Clinical Evaluation of Kidney Disease Flashcards
Which kidney is higher and larger?
the left
**What must we always ask when doing a clinical history for the kidney?
- Do you have DM? If so, how long?
- Do you have HTN? If so, how long?
- Do you have renal disease (glomerular, tubular, cystic).
- Do you have atherosclerotic disease?
- Pregnancy history (toxemia, proteinuria, HTN/preeclampsia)?
- Infections, stones, obstructions?
What should we ask about urinary symptoms?
- frequency, urgency, nocturia, dysuria
- urinary stream in men (can they put out a fire).
**What else is important to ask about the pts history?
- surgical history
- family history
- occupational exposure (metals like lead, solvents…)
***What will hypertensive retinopathy look like on fundoscopic examination?
- flame hemorrhage
- papilledema
- hard exudates
- cotton wool spots
**What is a basic metabolic profile (BMP) or chem7?
- Na+, K+, Cl-, CO2 (weirdly they call this bicarb; CO2=HCO3), blood urea nitrogen (BUN), creatinine, glucose, Ca2+
What is very important, but not included in the BMP?
Mg2+ and phosphorus
What does the complete metabolic profile (CMP) include in addition to the BMP?
- total protein, albumin, alkaline, phosphatase, total bilirubin, AST, ALT
How do you determine your BUN?
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.
What does an elevated creatinine indicate?
- 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.
**What will happen to serum creatinine levels with age, sex, race, diet, body habitus, and medications, respectively?
(TEST QUESTION)
- age= decrease
- female sex= decrease
- african race= increase
- vegetarian diet= decrease
- meat diet= increase
- obesity= no change
- trimethoprim (bactrim), gemfibrozil, and cephalosporins= increase
What are the 2 main determinants of GFR?
- glomerular capillary pressure (afferent/efferent arterioles).
- characteristics of glomerular basement membrane
What 8 main factors can affect GFR?
- kidney disease
- pregnancy (inc GFR due to inc blood volume, but remember decreased creatinine).
- reduced kidney perfusion
- extracellular fluid volume
- NSAIDS
- protein load/intake
- blood glucose
- arterial blood pressure
What GFR formula is used most often?
MDRD (Levey) formula
How much volume does the kidney get each day?
180 L
How much urine do you produce form this 180 L per day?
1 or 2 L
Are all creatinines created equal?
NO. Remember females will be lower.
**Is the severity of renal decline much greater at LOWER values than higher values?
(TEST QUESTION)
YES!!! See graph on written paper.
**What are the normal values for a urinalysis?
- 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 (
Are spot urines important?
clinically they are the best
What patients are at risk for proteinuria (kidney disease)?
- DM
- hypertension
- family history of kidney disease
- Use MICROALBUMIN/CREATININE ratio test. If >30 micrograms/mg, consult nephrology.
What test should we run for evaluation of proteinuria in pts who are not at risk for proteinuria?
standard dipstick is fine. If +1 or more, nephrology consultation is necessary.
What can happen if you ignore proteinuria?
progressive renal failure
What is an RTE cast?
protein matrix (tamm horsfall protein) that mirrors or is a reflection of the tubule. This is not a pathologic protein.
