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Renal II > Clinical > Flashcards

Clinical Flashcards

1
Q

Sympathetics

A

Kidney: T10-L1
Ureters: T10-L1
Bladder: T10-L1
Urethra: L1-2

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2
Q

Parasympathetics

A 
Kidney: Vagus
Proximal 2/3 ureters: vagus
Distal 1/3 ureters: S2-4
Bladder: S2-4
Urethra: S2-4
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3
Q

Kidney Chapman’s

A

Anterior: 1 in lateral and superior to umbilicus
Posterior: L1 transverse processes

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4
Q

Bladder Chapman’s

A

Anterior: periumbilical
Posterior: L2 transverse processes

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5
Q

Urethra Chapman’s

A

Anterior: pubic tubercles
Posterior: L3 transverse processes

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6
Q

Prostate Chapman’s

A

Anterior: lateral IT bands
Posterior: PSIS

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7
Q

UTIs

A
  • More common in women
  • Infection = increased sympathetic tone > incomplete emptying, reflux, loss of NML urethral peristalsis
  • Tx of pelvic floor SDs
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8
Q

Chronic bacterial prostatitis is MCC of….. in men

A

Relapsing cystitis

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9
Q

3 sites of nephrolithiasis

A
  • uteropelvic junction
  • pelvic brim
  • bladder wall (ureterocystic junction)
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10
Q

Nephrolithiasis s/s

A

Flank pain w. costovertebral tenderness > can radiate to abdomen (upper), pain radiating to groin, testicle, or labia (lower), N/V

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11
Q

Pyelonephritis

A

upper UTI involving renal parenchyma and collecting system; recurrent infection can lead to chronic pyelonephritis

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12
Q

Pyelonephritis s/s

A

Fever, chills, flank pain; may present septic or with lower UTI symptoms

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13
Q

acute and chronic GN s/s

A

Edema, HTN, oliguria, hematuria, proteinria

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14
Q

acute and chronic prostatitis s/s

A

fever, chills, myalgia, arthralgia, dribbling and/or slow urinary stream, perineal and LBP; can get dysuria, hematuria, resultant cystitis

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15
Q

BPH s/s

A

Changes in urinary force and stream, polyuria, nocturia, urinary dribbling, urgency, urge incontinence; incomplete emptying of bladder

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16
Q

CI to visceral tx

A

renal abscesses, abdominal aneurysms, internal bleeding, infection uncontrolled by antibiotics

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17
Q

Definition of CKD

A

Kidney damage for >/= 3months w/ or w/o decreased GFR OR

GFR<60 for >/= 3 months w/ or w/o kidney damage

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18
Q

Kidney failure

A
  • Based on disease severity
  • GFR <15 or tx by dialysis
  • does not include kidney transplant recipients unless they meet above criteria
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19
Q

What are the 3 ways to assess kidney damage?

A

-Imaging
-Urine
-GFR
Any one of these can define it

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20
Q

ESRD

A
  • Based primarily on decision for tx

- basically people who are on dialysis given a different term for coding purposes

21
Q

Stages of CKD

A 
Stage 1: >90
Stage 2: 60-89
Stage 3a: 45-59
Stage 3b: 30-44
Stage 4: 15-29
Stage 5: <15
-Stage 3 usually moderate, 4 is severe, 5 is close to end-stage
22
Q

Why does creatinine clearance overestimate GFR?

A

It is freely filtered but some is secreted by the PCT

23
Q

Creatinine is higher in…

A

Men, younger, African Americans, more muscle mass, pt with advanced CKD

24
Q

Why is serum not used along in assessing CKD stage?

A

Not accurate index of kidney function

25
Q

eGFR

A

Best overall indices of level of kidney function > account for variables like age, gender, size, and race

26
Q

CKD-epi is as accurate as MDRD for GFR…

A

<60

27
Q

CKD-epi is more accurate than MDRD for GFR…

A

> 60

28
Q

MDRD is especially helpful for…

A

over-diagnosis of CKD especially in elderly patients

29
Q

Exceptions for when 24-hour urine is more accurate

A

-Extremes of age, weight, diet (vegetarian creatinine supplements), amputated limbs, determine need for dialysis, pregnancy

30
Q

NML protein

A

<150mg/day

31
Q

NML albumin

A

<30mg/day

32
Q

What type of specimen is preferred for proteinuria?

A

First morning void

33
Q

If a dipstick is + must confirm with _______ ________ within 3 months

A

quantitative measurement > Protein (or albumin) to creatinine ratio

34
Q

Persistent proteinuria

A

> /= 2 quantitative tests spaced by 1-2 weeks > should undergo further eval of CKD

35
Q

Non-modifiable risk factors for progression of CKD

A
  • Cause: faster = diabetes, glomerular, polycystic; slower = HTN, tubulointerstitial
  • African American
  • Lower baseline function
  • Male
  • Older
36
Q

Modifiable risk factors for progression

A
  • Proteinuria
  • HTN
  • uncontrolled DM
  • smoking
  • lipid lowering, partial correction of anemia, dietary protein restriction (inconclusive)
37
Q

Common causes of acute decline in GFR

A
  • Volume depletion
  • nephrotoxins (IV contrast, antimicrobials, NSAIDs, ACEI/ARB, CNIs)
  • obstruction
38
Q

Traditional CV risk factors of CKD (much larger absolute increases in risk in development)

A

HTN, DM, hyperlipidemia, smoking, old age

39
Q

When do you measure Scr more than yearly?

A
  • GFR<60
  • GFR decline >4/year
  • risk factors for fast progression
  • ongoing tx to slow progression
  • exposure to risk for acute GFR decline
40
Q

Statins if one or more of…

A

known CAD, DM, prior ischemic CVA, estimated 10 year incidence of coronary death or non-fatal MI is <10%

41
Q

2nd leading cause of ESRD in US

A

HTN

42
Q

HTN target

A

<140/90

<130/80 if microalbuminuria or proteinuria

43
Q

Tx of HTN

A
  • Lifestyle and low salt
  • ACEI/ARB > direct effect on glomerulus > decrease rate of progression (esp with proteinuria) NOT COMBINED; becomes less effective with worse kidney function
  • thiazides not for GFR<40 > use loops
  • combo therapy usual
44
Q

Leading cause of ESRD in US

A

Diabetes

45
Q

HbA1c target

A

<7% but don’t be overzealous

46
Q

CKD management in diabetes

A
  • BP control
  • ACEI/ARB unless CI
  • lifestyle, diet
  • identify and treat proteinuria
47
Q

CKD complications

A

HTN, DM, proteinuria, hyperlipidemia, anemia, bone mineral metabolism, acid base, nutrition, neuropathy

48
Q

Physiology of anemia in CKD

A

peritubular area of kidney produces erythropoietin > kidney damaged = less erythropoietin

Renal II (1 decks)

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