GU Flashcards
Nephrotic Syndrome tx?
Immunosuppressive, ACE inhibitors, lipid lowering agents, mild diuretics to control edema, sodium restriction.
Complications of CKD?
fluid overload, metabolic acidosis, arrhythmias, anemia, uremic syndrome
Sx of acute GN?
edema, decreased urine output, HTN, sx of fluid overload, uremia
What is stage 2 CKD?
MILD LOSS of kidney function; GFR is 60-89
CKD sx caused by altered calcium and P?
Bone breakdown, osteodystrophies, defective bone development
What is stage 1 of CKD?
kidney damage w/ NORMAL function; GFR>90
Which AV access matures faster but does not last a long time?
AV graft
Common labs and diagnostics for CKD?
creatinine, BUN, electrolytes, H/H, GFR, urinalysis, X ray, CT scan
Sx of CKD caused by sodium and fluid imbalance?
HTN, heart failure, pulmonary edema
What are the advantages of PD?
less hazardous, more flexibility, may have less fluid and dietary restrictions.
Which AV access takes longer to mature and lasts a long time?
AV fistula
What is stage 5 CKD?
Kidney FAILURE; GFR <15
How is GFR calculated?
From serum creatinine levels and creatinine clearance levels from a 24 hour urine test
What causes oliguria or anuria in kidney stones?
obstruction at the bladder neck or urethra
What are examples of a complicated UTI?
UTI with pregnancy, obstruction, chronic kidney disease, drug resistant organism, men
How is fluid volume managed in CKD?
renal replacement therapies, diuretics, fluid restriction, sodium restriction.
Which foods should be avoided to prevent kidney stones?
foods high in oxalate, such as rhubarb, chocolate, tea, coffee, and nuts.
Contraindications for kidney transplant?
Active cancer, current infection, active psychiatric illness, active substance abuse, non-adherence with dialysis or medical regimen.
Abnormal lab findings of acute GN?
protein, blood, WBC casts in urine; elevated BUN/creatinine
Why is calcium gluconate IV administered w/ hyperkalemia?
to reduce myocardial irritability
What are early sx of CKD?
malaise, fatigue, pruritis, dry skin, weight loss, anorexia, nausea
CKD endocrine sx?
Infertility, amenorrhea, hyperparathyroidism, thyroid abnormalities
Which labs will be altered if there is a lot of protein in the system?
BUN and creatinine will be elevated
What is the normal GFR for a young adult?
125mL/min
What is PKD?
Genetic progressive kidney disorder characterized by fluid filled cysts in the kidneys.
Common diagnostics for PKD?
urinalysis, BUN, creatinine, US, MRI, IV pyelogram, CT
Dietary modifications needed with CKD?
protein, K, Na, and P restriction; sufficient carbohydrate calories, ; fluid restriction; calcium supplementation; iron, vitamin B12, and folic acid supplementation.
S/sx of uremic syndrome?
N/V, AMS, uremic frost, halitosis, stomatitis, metabolic acidosis, electrolyte imbalance, cardiac arrhythmia, abnormal bleeding.
What abx are 1st line for uncomplicated bacterial UTI?
- Nitrofurantoin (Macrobid, Macrodantoin)
2. Trimethoprim/Sulfamethoxazole (Bactrim)
Which medication will slow the progression to ESRD?
Tolvaptan
What is Epogen?
Synthetic version of erythropoietin
Sx of chronic GN?
proteinuria, hematuria, hypertension, fatigue, edema
How many units of heparin does the central venous catheter contain to avoid clotting?
10,000 units
What is stage 4 CKD?
SEVERE loss of function; GFR is 15-29
What are the 2 forms of PKD?
childhood and adult
What are surgical options for pyelonephritis?
pyelolithotomy, urethral diversion/ re-implantation of ureters, nephrectomy
Diagnostics for complicated UTI?
Pelvic US or CT, voiding cystourethrography, cystoscopy.
What is glomerulonephritis (GN)?
group of kidney disorders characterized by injury and inflammation to the glomeruli caused by immunity response.
Difference between fistula and graft?
both involve the combination of artery and vein but graft uses a synthetic tube to combine them
What causes chronic anemia in CKD?
kidneys not able to make erythropoietin
Are we allowed to flush the central venous catheters?
No; only dialysis trained nurses. However, we should monitor for sx of infection or occlusion.
Causes of secondary GN?
multi-system disease like lupus, HIV, amyloidosis
What is a normal BUN/creatinine ratio?
6-25
Common diagnostics for acute GN?
urinalysis, 24hr urine collection, serum albumin, serum creatinine, BUN, GFR, CBC, kidney biopsy
S/sx of chronic pyelonephritis?
1/. s/s of infection, however less dramatic presentation.
- Repeated low grade fevers.
- Hypertension
- Inability to conserve sodium, hyperkalemia.
- Nocturia
Which drugs should be avoided with CKD?
nephrotoxic (NSAIDs, aminoglycosides) and Mg containing like Malox
Meds used for kidney stone tx?
analgesics; abx; combination of Thiazide diuretic, allopurinol and high fluid intake; alpha adrenergic blockers and calcium channel blockers; citrate.
How to manage hyperkalemia with CKD?
K restriction.
Emergent: Kayexalate, Calcium gluconate, regular insulin
Urolithiasis risk factors?
family hx, hx of kidney stone, hx of diabetes, gout, and obesity, increased Na intake
How to manage hyperphosphatemia with CKD?
Low P diet.
Phosphate binders: Sevelemar carbonate (Renvela) and calcium carbonate
What abx is used to treat fungal UTI?
Fluconazole (Diflucan)
Sx of PKD?
HTN*, hematuria, flank pain, dysuria, HA, abd pain/distention, nocturia, frequent UTIs, cerebral aneurysms (some cases)
What is hydronephrosis?
Distention of the renal pelvis and calices caused by obstruction in the upper part of the urete.
What is GFR?
The rate at which the glomeruli filter blood
What is CKD?
Slow, progressive, irreversible loss in kidney function, with a GFR = 60mL/min for 3 months or longer.
What is hydroureter?
distention of the ureter caused by obstruction in lower part of the ureter
Sx of CKD caused by altered potassium excretion?
lethal arrhythmias
HD is often required when GFR level is what?
< 10-15mL/min
Sx of CKD caused by impaired metabolic waste elimination?
N/V, anorexia, neurological sx
Complications of kidney transplant?
organ rejection, infection, cancers, corticosteroid related sx.
What is a nephrolithotomy?
direct access is obtained to the kidney percutaneously, allowing a nephroscope to identify and remove the offending stone.
CKD sx caused by decreased acid clearance and bicarbonate production?
Metabolic acidosis
Which foods can prevent the formation of kidney stones?
citrate rich foods like lemons
Complications associated with peritoneal dialysis?
infection, peritonitis, fluid/electrolyte imbalance, more protein loss than HD.
What are the common types of PD?
Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD)
Do people on dialysis also have protein restrictions?
Will need more protein because a lot of it is getting filtered out during dialysis
Assessment for PD?
drained effluent, abd pain, hyperactive BS, diarrhea, abd distention, PD catheter site.
What is stage 3B CKD?
MODERATE TO SEVERE loss of function; GFR 30-44
How to improve cardiac function with CKD?
antihypertensive and lipid lowering agents
What kind of vascular access is used for long-term HD?
AV fistula and AV graft
S/sx of disequilibrium syndrome after dialysis?
N/V, changes in mental status, HA, twitching, seizure,
What is stage 3A CKD?
MILD TO MODERATE loss of function; GFR is 45-59
Late signs of CKD?
oliguria/anuria, drowsiness, confusion, excessive thirst, s/sx of uremic syndrome.
How much water should PKD patients drink?
3L/day to slow cyst growth only if poor kidney function has not been developed.
What are the 2 main causes of CKD?
HTN and DM
T/F. Chronic GN always leads to ESRD?
True
What is a normal creatine level?
0.6-1.2mg/dL
How many stages of CKD are there?
5 based on GFR category
What other sx can be seen in NS?
lipiduria; HLD; HTN; edema; delayed clotting/increased bleeding/high PT/INR; increased BUN/creatinine, decreased GFR
Contraindications for PD?
hx of peritoneal adhesions, extensive GI surgery, currently obese
Risk factors for CKD?
DM, HTN, HLD, smoking, recreational drug use, NSAIDs, obesity
How to manage hypocalcemia with CKD?
vitamin D and calcium supplementation, manage hyperP
Standard diagnostic for confirming presence of kidney stones?
Non-contrast helical CT scan of the abd and pelvis
What kind of vascular access is used for short-term HD?
central venous catheter
How to manage PKD?
Manage BP, pain; prevent constipation; manage UTIs and prevent complications of infection; slow progression to ESRD; dialysis.
How is anemia managed in CKD?
Epogen (Procrit); iron, vitamin B12, and folic acid supplements.
Common complications associated with HD vascular access?
- Thrombosis/stenosis
- Infection
- Aneurysm formation from increased pressure.
- Ischemia
Causes of primary GN?
infectious agent
Why should foods high in animal protein be limited for the prevention of kidney stones?
to reduce acidic urine and prevent calcium precipitation
Life expectancy after renal transplant?
Cadaver kidney: 8-12 years
Live donor kidney: 12-20
What is a normal BUN level?
10-20mg/dL
What is a ureteroscopy?
A flexible scope is inserted through the urethra, bladder, and ureter to identify and remove the stone.
What is nephrotic syndrome (NS)?
kidney disorder characterized by massive proteinuria, hypoalbuminemia, and edema.
When should we notify the provider after bladder scan?
if bladder has more than 300cc
Most common risk factor of urolithiasis?
Dehydration
Complications of kidney stones?
- Pyelonephritis
- Urosepsis
- hydronephrosis and hydroureter
- Irreversible renal damage
Complications of re-current pyelonephritis?
scaring, permanent renal damage, CKD, sepsis
What is uremic syndrome?
when urea and waste products build up because the kidneys are unable to excrete them
What causes disequilibrium syndrome?
rapid removal of solutes from the body during HD
