Clinical

Question 1

Sympathetics

Answer 1

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

Question 2

Parasympathetics

Answer 2

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

Question 3

Kidney Chapman’s

Answer 3

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

Question 4

Bladder Chapman’s

Answer 4

Anterior: periumbilical
Posterior: L2 transverse processes

Question 5

Urethra Chapman’s

Answer 5

Anterior: pubic tubercles
Posterior: L3 transverse processes

Question 6

Prostate Chapman’s

Answer 6

Anterior: lateral IT bands
Posterior: PSIS

Question 7

UTIs

Answer 7

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

Question 8

Chronic bacterial prostatitis is MCC of….. in men

Answer 8

Relapsing cystitis

Question 9

3 sites of nephrolithiasis

Answer 9

• uteropelvic junction
• pelvic brim
• bladder wall (ureterocystic junction)

Question 10

Nephrolithiasis s/s

Answer 10

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

Question 11

Pyelonephritis

Answer 11

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

Question 12

Pyelonephritis s/s

Answer 12

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

Question 13

acute and chronic GN s/s

Answer 13

Edema, HTN, oliguria, hematuria, proteinria

Question 14

acute and chronic prostatitis s/s

Answer 14

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

Question 15

BPH s/s

Answer 15

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

Question 16

CI to visceral tx

Answer 16

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

Question 17

Definition of CKD

Answer 17

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

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

Question 18

Kidney failure

Answer 18

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

Question 19

What are the 3 ways to assess kidney damage?

Answer 19

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

Question 20

ESRD

Answer 20

• Based primarily on decision for tx

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

Question 21

Stages of CKD

Answer 21

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

Question 22

Why does creatinine clearance overestimate GFR?

Answer 22

It is freely filtered but some is secreted by the PCT

Question 23

Creatinine is higher in…

Answer 23

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

Question 24

Why is serum not used along in assessing CKD stage?

Answer 24

Not accurate index of kidney function

Question 25

eGFR

Answer 25

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

Question 26

CKD-epi is as accurate as MDRD for GFR...

Answer 26

<60

Question 27

CKD-epi is more accurate than MDRD for GFR...

Answer 27

>60

Question 28

MDRD is especially helpful for...

Answer 28

over-diagnosis of CKD especially in elderly patients

Question 29

Exceptions for when 24-hour urine is more accurate

Answer 29

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

Question 30

NML protein

Answer 30

<150mg/day

Question 31

NML albumin

Answer 31

<30mg/day

Question 32

What type of specimen is preferred for proteinuria?

Answer 32

First morning void

Question 33

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

Answer 33

quantitative measurement > Protein (or albumin) to creatinine ratio

Question 34

Persistent proteinuria

Answer 34

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

Question 35

Non-modifiable risk factors for progression of CKD

Answer 35

- Cause: faster = diabetes, glomerular, polycystic; slower = HTN, tubulointerstitial - African American - Lower baseline function - Male - Older

Question 36

Modifiable risk factors for progression

Answer 36

- Proteinuria - HTN - uncontrolled DM - smoking - lipid lowering, partial correction of anemia, dietary protein restriction (inconclusive)

Question 37

Common causes of acute decline in GFR

Answer 37

- Volume depletion - nephrotoxins (IV contrast, antimicrobials, NSAIDs, ACEI/ARB, CNIs) - obstruction

Question 38

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

Answer 38

HTN, DM, hyperlipidemia, smoking, old age

Question 39

When do you measure Scr more than yearly?

Answer 39

- GFR<60 - GFR decline >4/year - risk factors for fast progression - ongoing tx to slow progression - exposure to risk for acute GFR decline

Question 40

Statins if one or more of...

Answer 40

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

Question 41

2nd leading cause of ESRD in US

Answer 41

HTN

Question 42

HTN target

Answer 42

<140/90 | <130/80 if microalbuminuria or proteinuria

Question 43

Tx of HTN

Answer 43

- 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

Question 44

Leading cause of ESRD in US

Answer 44

Diabetes

Question 45

HbA1c target

Answer 45

<7% but don't be overzealous

Question 46

CKD management in diabetes

Answer 46

- BP control - ACEI/ARB unless CI - lifestyle, diet - identify and treat proteinuria

Question 47

CKD complications

Answer 47

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

Question 48

Physiology of anemia in CKD

Answer 48

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