Exam 3 - Renal Diagnostics Flashcards
What is serum creatinine used for in clinical practice?
- Used to measure renal function and approximate the GFR
- Helpful to know when choosing or dosing medications
When is BUN typically elevated?
Dehydration, GI bleed, or use with certain meds such as steroids or tetracyclines
What is GFR used for in clinical practice?
- Gives rough measure of the number of functioning nephrons
- Used to track progression/regression of disease and to dose medications
What defines chronic kidney disease?
Presence of kidney damage or decreased kidney function for 3 or more months
If you suspect SLE, what lab study should you order?
ANA
If you suspect GPA, what lab study should you order?
C-ANCA and P-ANCA
If you suspect Goodpasture Syndrome, what lab study should you order?
Anti-GBM
If you suspect forms of glomerulonephritis, what lab study should you order?
Hep B, Hep C, HIV, VDRL, complement
If you suspect post-streptococcal glomerulonephritis, what lab study should you order?
Antistreptolysin O
If you suspect Multiple Myeloma, what lab study should you order?
Serum and urine protein electrophoresis (SPEP, UPEP)
What can be used as a screening method for early detection of prostate cancer and to monitor the disease after treatment?
Prostate-Specific Anitgen (PSA)
PSA levels are detected in every male but are elevated in what conditions?
- Prostate cancer
- BPH
- Prostatitis
- Following prostate manipulation (U/S, biopsy, sexual activity, prostate exam)
When should we start to screen with PSA?
- Recommended to start the conversation around 50 years old
- For high risk men (African Americans, family hx of prostate cancer), begin conversation around 40-45
- No benefit in screening men > 70
If RBC casts are found in UA, what should you be concerned for?
Glomerulonephritis
If WBC casts are found in UA, what should you be concerned for?
Pyelonephritis
If hyaline casts are found in UA, what should you be concerned for?
Dehydration
What is the earliest clinically detectable sign in the urine of diabetic nephropathy or other early kidney damage?
Microalbumin
What is urine eosinophils most commonly associated with?
Acute interstitial nephritis (associated with allergic rxn)
What is a 24-hour urine collection used for?
Provides a better quantitative measurement for proteinuria or GFR determination
What will be seen on UPEP in Multiple Myeloma?
Bence Jones protein
While KUB x-rays can identify calcium-containing, struvite, and cystine stones, what will they likely miss?
Miss smaller stones, radiolucent stones (uric acid) or stones overlying bony structures
What is meant by staghorn calculi which can be associated with cases of nephrolithiasis?
Stones involving the renal pelvis and extending into 2 or more calyces
What is the appropriate initial test to obtain in patients with renal failure of unknown etiology?
Renal Ultrasound
What is the test of choice to exclude urinary tract obstruction?
Renal Ultrasound
When would a Renal Doppler Ultrasound be used?
If concerned about blood flow as it will evaluate renal vascular flow
What is the diagnostic test of choice for evaluating nephrolithiasis?
Non-contrast CT
If a patient is taking Metformin, what should you instruct your patient to do after receiving a CT with contrast?
Hold Metformin for 48 hours as it can increase nephrotoxicity
What is the gold standard for diagnosis of renal vein thrombosis?
MRI
What are some contraindications to an MRI/A?
Renal failure/GFR < 30 as Gadolinium may increase risk for nephrogenic systemic fibrosis
If you observe a “string of pearls” on renal angiography, which should you be concerned about?
Fibromuscular Dysplasia
What study is best to evaluate for Vesicoureteral reflux?
Voiding Cystourethrogram
What study is best to evaluate for distortion of the bladder (due to tumor)?
Voiding Cystourethrogram
What study is best to evaluate for a fistula?
Voiding Cystourethrogram
What study is best to evaluate for bladder perforation?
Voiding Cystourethrogram
What are indications to using cystoscopy?
- Assess bladder and ureteral involvement due to malignancies
- Evaluate urogynecologic conditions (recurrent infection, hematuria, incontinence)
- Diagnose intrinsic bladder disease
If you are ordering a testicular ultrasound, what else should you order?
Make sure to get a doppler to look at blood flow
What is the test of choice for a male presenting with severe/acute testicular pain?
Testicular Ultrasound
What is a prostate ultrasound and biopsy helpful for?
In detection of prostate cancer in patients with elevated PSA
