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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
Don’t prescribe what to those with AKI or kidney problems
NSAIDS ABs BP meds (or anything causing HypOtention)
26
how to treat most pre-renal AKI patients
They need IV fluids
27
Chronic Kidney Disease | 3 things that can diagnose this
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
CKD stage 1 and stage 5 GFR
>90 | <15 (ESRD, kidney failure, dialysis)
29
Risk factors for CKD | MAJOR 4
DM CVD (cardiovascular Disease) HTN AKI (especially glomerulonephritis)
30
What should you ask fro CKD
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
Differences between GFR and eGFR
eGFR is estimated GFR with calculations
32
limitations to eGFR
NOT RELIABLE WHEN 1. GFR > 60 2. AKI (Cr changes rapidly) 3. Low muscle mass
33
How do I measure proteinuria
Urine albumin: creatinine Urine Protein : creatinine Cr. Doesn’t change as much over time so its constant
34
Complications of CKD | Not really need to memorize
``` CVD CKD-Mineral Bone Disease Anemia Electrolyte abnormalities Acidosis Uremia HTN Volume overload ```
35
Tx for CKD
Renal Replacement Therapy: Hemodialysis Peritoneal Dialysis Renal Transplant
36
INDICATIONS FOR DIALYSIS
1. A : Severe Acidosis 2. E : Electrolyte disturbance (hyperkalemia) 3. I : Ingestion (methanol, ethylene glycols....) 4. O : Volume Overload 5. U : Uremia
37
UTI 4 types
1. Asymptomatic Bacteriuria : bacteria, no Sx 2. Cystitis : bladder infection , Sx 3. Proststitis : prostate inflammation, Sx 4. Pyelonephritis : Kidney infection, Sx
38
Most common pathogen for UTI
E. coli
39
Most common causes of UTI
Fecal contamination Outflow obstruction Sex Catheterization
40
Cystitis Sx:
Dysuria Frequent urination Suprapubic pain Hematuria
41
Pyelonephritis Sx:
Fever, Flank pain, Costovertebral angle Tenderness, N/V | + all Cystitis Sx
42
what to get for UTI
CBC, BMP, Urinalysis, Urine Culture *over 100000cfu/mL
43
when does urine culture show UTI
Above 100,000cfu/mL
44
What to do for pyelonephritis
CT scan CBC, BMP, urinalysis, urine culture, blood culture Imaging : only if very sick, or no improvement in 48hrs
45
+ Lloyds test
Pyelonephritis | Nephrolithiasis
46
Tx: UTI
CRITERIA for ABs: 1. Symptomatic 2. >100,000cfu/mL
47
Days of AB to UTI
Cystitis : 3-5 days | Pyelonephritis : 7-14 days
48
Nephrolithiasis (stones)
Ca Oxalate (80%) Uric Acid STRUVITE : bacteria causing ammonia infection
49
Nephrolithiasis Sx:
Unilateral sharp pain Polyuria Dysuria Hematuria
50
preferred imaging for nephrolithiasis
Non-contrast CT
51
Tx: Nephrolithiasis
Treat pain, N IV Fluids if needed If severe you might need surgery
52
SYMPATHETIC to GU
T10-L2
53
SYMPATHETIC to Upper Ureter
T10-T11
54
SYMPATHETIC to Lower Ureter
T12-L2
55
PARASYMPATHETIC to Upper Ureter
Vagus N (OA,AA)
56
PARASYMPATHETIC to Bladder
S2-S4
57
PARASYMPATHETIC to Lower Ureter
S2-S4

ECOS2 Exam 1 (15 decks)

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