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Step Up To Medicine > Diseases Of The Renal And Genitourinary System > Flashcards

Diseases Of The Renal And Genitourinary System Flashcards

1
Q

What is acute kidney injury?

A

A rapid decline in renal function, with a sudden increase in BUN and serum creatinine level.

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2
Q

What is the most common cause of acute kidney injury?

A

Prerenal failure, in which there is a decrease in systemic arterial blood volume or renal perfusion leading to renal ischemia.

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3
Q

What are the laboratory findings of prerenal failure?

A
  1. Oligouria
  2. Increased BUN-to-serum Cr ratio, >20:1
  3. Increased urine osmolality, >500 mOsm
  4. Decreased urine Na, <20
  5. Increased urine-plasma Cr ratio, >40:1
  6. FENa <1%
  7. Hyaline casts in urinalysis
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4
Q

What is the end result if hypoperfusion from prerenal failure persists?

A

Ischemia results and can lead to acute tubular necrosis, which is manifested by increased urine Na >40.

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5
Q

What are the laboratory findings of intrinsic failure?

A
  1. Decreased BUN-to-serum Cr ratio, <20:1
  2. Decreased urine osmolality, <350 mOsm
  3. Increased urine Na, >40
  4. Decreased urine-plasma Cr ratio, <20:1
  5. FENa >2-3%
  6. Abnormal urinalysis findings depending on the underlying cause
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6
Q

What are the 3 basic tests for postrenal failure?

A
  1. Physical examination: palpate the bladder
  2. Ultrasound: look for obstruction, hydronephrosis
  3. Catheter: look for large volume of urine
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7
Q

What tests are obtained for any patients with acute kidney injury?

A
  1. Urinalysis
  2. Urine chemistry
  3. Serum electrolytes
  4. Bladder catheterization to rule out obstruction
  5. Renal ultrasound to look for obstruction
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8
Q

What are the indications for urgent dialysis?

A

AEIOU
1. Acidosis
2. Electrolytes
3. Intoxications
4. Volume Overload
5. Uremia

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9
Q

What is chronic kidney disease?

A

Defined as either decreased kidney function or kidney damage for at least 3 months regardless of cause.

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10
Q

What are the most common causes of chronic kidney disease?

A

Diabetes and HTN

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11
Q

How is chronic kidney disease diagnosed?

A
  1. Urinalysis: examine sediment
  2. Measure Cr clearance to estimate GFR
  3. CBC: for anemia, thrombocytopenia, infection
  4. Serum electrolytes and ABG
  5. Renal ultrasound
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12
Q

What are the life-threatening complications in CKD?

A
  1. Hyperkalemia
  2. Pulmonary edema secondary to volume overload
  3. Infection
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13
Q

What are the findings on physical examination that indicate a patent arteriovenous fistula?

A

An audible bruit and a palpable thrill. The arm that has the AV fistula should not be used for drawing blood or BP measurement.

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14
Q

What are the advantages and disadvantages of hemodialysis?

A

Advantages:
1. More efficient than peritoneal dialysis
2. Can be initiated more quickly than peritoneal dialysis

Disadvantages:
1. It is less similar to the natural kidney function
2. Requires vascular access which increases risk of infections, aneurysms and thrombosis

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15
Q

What are the contraindications of hemodialysis?

A
  1. Patient refusal
  2. Severe cardiac diseases
  3. End-stage liver disease
  4. Advanced malignancy
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16
Q

What are the advantages and disadvantages of peritoneal dialysis?

A

Advantages:
1. Patient can learn to perform on his or her own
2. It mimics the physiology of normal kidney function

Disadvantages:
1. High glucose load may lead to hyperglycemia and hypertriglyceridemia
2. Peritonitis is a significant complication
3. Patient must be motivated to self-administer it
4. Cosmetic issues

17
Q

What are the contraindications of peritoneal dialysis?

A
  1. Patient refusal
  2. Pregnancy
  3. Recent abdominal surgery
  4. Infection or fibrosis at the area
  5. Severe cardiac disease
  6. En-stage liver disease
  7. Advanced malignancy
18
Q

How is proteinuria defined?

A

Urinary excretion of >150 mg protein/24 hours.

19
Q

What is nephrotic syndrome?

A

Urine protein excretion rate >3.5 g/24 hours, causing hypoalbuminemia because hepatic albumin synthesis cannot keep up with these urinary protein losses. It is a cause of glomerular proteinuria.

20
Q

What are the key features of proteinuria?

A
  1. Proteinuria
  2. Hypoalbuminemia
  3. Hyperlipidemia
21
Q

What is the most common cause of nephrotic syndrome in adults an children?

A

Adults: Membranous nephropathy
Children: Minimal change disease

22
Q

How is proteinuria diagnosed?

A
  1. Urine dipstick
  2. Urinalysis (examine for urine sediment)
  3. Test for microalbuminuria
23
Q

What is hematuria?

A

> 3 erythrocytes/HPF on urinalysis, if microscopic it is most likely glomerular in origin. Consider gross hematuria to be a sign of bladder or kidney cancer until proven otherwise.

24
Q

How is hematuria diagnosed?

A
  1. Urine dipstick
  2. Urinalysis
  3. Urine specimen
  4. 24-hour urine
  5. Labs: CBC, BUN/Cr, coagulation studies
25
What are glomerular diseases?
A group of diseases of inflammatory, non-inflammatory and immune-mediated mechanisms causes that involve renal glomeruli.
26
How are glomerular diseases diagnosed?
1. Urinalysis 2. Blood tests: CBC, RFT 3. 24 hour urine protein collection or an alternative method that involves measuring urine protein/creatinine ratio >3 4. Needle biopsy of the kidney and ultrasound
27
What is minimal change disease?
Most common type of nephrotic syndrome in children showing fusion/effacement of foot processes on electron microscopy. Has good response to steroid therapy, given for 4-8 weeks.
28
What is membranous glomerulonephritis?
A type of nephrotic syndrome, in which there is damage and thickening in basement membrane (subepithelial deposits) resulting in heavy proteinuria. Primary causes are idiopathic, but it can occur secondary to infections such as hepatitis.
29
What is IgA nephropathy?
AKA Berger disease, gross hematuria 1-3 days after an URTI. IgA-IgG antibodies will deposit in the bowman’s capsule resulting in activation of complement system leading to inflammation, these deposits are seen on electron microscopy. It is the most common cause of hematuria.
30
What are the primary glomerular disorders?
1. Minimal change disease 2. Focal segmental glomerulosclerosis 3. Membranous glomerulonephritis 4. IgA nephropathy 5. Hereditary nephritis
31
What are the secondary glomerular disorders?
1. Diabetic nephropathy 2. Hypertensive nephropathy 3. Lupus 4. Membranoproliferative GN 5. Poststreptococcal GN 6. Goodpasture syndrome 7. Dysproteinemias 8. Sickle cell nephropathy 9. Granulomatosis with polyangiitis 10. Polyarteritis nodosa
32
What is poststreptococcal GN?
Most common type of nephritic syndrome. Occurs after infection with group A beta-hemolytic streptococcal of URTI about 10-14 days. Characterized by subepithelial deposits of C3 and C4, hematuria, low complement levels and proteinuria.
33
What is Goodpasture sydrome?
Classic triad of proliferative GN, pulmonary hemorrhage, and IgG antiglomerular basement membrane antibody. Renal biopsy shows linear immunofluorescence pattern in the glomeruli. Treated with plasmapheresis.
34
What is acute interstitial nephritis?
Inflammation involving interstitium commonly due to acute allergic reaction to medication. Presents with rash, fever, acute renal insufficiency and eosinophilia. Presence of eosinophils in the urine suggests the diagnosis. Removal of the offending agent is usually enough to reverse the clinical finding.
35
What is autosomal dominant polycystic kidney disease?
Most common genetic cause of CKD. Renal failure occurs from cysts replacing renal parenchyma over time confirmed by ultrasound, as well as recurrent episodes of pyelonephritis and nephrolithiasis. Presents with pain, hematuria, infection, hypertension, kidney stones.
36
What is autosomal recessive polycystic kidney disease?
Characterized by cysts predominantly in the renal collecting ducts as well as hepatic fibrosis. Cysts seen on ultrasound in the absence of renal cysts in either parents.
37
What is medullary sponge kidney?
Characterized by cystic dilation of the collecting ducts, diagnosed by IVP showing bouquets of flowers appearance.
38
What is hypertensive nephrosclerosis?
Systemic HTN increases capillary hydrostatic pressure in the glomeruli, leading to benign or malignant sclerosis.
39
What are the most common causes nephrosclerosis that leads to ESRD?
1. Diabetes MCC 2. HTN

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