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MHD Renal Block > Clinical Approach to Renal > Flashcards

Clinical Approach to Renal Flashcards

1
Q

Common causes of AKI

A
  • Pre renal azotemia
  • Ischemia ATN
  • 75% of all cases of AKI
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2
Q

Drop in Blood Pressure or ECV leads to:

A
  • Vasodilation of pre-glomerular arterioles (antagonized by NSAIDs)
  • Vasoconstriction of post-glomerular arterioles (antagonized by ACE-I/ARB)
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3
Q

Risk Factors for Post-renal failure

A
  • older men with prostate disease
  • solitary kidney
  • intra-abdominal cancer
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4
Q

Post interventional sequelae for post renal failure

A
  • post obstructive diuresis

- hyperkalemic, hyperchloremic RTA

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5
Q

Clinical features of ATN

A
  • gross appearance of urine (dirty or muddy brown)
  • oliguric phase
  • polyuric phase
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6
Q

Classic Triad for Acute Interstitial Nephritis

A
  • fever
  • peripheral eosinophilia
  • rash
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7
Q

AKI History

A
  • illness or trauma?
  • oral intake?
  • vomiting or diarrhea?
  • insensible water loss?
  • new meds or doses?
  • recent med procedures/IV dye use?
  • rash, joint pain, pulm symptoms
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8
Q

AKI Chart Review

A

-weight trends
-intake/output trends
-BP trends
O2 Sat (including from surgery)

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9
Q

AKI Physical Exam

A 
-Too wet?
Abdominojugular reflux
s3 gallop
ascites
peripheral edema
-Too dry?
dry mucous membranes
skin tenting (only useful if positive in adults)
neck veins flat at 0 degrees
signs of shock
-Urine Color
Bloody?
Muddy?
Dark yellow/conc.?
-Urinary retention
fullness/dullness on suprapubic exam
enlarged prostate on rectal exam
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10
Q

AKI Lab Review

A
  • Renal Indices (BUN/creatinine)

- Urinalysis and urine indices

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11
Q

AKI Imaging Review

A

Renal Ultrasound

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12
Q

Pitfall of Creatinine in AKI

A
  • AKI is not a steady state condition

- poor estimate of GFR

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13
Q

What are the complications in AKI?

A
  • electrolyte derangement
  • metabolic acidosis
  • pulmonary edema
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14
Q

General Indications for Hemodialysis

A

AEIOU

  • Acidosis
  • Electrolyte Derangement
  • Intoxication
  • Overload
  • Uremia
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15
Q

Risk Factors for CKD

A
  • HTN
  • Diabetes
  • African American
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16
Q

CKD Stage 1 Description

A

Kidney damage with normal or increased GFR

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17
Q

CKD Stage 1 GFR

A

over 90

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18
Q

CKD Stage 2 Description

A

Kidney damage with mild in GFR

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19
Q

CKD Stage 2 GFR

A

60-89

20
Q

CKD Stage 3 Description

A

Moderate decrease in GFR

21
Q

CKD Stage 3 GFR

A

30-59

22
Q

CKD Stage 4 Description

A

Severe decrease in GFR

23
Q

CKD Stage 4 GFR

A

15-29

24
Q

CKD Stage 5 Description

A

Kidney Failure

25
Q

CKD Stage 5 GFR

A

Under 15

26
Q

What is renovascular hypertension?

A

-secondary HTN due to renal artery stenosis

27
Q

Cholesterol Atheroembolic Disease

A

-Fever, malaise, digital gangrene, characteristic rash (lived reticular), renal failure

28
Q

CKD Stage 2 & 3 Management

A
  • conservative renoprotection
  • promote healthy living, BP, glycemic, and lipid control
  • ACE inhibitors/ARBs
29
Q

CKD Stage 4 Management

A
  • Goal BP (130/80)
  • Low Salt diet
  • ACE-I/ARB first line
  • Adjuncts: BBs, CCBs
  • Goal is less than 300mg
30
Q

Imposters of Hematuria

A
  • hemoglobinurin
  • myoglobinuria
  • menstrual contamination
31
Q

Risk factors for urologic cancer

A
  • cigarette smoking
  • occupational exposures
  • phenacetin use (analgesic)
  • Aristolochic acid (herbal diet)
32
Q

Evaluation of glomerular hematuria will reveal?

A
  • RBC cast
  • dysmorphic RBCs
  • proteinuria
  • elevated renal indices
33
Q

What imaging is used to evaluate upper tract?

A

CT Urogram

34
Q

How to evaluate patients’ microscopic hematuria based on age

A
  • under 50 with no risk factors for urologic cancer. Perform cytology of urine. workup ends if negative, cytoscopy if neoplastic cells are seen
  • over 50 or with risk factors for urologic cancer. price cytology and cytoscopy. work up ends if both negative.
  • GROSS hematuria always gets full work up
35
Q

Population with highest rates of nephrolithiasis

A

Old white males in the south (/southwest) during summer

36
Q

Causes of Calcium stones

A
  • hypercalciuria
  • chronic metabolic acidosis
  • low urine volume
  • hyeruricosuria
  • hyperoxaluria
  • hypocitraturia
  • high protein, low carbohydrate diets
37
Q

Radiologic evaluation for nephrolithiasis

A

CT scan without contrast

38
Q

Laboratory evaluation for nephrolithiasis

A
  • retrieving stone is crucial
  • iPTH level if hypercalcemia or hypercalciuria
  • full metabolic 24 hour workup (2 consecutive 24 hour urine collection 6 weeks after stone event)
39
Q

Nephrolithiasis management

A

-for stones under 5 mm, medical therapy is reasonable.
control pain with Analgesia (NSAIDs/opiates in RCT)
oral intake of 2-3L/day
tansulosin
-for stones over 6 mm, not passing after 4 weeks, or associated UTI/obstruction, then INTERVENTIONAL therapy.

40
Q

Future stone prevention

A
  • increase daily fluid
  • 2-3L/day (preferably water)
  • double urine output
41
Q

Future calcium stone prevention

A
  • Low sodium
  • normal dietary calcium
  • thiazide diuretic
42
Q

Future uric acid stone prevention

A
  • Low purine diet

- medication: sodium bicarbonate, potassium citrate to alkalinize urine

43
Q

Some foods with calcium

A 
-dairy products
yogurt
sardines
dark leafy greens
fortified cereal, soy milk and OJ
soybeans, breads, grains
44
Q

Foods high in Purines

A

Meats, such as seafood and shellfish

alcohol

45
Q

Foods high in Oxalate

A 
Black tea
Chocolate
soy milk
Nuts
Berries
Beans, spinach, okra
Carrots
Sweet potatoes
celery

MHD Renal Block (4 decks)

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