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)
Kidney disease suggested by the following urinary pattern:
- WBC, WBC cast, or urine eosinophils
acute interstitial nephritis (AIN) or polynephritis
Kidney disease suggested by the following urinary pattern:
- Dysmorphic RBCs, RBC casts
vasculitis or glomerulonephritis
Kidney disease suggested by the following urinary pattern:
- Proteinuria (<3.5 g/day), hematuria, dysmorphic RBC and RBC casts
nephritic syndrome
Kidney disease suggested by the following urinary pattern:
- Heavy Proteinuria (> 3.5g/day), lipiduria, minimal hematuria
nephrotic syndrome
Kidney disease suggested by the following urinary pattern:
- Hyaline cast
non-specific, prerenal azotemia
Kidney disease suggested by the following urinary pattern:
- WBCs, RBCs, bacteria
urinary tract infection (UTI)
Anuria is how many ml/day?
<50-100 ml/day
Oliguria is how many ml/day?
<400-500 ml/day
Polyuria is how many ml/day?
>3000 ml/day
What is the purpose of ordering an FeNa or FeUrea?
To distinguish between prerenal azotemia from intrinsic renal injury (i.e. ATN)
FeNa or FeUrea is only valid in which type of patients, oliguric or non-oliguric patients?
Oliguric
What 4 conditions are usually tested for using urine eosinophils?
- acute interstitial nephritis (AIN)
- pyelonephritis
- UTI
- atheroembolic renal disease
