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MHD II Test 4 > Clinical Introduction to Renal Disease > Flashcards

Clinical Introduction to Renal Disease Flashcards

1
Q

Major functions of the kidney (6)

A
  1. glomerular filtration
  2. excretion (metabolic by-products, drugs, toxins)
  3. Electrolyte and acid-vase homeostasis
  4. BP regulation
  5. Volume homeostasis
  6. Endocrine regulation(EPO, Vit D, renin)
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2
Q

Acid Base Values

  1. normal pH
  2. acidemia
  3. alkalemia
  4. acidosis
  5. alkalosis
A
  1. 7.35-7.45
  2. 7.35-7.40
  3. 7.40-7.45
  4. 7.45
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3
Q
  1. simple GFR equation
  2. What does MDRD stand for?
  3. When can these equations be used?
  4. When is MDRD not used?
A
  1. GFR= Ucre*V/Pcre
  2. Modification of Diet in Renal Disease
  3. in pts with stable renal function
  4. high/nl/near nl renal function, children, certain ethnic groups, pregnant women, unusual muscle mass, body habitus, or weight
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4
Q
  1. Fractional Excretion of Na equation (FE Na)
  2. Fraction Excretion of Urea (FE Urea)
  3. What are they useful for?
  4. What values for FeNA are useful?
  5. FE Urea?
A
  1. FE NA = (Una/Pna)/(Ucr/Pcr)*100
  2. FE Urea = (Uurea/Purea)/(Ucr/Pcr)*100
  3. determining the cause of acute kidney injury
  4. 2%, 1-2=indeterminate
  5. 35%
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5
Q

Volumes of

  1. Normal urine output
  2. Oligouria
  3. Anuria
  4. Polyuria
A
  1. 1500 mL/24 hours

2. 3000 mL/24 hrs

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6
Q
  1. Define Azotemia
  2. Define Uremia
  3. Symptoms/Signs
A
  1. elevation in renal indices (BUN, technically)
  2. clinical syndrome that can accompany kidney failure, usually when advanced and/or severe
  3. fatigue, anorexia, nausea, mental status changes, itching; serositis (pericarditis, pleural effusion); platelet dysfunction
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7
Q
  1. What is an acute decline in renal function called?
  2. What is a chronic decline in renal function called?
  3. What is the most advanced stage of renal dysfunction called?
A
  1. Acute Kidney Injury (AKI)
  2. Chronic Kidney disease (CKD)
  3. End Stage Renal Disease (ESRD)
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8
Q
  1. Define Acute Kidney Injury (3 criteria)
A
  1. abrupt reduction in kidney function, defined as:
    Increase in serum creatinine of >0.3 mg/dl
    OR
    Percentage increase in serum creatinine of 50%
    OR
    Oliguria of 6 hours
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9
Q 
1. Define Chronic Kidney Disease
Describe Stage and give GFR
2. Stage 1
3. Stage 2
4. Stage 3
5. Stage 4
6. Stage 5
A
  1. progressive decline in GFR over time (at least 3 months), with/without albuminemia
  2. kidney damage with nl or increased GFR (>=90)
  3. Kidney damage with mild decrease in GRF (60-89)
  4. Moderate drop in GFR (30-59)
  5. Severe drop in GFR (15-29); also has significant dysregulation of Fe, Vit D
  6. Kidney failure (<15)
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10
Q

Proteinuria

  1. Normal Urinary protein/Urinary Albumin
  2. Nephrotic range of Proteinuria
  3. How is it quantified?
A
  1. 3-3.5 gm/24 hrs

3. 24 hr urinary collection or random urine protein/creatinine ratio

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11
Q

Hematuria

  1. Types
  2. Locations or origins
  3. False +s
A
  1. Gross vs Microscopic (>= 2 RBC/hpf)
  2. Upper vs Lower Urinary Tract
  3. free Hb, myoglobin, menstrual contamination
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12
Q

Nephrolithiasis

  1. How does it present?
  2. Most common stones
  3. Treatment (2)
A
  1. moderate-severe renal colic
  2. calcium oxalate, Ca phosphate stones
  3. active stone management (medical vs interventional);
    Prevention of future stones (fluid intake/dietary changes, medications)
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13
Q

What can be in Abnormal Urinary Sediment (

A
  1. Hematuria
  2. Dysmorphic RBCs
  3. Pyuria
  4. Casts (RBC, WBC, Tubular)
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14
Q

Types of Tubular Casts and what they represent

A
  1. Epithelial casts (muddy brown casts)- acute tubular necrosis
  2. Fatty casts- lipiduria, usually seen in nephrotic syndrome
  3. Granular casts- CKD, nonspecific finding
  4. Hyaline casts- dehydration, exercise, diuretic therapy
  5. Waxy casts- advanced kidney disease
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15
Q

Describe Nephrotic Syndrome

A

> 3-3.5 gm protein/24 hours (lots of protein loss)
Hypoalbuminemia
Periphereral edema
Hyperlipidemia
Thrombophilia (lose antithrombin III –> DVTs)
Bland Urinary sediment
Noninflammatory renal biopsy

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16
Q

Describe Nephritic Syndrome

A

Inflammatory renal biopsy
Active urinary sediment (hematuria, dysmorphic RBCs, RBC casts)
Variable proteinuria
Azotemia, oliguria
Mild/moderate HTN
Other systemic features (vasculitis, arthralgias, myalgias)

17
Q

Common electrolyte imbalances in Acid-Base disease

A 
Hyper/hyponatremia
Hyper/hypochloremia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Anion gap metabolic acidosis
Non anion gap metabolic acidosis
18
Q

Blood Pressure Values

  1. Nl
  2. PreHTN
  3. Stage 1 HTN
  4. Stage 2 HTN
A
  1. =160 / >=100
19
Q

Secondary Causes of HTN

A 
Anatomic/Vascular causes
Endocrinopathies
Renal dieases, volume overloaded states
Pregnancy related diseases
Medications
20
Q
  1. What is total body water (TBW)?
  2. What is Intracellular water (ICW)?
  3. What is Extracellular water (ECW)?
  4. What is interstitial space (ISS)?
  5. What is plasma volume (PV)?
A
  1. 60% of total body weight
  2. 2/3 of TBW
  3. 1/3 of TBW
  4. 3/4 of ECW
  5. 1/4 of ECW
21
Q

Correction of Volume Depletion (3)

A
  1. Oral fluid replacement (mild/moderate depletion)
  2. IV Crystalloid solutions (disperse across ECW): 0.9% Normal saline or Lactated Ringers Solution
  3. IV colloid solutions (tend to remain within PV)- made of Packed RBCs, Albumin, Synthetic solutions (costly, impractical)
22
Q
  1. What is in 0.9% Normal saline?
  2. Who tends to use it?
  3. What is in Lactated Ringer’s Solution?
  4. Who tends to use it?
A
  1. Na and Cl
  2. medicine
  3. Na, Cl, lactate (replaces HCO3), K, Ca
  4. surgeons, if pt is given blood, it has citrate, which may bind Ca in pt’s blood, so ringer’s replaces it
23
Q

How is Volume Overload treated? (4)

A
  1. Fluid restriction
  2. Diuretic therapy (loop)
  3. Removal of accessible third space fluid (thoracentesis, paracentesis)
  4. Hemodialysis w/ ultrafiltration)
24
Q
  1. Role of Erythropoietin
  2. Role of Vitamin D
  3. What happens in advanced kidney disease to each? (2)
A
  1. regulates HGB/HCT concentrations
  2. regulates calcium absorption, maintains nl levels of Ca and Phosphorus
  3. chronic EPO deficiency–> anemia of chronic disease, typically normocytis
  4. Chronic hyperphosphatemia, decreased renal activation of vit D3 (1,25), hyperparathyroidism, renal osteodystrophy
25
Q
  1. What are some nonspecific signs seen in many forms of renal function?
  2. What renal function?
A
  1. fever/pain/rash/eosinophilia
  2. UTI, nephrolithiasis, renal infarction, papillary necrosis, renal cell carcinoma, Vasculitis (SLE, Wegener’s), cholesterol atheroembolic disease
26
Q
  1. How may AKI/CKD present?
  2. What may cause it?
  3. Management
A
  1. drug toxicity from renal dysfunction
  2. endogenous substances as well, such as insulin –> hypoglycemia
  3. drug dosage therapy, drug holiday; antidote therapy (digoxin), hemodialysis in certain circumstances (Li)
27
Q

How is Renal Dysfunction detected on

  1. History?
  2. PE?
  3. Lab
  4. Imaging studies
A
  1. symptoms of uremia or volume overload; fever, rash, pain in some instances, more global symptoms from a disease affecting multiple organ systems
  2. abnormal volume status (too wet/dry), abnormal BP, rashm synovitis, serositis, pulmonary/sinus findings, microvascular disease (retinopath, neuropathy)
  3. BUN/Creatinine, serum electrolytes, arterial blood gases, urinalysis, other tests (autoimmune)
  4. change in renal size/parenchyma, neoplastic or cystic changes, urinary obstruction findings
28
Q

Clinical Detection of Renal Dysfunction

  1. Biopsy Approaches
  2. What is done to specimen?
A
  1. percutaneous, transjugular

2. histology (H+E stain), IHC, electron microscopy

29
Q

Treatment of Renal Dysfunction

  1. Depends on
  2. What can happen?
A
  1. cause
  2. can be reversible
  3. may be irreversible, but can be stabilized and managed
  4. may progress to ESRD despite treatment, requiring renal replacement therapy (RRT)
30
Q

ESRD and RRT

  1. Hemodialysis methods
  2. Peritoneal Dialysis method
  3. Kidney Transplant from (3)
A
  1. AV Graft, AV Fistula, Central Venous catheter
  2. intra-abdominal catheter
  3. deceased-donor, living-related donor, living-unrelated donor

MHD II Test 4 (4 decks)

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