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CRP- Renal > Clinical Evaluation of Kidney Disease > Flashcards

Clinical Evaluation of Kidney Disease Flashcards

1
Q

Which kidney is higher and larger?

A

the left

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2
Q

**What must we always ask when doing a clinical history for the kidney?

A
  1. Do you have DM? If so, how long?
  2. Do you have HTN? If so, how long?
  3. Do you have renal disease (glomerular, tubular, cystic).
  4. Do you have atherosclerotic disease?
  5. Pregnancy history (toxemia, proteinuria, HTN/preeclampsia)?
  6. Infections, stones, obstructions?
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3
Q

What should we ask about urinary symptoms?

A
  • frequency, urgency, nocturia, dysuria

- urinary stream in men (can they put out a fire).

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4
Q

**What else is important to ask about the pts history?

A
  • surgical history
  • family history
  • occupational exposure (metals like lead, solvents…)
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5
Q

***What will hypertensive retinopathy look like on fundoscopic examination?

A
  • flame hemorrhage
  • papilledema
  • hard exudates
  • cotton wool spots
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6
Q

**What is a basic metabolic profile (BMP) or chem7?

A
  • Na+, K+, Cl-, CO2 (weirdly they call this bicarb; CO2=HCO3), blood urea nitrogen (BUN), creatinine, glucose, Ca2+
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7
Q

What is very important, but not included in the BMP?

A

Mg2+ and phosphorus

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8
Q

What does the complete metabolic profile (CMP) include in addition to the BMP?

A
  • total protein, albumin, alkaline, phosphatase, total bilirubin, AST, ALT
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9
Q

How do you determine your BUN?

A

GFR and catabolism. BUN is freely filtered in the glomerulus and reabsorbed in the PCT.
*This is one way we look at kidney function via GFR.

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10
Q

What does an elevated creatinine indicate?

A
  • decrease in GFR.
  • remember this is a byproduct of muscle metabolism that is freely filtered by the glomerulus and can also be SECRETED in the PCT.
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11
Q

**What will happen to serum creatinine levels with age, sex, race, diet, body habitus, and medications, respectively?
(TEST QUESTION)

A
  • age= decrease
  • female sex= decrease
  • african race= increase
  • vegetarian diet= decrease
  • meat diet= increase
  • obesity= no change
  • trimethoprim (bactrim), gemfibrozil, and cephalosporins= increase
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12
Q

What are the 2 main determinants of GFR?

A
  1. glomerular capillary pressure (afferent/efferent arterioles).
  2. characteristics of glomerular basement membrane
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13
Q

What 8 main factors can affect GFR?

A
  1. kidney disease
  2. pregnancy (inc GFR due to inc blood volume, but remember decreased creatinine).
  3. reduced kidney perfusion
  4. extracellular fluid volume
  5. NSAIDS
  6. protein load/intake
  7. blood glucose
  8. arterial blood pressure
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14
Q

What GFR formula is used most often?

A

MDRD (Levey) formula

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15
Q

How much volume does the kidney get each day?

A

180 L

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16
Q

How much urine do you produce form this 180 L per day?

A

1 or 2 L

17
Q

Are all creatinines created equal?

A

NO. Remember females will be lower.

18
Q

**Is the severity of renal decline much greater at LOWER values than higher values?
(TEST QUESTION)

A

YES!!! See graph on written paper.

19
Q

**What are the normal values for a urinalysis?

A
  • color= yellow
  • clarity= clear
  • pH= 5.0-9.0
  • ketones= negative
  • specific gravity= 1.003 (max dilute) - 1.035 (max concentrated) or osmolality= (30 - 1200).
  • glucose= negative
  • protein= negative (
20
Q

Are spot urines important?

A

clinically they are the best

21
Q

What patients are at risk for proteinuria (kidney disease)?

A
  • DM
  • hypertension
  • family history of kidney disease
  • Use MICROALBUMIN/CREATININE ratio test. If >30 micrograms/mg, consult nephrology.
22
Q

What test should we run for evaluation of proteinuria in pts who are not at risk for proteinuria?

A

standard dipstick is fine. If +1 or more, nephrology consultation is necessary.

23
Q

What can happen if you ignore proteinuria?

A

progressive renal failure

24
Q

What is an RTE cast?

A

protein matrix (tamm horsfall protein) that mirrors or is a reflection of the tubule. This is not a pathologic protein.

25
Q

***With what is a WBC cast associated?

A

interstitial nephritis.

*This can be caused by nonsteroidals.

26
Q

What imaging techniques use contrast, which can be detrimental to the kidney?

A

CAT scan, intravenous pyelogram, MRI (using gadolinium), angiography, nuclear medicine scan

27
Q

**How can a nuclear isotope show us a renal obstruction?

TEST QUESTION

A

You can look at the right and left kidney, each taking on the isotope, and how quickly each excretes it. If one kidney does not excrete it as quickly, then there is likely an obstruction.

28
Q

What is renal pain?

A
  • inflammation and distention of the capsule.
  • dull visceral pain
  • colicky= stones possibly
  • groin radiation
29
Q

What are the sympathetics to the kidney?

A

T6- 10

30
Q

What are the 2 types of dialysis?

A
  1. hemodialysis= cleans the blood via blood to blood connections.
  2. peritoneal dialysis= fluid based that goes into the peritoneal space
31
Q

What happens with hemodialysis?

A

surgical team creates a fistula between the cephalic vein and brachial artery (brachiocephalic fistula), which will increase the size of the vein overtime, in order to more easily access the vein for weekly procedures.

32
Q

What does all of the work in dialysis?

A

dialyzer which cleans the blood

CRP- Renal (19 decks)

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