic Bacteriuria : bacteria, no Sx
  2. Cystitis : bladder infection , Sx
  3. Proststitis : prostate inflammation, Sx
  4. Pyelonephritis : Kidney infection, Sx
38
Q

Most common pathogen for UTI

A

E. coli

39
Q

Most common causes of UTI

A

Fecal contamination
Outflow obstruction
Sex
Catheterization

40
Q

Cystitis Sx:

A

Dysuria
Frequent urination
Suprapubic pain
Hematuria

41
Q

Pyelonephritis Sx:

A

Fever, Flank pain, Costovertebral angle Tenderness, N/V

+ all Cystitis Sx

42
Q

what to get for UTI

A

CBC, BMP, Urinalysis, Urine Culture *over 100000cfu/mL

43
Q

when does urine culture show UTI

A

Above 100,000cfu/mL

44
Q

What to do for pyelonephritis

A

CT scan
CBC, BMP, urinalysis, urine culture, blood culture
Imaging : only if very sick, or no improvement in 48hrs

45
Q

+ Lloyds test

A

Pyelonephritis

Nephrolithiasis

46
Q

Tx: UTI

A

CRITERIA for ABs:

  1. Symptomatic
  2. > 100,000cfu/mL
47
Q

Days of AB to UTI

A

Cystitis : 3-5 days

Pyelonephritis : 7-14 days

48
Q

Nephrolithiasis (stones)

A

Ca Oxalate (80%)
Uric Acid
STRUVITE : bacteria causing ammonia infection

49
Q

Nephrolithiasis Sx:

A

Unilateral sharp pain
Polyuria
Dysuria
Hematuria

50
Q

preferred imaging for nephrolithiasis

A

Non-contrast CT

51
Q

Tx: Nephrolithiasis

A

Treat pain, N
IV Fluids if needed
If severe you might need surgery

52
Q

SYMPATHETIC to GU

A

T10-L2

53
Q

SYMPATHETIC to Upper Ureter

A

T10-T11

54
Q

SYMPATHETIC to Lower Ureter

A

T12-L2

55
Q

PARASYMPATHETIC to Upper Ureter

A

Vagus N (OA,AA)

56
Q

PARASYMPATHETIC to Bladder

A

S2-S4

57
Q

PARASYMPATHETIC to Lower Ureter

A

S2-S4

ECOS2 Exam 1 (15 decks)

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