CIS 3: Renal Case

Question 1

Where is the most accurate place on the body to check skin turgor?

Answer 1

Forehead

Question 2

What are 2 acute phase reactants which decrease during inflammation/infectiojn?

Answer 2

• Albumin
• Transferrin

Question 3

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?

Answer 3

Reactive thrombocytosis

Question 4

What is the criteria for acute kidney injury based off serum Cr and urine output using the KDIGO criteria?

Answer 4

• 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

Question 5

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?

Answer 5

Stage 2

Question 6

A pt presenting with elevated K+ warrants what type of diagnostic study?

Answer 6

Baseline EKG

Question 7

Common EKG findings associated w/ hyperkalemia?

Answer 7

• Tall peaked T waves
• Shrinking and then loss of P waves
• Widening of the QRS interval and then “sine wave,” ventricular arrhythmia, and asystole

Question 8

What are 3 criteria for a pt to be considered a hyperkalemic emergency?

Answer 8

1. Clinical manifestations or ECG changes
2. Serum K+ of >6.5 mEq/L
3. Serum K+ of >5.5 mEq/L + renal impairment and ongoing tissue breakdown or K+ absorption

Question 9

What should be given to patients with a hyperkalemic emergency?

Answer 9

• Give calcium gluconate IV over 2-3 mins
• Give insulin and glucose (only give glucose if serum levels <250)

Question 10

How should K+ be removed from body in pts with ESRD or severe renal impairment?

Answer 10

Hemodialysis

Question 11

In hyperkalemic patients w/ severe renal impairment in whom dialysis cannot be swifty performed what should be used to remove K+ from body?

Answer 11

GI cation exchanger

Question 12

In hyperkalemic pts that are nonoliguric and without severe renal impairment what can be given to remove K+ from body?

Answer 12

Diuretics (hypervolemic pts) or saline infusion w/ IV diuretics (i.e., furosemide)

Question 13

The use of catheters for incontinence should be avoided in which population of patients?

Answer 13

Nursing home residents

Question 14

Which pts are at a higher risk for CAUTI or mortality from catheterization?

Answer 14

• Women
• Elderly
• Pts w/ impaired immunity

Question 15

Shold urinary catheters be used routinely in operative patients?

Answer 15

Use only as necessary, rather than routinely

Question 16

What are 4 indications for the perioperative use of indwelling catheters?

Answer 16

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

Question 17

Indwelling catheters are appropriately indicated in pts with what type of healing wounds?

Answer 17

Open sacral or perineal wounds in incontinent pts

Question 18

What are 4 differential diagnoses for renal mass?

Answer 18

• Renal cell carcinoma
• Benign renal tumors: oncocytoma, angiomyolipoma, metanephric adenoma
• Metastatic disease
• Xanthogranulomatous pyelonephritis

Question 19

What are some of the possible causes of atrophic kidney (renal hypoplasia) in utero?

Answer 19

• Vascular event
• Postrior urethral valves, VUR, UPJO
• ACE-I use
• Hyperglycemia/DM of mother
• Maternal Vit A deficiency
• Intrauterine growth retardation

Question 20

What are some of the possible causes of atrophic kidney (renal hypoplasia) during first year of life?

Answer 20

• Persistent anorexia and vomiting
• Failure to thrive

Question 21

What are some of the possible causes of atrophic kidney (renal hypoplasia) after first year of life?

Answer 21

• Frequent pyelonephritis
• Other disorders leading to renal scarring and ESRD

Question 22

What are 4 accepted indications for the use of dialysis in pts w/ AKI?

Answer 22

• 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

Question 23

In pts with sepsis what needs to be done before giving Abx?

Answer 23

Blood cultures

Question 24

SIRS is a response manifested by 2 or more of what 4 conditions including temperature, HR, RR, and WBC?

Answer 24

• 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

Question 25

Which bacteria is the primary cause of “honeymoon” cystitis?

Answer 25

Staph saprophyticus

Question 26

If previous urine cultures exist for patient presenting with UTI why is it important to look at them?

Answer 26

Often will be infected by same organism

Question 27

What is the sympathetic level for viscerosomatics of the kidney?

Answer 27

T10-T11

Question 28

What does “gravidity” and “parity” refer to for a woman?

Answer 28

- 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

Question 29

What is the parasympathetic innervation of the kidneys?

Answer 29

Vagus

Question 30

What is the parasympathetic innervation for the upper 1/2 and the lower 1/2 of the ureters?

Answer 30

• Upper 1/2 = vagus
• Lower 1/2 = S2-S4

Question 31

What are the sympathetic viscerosomatic levels for the upper 1/2 and lower 1/2 of ureters?

Answer 31

• Upper 1/2 = T10-T11
• Lower 1/2 = T12-L2

Question 32

What is the sympathetic levels for the viscerosomatics of the bladder?

Answer 32

T12-L2

Question 33

Pain tolerance in a patient with renal disease is lowered due to hyperactivity of which part of the ANS?

Answer 33

SNS

Question 34

Where is the anterior chapman’s point for the kidneys?

Answer 34

1” above and 1” lateral to umbilicus

Question 35

Where is the anterior chapman’s point for the bladder?

Answer 35

Periumbilical/umbilical

Question 36

Where is the posterior chapman’s point for the bladder/urethra?

Answer 36

Superior edge of L2 TP

Question 37

Where is the posterior chapman’s point for the kidney?

Answer 37

Intertransverse spaces between T12-L2