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503 > Exam 1: Renal > Flashcards

Exam 1: Renal Flashcards

1
Q

What is normal specific gravity of urine?

A

1.003 (dilute) - 1.030 (very concentrated)

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2
Q

What is the normal pH of urine?

A

5-8

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3
Q

Which vaccines should never be given to patients with acute renal issues?

A

Do not give live vaccines if acute renal issues (MMR, varicella)

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4
Q

Which type of cast is most commonly found in urine and is usually due to dehydration or vigorous exercise?

A

Hyaline casts; frequently seen in athletes

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5
Q

How many RBC found in spun urine is considered normal?

A

Asynch: < 5 RBCs are normal
Book: < 3-5 are normal

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6
Q

What are some differential diagnoses for hematuria in children?

A 
UTI
Trauma/irritation
Glomerulonephritis
Coagulopathy
Hemoglobinopathy
Stones
Hydronephrosis
Tumor
Epididymitis

Also: gonorrhea and chlamydia

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7
Q

What is the initial work-up for hematuria?

A

Initial workup for hematuria:

UA
Urine culture
CBC, renal function, sed rate

** Don’t get too excited about hematuria in kids unless there’s a ton of it and is accompanied by protein

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8
Q

What would the initial work-up be for proteinuria?

A

UA

24-hour urine collection for proteinuria

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9
Q

What would be present in the urine to make you suspect nephrotic syndrome?

A

Protein 1+

Increased specific gravity

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10
Q

T/F: Always look at protein and specific gravity together?

A

True; specific gravity of urine can be affected by protein

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11
Q

If there is protein in the urine and specific gravity is > 1.105; is this concerning?

A

Yes:
Concerning if specific gravity is >1.015
Needs to be checked again if specific gravity is =/< 1.015

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12
Q

What are conditions that put patients at risk for renal disease?

A 
Diabetes
HTN
OTC meds (NSAIDs, APAP, ASA)
Polycystic disease
Trauma
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13
Q

What is a big concern when hematuria is found in adults?

A

85% of bladder cancer presents with hematuria

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14
Q

What abnormal results will be found in the UA of someone with probable UTI?

A

+ Leuks
+ Nitirites
Possibly hematuria
Cloudy

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15
Q

Why would you want to recheck a patient’s urine after antibiotic treatment for UTI has been completed if there was hematuria present on the original diagnosis?

A

Check to see if hematuria still present; could be sign of cancer and needs work-up

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16
Q

What are the stages of chronic kidney disease?

A 
Stage:
1 - normal; GFR >90
2 - mild loss; GFR 60-90
3a - mild to moderate; GFR 45-59
3b - moderate to severe; GFR 30-44
4 - severe loss; GFR 15-29
5 - kidney failure: GFR < 15 (needs dialysis  and/or transplant)
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17
Q

An acute infection in the kidneys of children and adults that is most commonly caused by strep; symptoms typically appear 7-10 days after infection

A

Acute Glomerulonephritis

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18
Q

What are signs and symptoms of glomerulonephritis?

A 
Acute onset
Hematuria, proteinuria
Oliguria
Low grade fever
Headache
HTN
Periorbital edema
Edema of hands and face in morning
Edema of feet/ankles in evening
Weight gain
Lethargy
N/V
Abdominal pain
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19
Q

How would the primary care office treat acute glomerulonephritis?

A

Refer urgently to nephrology to be seen that day or send to the ED

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20
Q

Other than post-strep infection, what are some other causes of glomerulonephritis?

A

Lupus
Henoch-Schonlein purpura
Vasculitis
Good Pastures Syndrome (rare autoimmune attacks lungs, kidneys)
Drug hypersensitivity
IgA Nephropathy (Berger disease - local inflammation of kidneys)
Hereditary problems

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21
Q

What are signs and symptoms of nephrotic syndrome?

A

Signs and symptoms of nephrotic syndrome:

N/V/D
Fatigue
Edema (eyes, hands, feet, legs) - may c/o tight underwear
Weight gain
HTN or hypotension if hypovolemic
Ill appearing
Muscle wasting, malnourishment, growth failure

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22
Q

Which factors increase risk of renal stones? (Choose all that apply)

Excess antacid use
Living in cold climate
Obesity
History of gout
Vitamin D excess
A

Excess antacids
Obesity
History of gout

23
Q

Which is a prerenal cause of acute kidney injury?

Hemorrhagic shock
Hydronephrosis
HTN
Renal calculi

A

Hemorrhagic shock interferes with perfusion of kidney and would be a prerenal cause

24
Q

Which tests should be monitored regularly for complications of chronic renal disease? (Choose all that apply)

Liver enzymes
Parathyroid hormone levels
Serum glucose
Serum lipids
Vitamin D
A 
CKD can cause the following:
Hyperparathyroidism
Hyperlipidemia
Alterations to vitamin D
Calcium
Phosphorus
25
Q

What are we concerned for if a pregnant woman has protein in her urine?

A

Proteinuria after 24 weeks gestation is a sign of pre-eclampsia and should be evaluated by her OB/GYN

Preeclampsia symptoms can include: HTN, edema (weight gain), proteinuria

26
Q

An older male patient presents with gross hematuria and is without flank pain or fever? What are you concerned for and what will you do?

A

Significant risk of malignant disease

Refer for cystoscopy and imaging

27
Q

Which type of kidney stone is most common in patients with diabetes?

Citrate
Cystein
Oxalate
Uric acid

A

Most common in DM: Uric acid stones

Oxalate is the most common stone in patients with few comorbidities

28
Q

A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What is the likely diagnosis?

Henoch-Schonlein purpura
Rhabdomyosarcoma
Sickle Cell Disease
Systemic Lupus Erythematosus

A

HSP can present with:

Gross hematuria
Abdominal pain with or without bloody stools
Arthralgias
Purpuric rash

29
Q

An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first morning void is negative. What is the next step?

Monitor for proteinuria annually
Order 24-hour urine collection
Reassure parents it’s benign & no followup
Refer to nephrology

A

Monitor annually:

If the first morning void is negative, monitor annually

30
Q

Is nephrotic syndrome acute or chronic?

A

Nephrotic syndrome is a chronic disease characterized by remission and relapse

31
Q

How is nephrotic syndrome managed?

A

Steroids (Prednisone) 4-6 weeks with taper
Low sodium diet initially, high protein, low cholesterol
Possibly diuretics and albumin

Other needs d/t oral steroids:
Calcium/Vit D supplementation
Weight bearing exercises
Frequent eye exams
No live virus vaccines
Consider PPD prior to start of immunosuppressive meds
32
Q

What is first-line therapy for all stone types?

A

Increase fluids

33
Q

T/F: Antibiotic therapy for Group A Strep infections decreases the incidence of poststreptococcal glomerulonephritis?

A

False

34
Q

What are red flags for renal disease in kids?

A

Red flags for renal disease in kids:

Failure to thrive
Prolonged N/V, inability to eat, weight loss
Chronic anemia (normocytic, normochromic)
Complicated enuresis
Hypotension
Unusual bone disease
Poor school performance

35
Q

T/F: An albumin/creatinine ratio greater than 300 mg/g warrants a referral to nephrology?

A

True

36
Q

How are you going to treat a patient with a kidney stone and when do you refer to urology?

A

Increase fluids
Analgesics (Start with NSAIDs)
Flomax for a few days to help dilate the ureters and ease the passing (if you know there’s a stone for sure)
Send home to pass on its own

Typically don’t refer to urology unless > 6mm

37
Q

How is nephrotic syndrome diagnosed?

A

Diagnostics for nephrotic syndrome:

UA = protein +2 or higher
Elevated urine specific gravity
Hyaline and fine granular casts
Microhematuria in about 30%
Fat bodies in urine
38
Q

What are the clinical manifestations of renal tubal acidosis in children?

A 
Failure to thrive, poor linear growth
Polyuria and polydipsia
Muscle weakness
Feeding problems
V/D
Constipation
Preference for liquids over solids
Poor appetite
39
Q

What are the diagnostics for renal tubal acidosis?

A

Diagnostics for renal tubal acidosis:

UA for glucose and pH (if abnormal do 24-hour urine for creatinine clearance)
CMP w/CO2, calcium, phos, alkaline phosphatase
Renal US - check for obstruction

40
Q

How is renal tubal acidosis managed?

A 
Correct acidosis (Na bicarb, K bicarb, Na citrate) - give bicarb if pH is low
Check potassium and treat accordingly
Maximize caloric intake
Closely follow for weight and labs
If no improvement refer
41
Q

What is the definition of chronic kidney disease?

A

Persistent/progressive decrease in GFR (<60)

Albuminuria (spilling of protein into urine) >30 mg/g urinary creatinine

42
Q

How is CKD managed in primary care?

A 
Maintain BP < 140/90
ACE or ARB, and possibly a diuretic
Closely monitor Hgb and phosphorus
Tight glycemic control for DM
Consult nephrology early
43
Q

What are the ADA recommendations for screening diabetics for CKD?

A

Annual test for urine albumin for:
T1DM
T2DM
DM > 5 years

Annually serum creatinine

44
Q

What are the causes of nephrotic syndrome?

A

Primary (80-90% of cases):
Usually idiopathic

Secondary (10%):
Lupus
Infections (syphilis, Hep B, HIV, malaria)
Henoch-Schonlein Purpura
Drugs (NSAIDs, mephenytoin)
Allergens
45
Q

What is nephrotic syndrome?

A

A chronic condition where excess protein is lost into the urine

46
Q

How many organisms and WBCs are found for diagnosis of UTI?

A

A UTI is defined as the presence of 100,000 organisms/mL of urine in ASYMPTOMATIC patients

Or

Greater than 100 organisms/mL of urine with pyuria (WBC >7-10) in a SYMPTOMATIC patient

47
Q

Name some risk factors for UTI

A

Some risk factors for UTI:

Female
Diabetes
Immunocompromised patients
Spermicide use during the past year
Having a mother with history of UTI
Having a new sex partner during the past year
Urinary incontinence
Cystocele (prolapsed or herniated bladder)
Anticholinergic drugs (ex: atropine, belladonna) - causes bladder does not to empty as well

48
Q

If the GFR is decreased to 40, are there specific drugs you would worry about and need to be renally dosed?

A

Yes, if GFR is dipping below 40 adjust dosages of:

Antibiotics (Gent and Vanc)
NSAIDs
Lithium
Metformin
Aminoglycosides (the "mycin"/"micin" meds, ex: Gentamicin
49
Q

Which renal protective drugs need to be discontinued if GFR <10?

A

ACEi

50
Q

What are the Metformin guidelines when GFR gets down below 40?

A

If GFR < 40, you can’t start Metformin

If GFR < 30, you have to d/c Metformin

51
Q

Which diagnostic test might you order for abrupt onset of behavioral changes, OCD, tics, separation anxiety, mood changes after a strep infection?

A

ASO titer: if elevated reveals patient had a recent strep infection

PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus
Rare condition
PANDAS is a controversial diagnoses among MDs

Antibiotics to treat:
Amoxicillin
Penicillin
Azithromycin
Cephalosporins
52
Q

What are some complications of nephrotic syndrome?

A

Complications of nephrotic syndrome:

Hyperlipidemia
Proteinuria
Tachycardia
HTN
Blood clots

Examples of when to think of nephrotic syndrome as a differential:

Patient has a HR of 140 and has protein in the urine.

Patient now has a total cholesterol of 380 when they had a normal cholesterol 6 months ago and is tachycardic.

53
Q

What are some things to be careful of when prescribing Levaquin?

A

Levaquin can increase risk of Achilles tendon rupture

Levaquin can change the mentation of the elderly

54
Q

How many RBC found in spun urine is considered hematuria?

A

> 5 RBC

503 (16 decks)

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