CIS 3: Renal Case Flashcards
Where is the most accurate place on the body to check skin turgor?
Forehead
What are 2 acute phase reactants which decrease during inflammation/infectiojn?
- Albumin
- Transferrin
What may be seen in some patients following a recent surgery, bacterial infection, or trauma as the platelet count normalizes or when the platelet count increases?
Reactive thrombocytosis
What is the criteria for acute kidney injury based off serum Cr and urine output using the KDIGO criteria?
- Increase in serum Cr of ≥0.3 mg/dL within 48 hrs OR ≥50% within 7 days
- Urine output of <0.5 mL/kg/hr for >6 hours
Increase in serum Cr of 100-199% OR urine output <0.5 mL/kg/hr for 12-24 hrs is associated with what stage of acute kidney injury using KDIGO criteria?
Stage 2
A pt presenting with elevated K+ warrants what type of diagnostic study?
Baseline EKG
Common EKG findings associated w/ hyperkalemia?
- Tall peaked T waves
- Shrinking and then loss of P waves
- Widening of the QRS interval and then “sine wave,” ventricular arrhythmia, and asystole
What are 3 criteria for a pt to be considered a hyperkalemic emergency?
- Clinical manifestations or ECG changes
- Serum K+ of >6.5 mEq/L
- Serum K+ of >5.5 mEq/L + renal impairment and ongoing tissue breakdown or K+ absorption
What should be given to patients with a hyperkalemic emergency?
- Give calcium gluconate IV over 2-3 mins
- Give insulin and glucose (only give glucose if serum levels <250)
How should K+ be removed from body in pts with ESRD or severe renal impairment?
Hemodialysis
In hyperkalemic patients w/ severe renal impairment in whom dialysis cannot be swifty performed what should be used to remove K+ from body?
GI cation exchanger
In hyperkalemic pts that are nonoliguric and without severe renal impairment what can be given to remove K+ from body?
Diuretics (hypervolemic pts) or saline infusion w/ IV diuretics (i.e., furosemide)
The use of catheters for incontinence should be avoided in which population of patients?
Nursing home residents
Which pts are at a higher risk for CAUTI or mortality from catheterization?
- Women
- Elderly
- Pts w/ impaired immunity
Shold urinary catheters be used routinely in operative patients?
Use only as necessary, rather than routinely
What are 4 indications for the perioperative use of indwelling catheters?
1) Pt undergoing urological surgery or surgery on contiguos structures of GU tract
2) Anticipated prolonged duration of surgery
3) Pts anticipated to receive large-volume infusions of diuretics during procedure
4) Need for intraoperative monitoring of urinary output
Indwelling catheters are appropriately indicated in pts with what type of healing wounds?
Open sacral or perineal wounds in incontinent pts
What are 4 differential diagnoses for renal mass?
- Renal cell carcinoma
- Benign renal tumors: oncocytoma, angiomyolipoma, metanephric adenoma
- Metastatic disease
- Xanthogranulomatous pyelonephritis
What are some of the possible causes of atrophic kidney (renal hypoplasia) in utero?
- Vascular event
- Postrior urethral valves, VUR, UPJO
- ACE-I use
- Hyperglycemia/DM of mother
- Maternal Vit A deficiency
- Intrauterine growth retardation
What are some of the possible causes of atrophic kidney (renal hypoplasia) during first year of life?
- Persistent anorexia and vomiting
- Failure to thrive
What are some of the possible causes of atrophic kidney (renal hypoplasia) after first year of life?
- Frequent pyelonephritis
- Other disorders leading to renal scarring and ESRD
What are 4 accepted indications for the use of dialysis in pts w/ AKI?
- Fluid overload that is refractory to diuretics
- Hyperkalemia or rapidly rising K+ levels, refractory to intervention
- Metabolic acidosis, lactic acidosis or ketoacidosis, in whom HCO3- is not indicated or is not effective
- Signs of uremia, such as pericarditis, neuropathy, or otherwise unexplained decline in mental status
In pts with sepsis what needs to be done before giving Abx?
Blood cultures
SIRS is a response manifested by 2 or more of what 4 conditions including temperature, HR, RR, and WBC?
- Temp = >38 C or <36 C
- HR = >90 bpm
- RR = >20 breaths/min or PaCO2 <32 mmHg
- WBC count >12,000 uL, <4000/uL or >10% immature (band) forms
Which bacteria is the primary cause of “honeymoon” cystitis?
Staph saprophyticus
If previous urine cultures exist for patient presenting with UTI why is it important to look at them?
Often will be infected by same organism
What is the sympathetic level for viscerosomatics of the kidney?
T10-T11
What does “gravidity” and “parity” refer to for a woman?
- Gravidity = The # of times a woman has been pregnant
- Parity = the # of pregnancies that led to birth at or beyond 20 wks or of an infant weighing >500 grams
What is the parasympathetic innervation of the kidneys?
Vagus
What is the parasympathetic innervation for the upper 1/2 and the lower 1/2 of the ureters?
- Upper 1/2 = vagus
- Lower 1/2 = S2-S4
What are the sympathetic viscerosomatic levels for the upper 1/2 and lower 1/2 of ureters?
- Upper 1/2 = T10-T11
- Lower 1/2 = T12-L2
What is the sympathetic levels for the viscerosomatics of the bladder?
T12-L2
Pain tolerance in a patient with renal disease is lowered due to hyperactivity of which part of the ANS?
SNS
Where is the anterior chapman’s point for the kidneys?
1” above and 1” lateral to umbilicus
Where is the anterior chapman’s point for the bladder?
Periumbilical/umbilical
Where is the posterior chapman’s point for the bladder/urethra?
Superior edge of L2 TP
Where is the posterior chapman’s point for the kidney?
Intertransverse spaces between T12-L2
