Clinical Approach to Renal

Question 1

Common causes of AKI

Answer 1

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

Question 2

Drop in Blood Pressure or ECV leads to:

Answer 2

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

Question 3

Risk Factors for Post-renal failure

Answer 3

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

Question 4

Post interventional sequelae for post renal failure

Answer 4

• post obstructive diuresis

- hyperkalemic, hyperchloremic RTA

Question 5

Clinical features of ATN

Answer 5

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

Question 6

Classic Triad for Acute Interstitial Nephritis

Answer 6

• fever
• peripheral eosinophilia
• rash

Question 7

AKI History

Answer 7

• 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

Question 8

AKI Chart Review

Answer 8

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

Question 9

AKI Physical Exam

Answer 9

-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

Question 10

AKI Lab Review

Answer 10

• Renal Indices (BUN/creatinine)

- Urinalysis and urine indices

Question 11

AKI Imaging Review

Answer 11

Renal Ultrasound

Question 12

Pitfall of Creatinine in AKI

Answer 12

• AKI is not a steady state condition

- poor estimate of GFR

Question 13

What are the complications in AKI?

Answer 13

• electrolyte derangement
• metabolic acidosis
• pulmonary edema

Question 14

General Indications for Hemodialysis

Answer 14

AEIOU

• Acidosis
• Electrolyte Derangement
• Intoxication
• Overload
• Uremia

Question 15

Risk Factors for CKD

Answer 15

• HTN
• Diabetes
• African American

Question 16

CKD Stage 1 Description

Answer 16

Kidney damage with normal or increased GFR

Question 17

CKD Stage 1 GFR

Answer 17

over 90

Question 18

CKD Stage 2 Description

Answer 18

Kidney damage with mild in GFR

Question 19

CKD Stage 2 GFR

Answer 19

60-89

Question 20

CKD Stage 3 Description

Answer 20

Moderate decrease in GFR

Question 21

CKD Stage 3 GFR

Answer 21

30-59

Question 22

CKD Stage 4 Description

Answer 22

Severe decrease in GFR

Question 23

CKD Stage 4 GFR

Answer 23

15-29

Question 24

CKD Stage 5 Description

Answer 24

Kidney Failure

Question 25

CKD Stage 5 GFR

Answer 25

Under 15

Question 26

What is renovascular hypertension?

Answer 26

-secondary HTN due to renal artery stenosis

Question 27

Cholesterol Atheroembolic Disease

Answer 27

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

Question 28

CKD Stage 2 & 3 Management

Answer 28

- conservative renoprotection - promote healthy living, BP, glycemic, and lipid control - ACE inhibitors/ARBs

Question 29

CKD Stage 4 Management

Answer 29

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

Question 30

Imposters of Hematuria

Answer 30

- hemoglobinurin - myoglobinuria - menstrual contamination

Question 31

Risk factors for urologic cancer

Answer 31

- cigarette smoking - occupational exposures - phenacetin use (analgesic) - Aristolochic acid (herbal diet)

Question 32

Evaluation of glomerular hematuria will reveal?

Answer 32

- RBC cast - dysmorphic RBCs - proteinuria - elevated renal indices

Question 33

What imaging is used to evaluate upper tract?

Answer 33

CT Urogram

Question 34

How to evaluate patients' microscopic hematuria based on age

Answer 34

- 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

Question 35

Population with highest rates of nephrolithiasis

Answer 35

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

Question 36

Causes of Calcium stones

Answer 36

- hypercalciuria - chronic metabolic acidosis - low urine volume - hyeruricosuria - hyperoxaluria - hypocitraturia - high protein, low carbohydrate diets

Question 37

Radiologic evaluation for nephrolithiasis

Answer 37

CT scan without contrast

Question 38

Laboratory evaluation for nephrolithiasis

Answer 38

- 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)

Question 39

Nephrolithiasis management

Answer 39

-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.

Question 40

Future stone prevention

Answer 40

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

Question 41

Future calcium stone prevention

Answer 41

- Low sodium - normal dietary calcium - thiazide diuretic

Question 42

Future uric acid stone prevention

Answer 42

- Low purine diet | - medication: sodium bicarbonate, potassium citrate to alkalinize urine

Question 43

Some foods with calcium

Answer 43

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

Question 44

Foods high in Purines

Answer 44

Meats, such as seafood and shellfish | alcohol

Question 45

Foods high in Oxalate

Answer 45

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