Approach to Renal GU Complaint Flashcards
Define Chronic Kidney Disease (CKD):
- Present for _____ mos, w/ GFR < ______ ml/min AND/OR ______ present
Present for 3+ mos w/ GFR <60 ml/min AND/OR markers of kidney damage present
Define Acute Kidney Injury (AKI):
- Present for _____ mos, w/ GFR < ______ ml/min AND/OR ______ present
Present for <3 mos, w/ GFR <60 ml/min AND/OR markers of kidney damage present
What are markers of kidney damage? List 6.
- Proteinuria
- Abnml urinary sediment
- Abnml kidney biopsy
- Abnml renal imaging
- Electrolyte abnormalities from tubular disorders
- Hx of kidney transplant
Under what circumstances would patients w/ a GFR category 1 (90+ ml/min) or category 2 (60-89 ml/min) be diagnosed w/ CKD?
If they had markers of kidney damage present for 3+ mos
Name 4 risk factors for CKD.
What are the top 2 that account for >60% of CKD?
4 risk factors:
- DM
- HTN
- CVD
- AKI
Top 2 risk factors: DM, HTN
Clinical Presentation of CKD and AKI (note: same types of sx just to different severities)
- E_____
- ____tension
- ____ urine output
- ____ urine
- ____uria
- ____emia
- ____ ____ rub
- A____ (hand tremors when wrist is extended)
- Uremic ____ (crystallized urea)
- Edema
- Hypertension
- Decreased urine output
- Foamy urine
- Hematuria
- Uremia
- Pericardial friction rub
- Asterexis
- Uremic frost
Also nausea, vomiting, metallic taste
What are 3 tests to diagnose most CKD patients?
- eGFR (estimated) - utilizes equations
- urine albumin-to-creatinine ratio OR urine protein-to-creatinine ratio
- urinalysis
What abnormality does urine albumin-to-creatinine ratio OR urine protein-to-creatinine ratio tell us about?
proteinuria
What are 4 situations in which eGFR is not a reliable measure for diagnosing patients?
- AKI b/c of rapidly fluctuating creatinine levels
- GFR >60 ml/min
- Low muscle mass
- Patients <18 yo
Name 4 major abnormal renal ultrasound (U/S) findings to look for during imaging that would indicate CKD.
- atrophic/small kidneys
- cortical thinning
- increased echogenecity
- elevated resistive indices
Relationship between kidney fx and aging:
- _____ declines by _____ ml/min/year after ages ___ to ____
GFR declines by 1 ml/min/year after ages 30 to 40
Majority (50+%) of deaths among CKD patients are due to what complication?
CVD
Indications for dialysis tx:
- A:
- E:
- I:
- O:
- U:
- A: severe acidosis
- E: electrolyte disturbance (usually hyperkalemia, hypocalcemia, hyperphosphatemia)
- I: ingestion of ethylene glycol, methanol
- O: volume overload
- U: uremia
Elevated BUN w/o sx is?
Azotemia
Elevated BUN w/ sx is?
Uremia
Current definition of AKI is based on what criteria established in 2012?
KDIGO guidelines
- According to KDIGO, AKI is defined as a change in _____ or _____.
- The stage of AKI is then determined based on _______.
- Change in serum creatinine (SC) or urine output (UO)
- Stage based on whichever (SC or UO) is worse
Major risk factors for AKI:
- ____ age
- ____uria
- CKD, D___, H___, C___
- ____toxins
- ____ surgery
- fluid _____
- s____
- old age
- proteinuria
- CKD, DM, HTN, CVD
- nephrotoxins
- cardiac surgery
- fluid overload
- sepsis
Common etiology of AKI is divided into what 3 categories?
- prerenal (i.e. “the hypos” - hypotension, hypovolemia)
- intrinsic (i.e. tubular necrosis is a biggie)
- postrenal (i.e. obstructions)
- 3 causes of acute interstitial nephritis (AIN)?
- Of the above, the most common cause and 3 examples of it?
- drugs, infections, autoimmune disorders
- drugs: antibiotics, NSAIDs, PPIs
Top 4 complications of AKI?
- Development CKD
- Progression CKD
- ESRD
- CVD
What 2 labs need to be obtained on all patients w/ AKI?
- urinalysis w/ urine microscopy
- urine albumin-to-creatinine ratio or protein-to-creatinine ration
Describe the general workup for an AKI patient
- urinalysis w/ urine microscopy
- urine albumin-to-creatinine ratio or protein-to-creatinine ratio
- renal U/S
Kidney disease suggested by the following urinary pattern:
- Renal tubular epithelial cells, transitional epithelial cells, granular casts, or waxy casts
acute tubular necrosis (ATN)
