Approach to Renal Complaint Flashcards
What is blood urea nitrogen (BUN)?
urea nitrogen is a waste product, created when the liver breaks down proteins; normally travels from the liver to the kidneys and is excreted as waste product
what is creatinine?
waste product of muscle breakdown; created constantly and properly functioning kidneys excrete this waste product
what are nitrites in the urine associated with?
UTI (bacteria have the ability to convert nitrate into nitrite)
AKI may progress to CKD if the renal dysfunction is not resolved in what time frame?
3 months
what might the history of a pre-renal AKI look like?
history of fluid loss or poor fluid intake, hx of decreased effective circulatory volume, chronic use of NSAIDs or blood pressure medications
what might a physical exam of a pre-renal AKI patient look like?
dry mucous membranes, tachycardia, hypotension, poor skin turgor
what might the history of an intrinsic AKI patient look like?
history of CKD/diabetes/HTN, history of recent URI, auto-immune disease, hematuria, foamy urine
what might the history of a post-renal AKI patient look like?
kidney stones, prostate issues, pelvic neoplasm, foley catheter
what are three important signs to check when assessing volume status?
jugular venous pressure (JVD), oral mucosa (dry, tongue fissuring), and skin tenting (poor skin turgor)
what abdominal exam is important to assess when you have a renal complaint?
abdominal bruits (renal artery stenosis)
what labs must you obtain to diagnose AKI?
BMP and UA
how do you treat AKI?
it depends on the etiology (either pre, intrinsic, or post-renal)
what should you discontinue if you diagnose a patient with AKI?
nephrotoxins
what are the main risk factors for CKD?
DM, HTN, cardiovascular disease, AKI
what are symptoms of uremia?
n/v, confusion, metallic taste in mouth, fatigue, pericardial friction rub, asterixis, uremic frost
what are three simply tests to identify most CKD patients?
glomerular filtration rate (GFR), proteinuria, and urinalysis with microscopy
what are the limitations of GFR?
it is not reliable when GFR is >60, not reliable in AKI, not reliable in low muscle mass patients
how do you measure proteinuria?
urine albumin to creatinine ratio or urine protein to creatinine ratio
what is GFR based off of?
weight, creatinine, race, and sex
what are two major complications of CKD?
cardiovascular disease (CVD) and osteoporosis
what are the indications for dialysis?
AEIOU; severe acidosis, electrolyte disturbance, ingestion (ethylene glycols, methanol, etc.), volume overload, uremia
what is the most common cause of a UTI?
E. coli
what should you look for in a urine culture to diagnose cystitis?
> 100,000 cfu/mL on urine culture
the duration of antibiotics will vary based off UTI type and severity. What are these variations?
for cystitis: 3-5 days of treatment; for pyelonephritis: 7-14 days
what is the medical term for kidney stones?
nephrolithiasis
what is nephrolithiasis caused by?
precipitation of minerals in the kidney and ureters that were soluble in the blood
what is the most common type of kidney stone?
calcium oxalate
what stone is caused by infection with organisms that produce ammonia?
struvite stones
where would a stone be located if the patient has flank pain?
at the kidney or the renal pelvis
where would a stone be located if the patient has groin/lower abdominal pain?
at the lower ureter
