Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Foundations II- Nephrology > Hydronephrosis, ARF, CKD, ESRD > Flashcards

Hydronephrosis, ARF, CKD, ESRD Flashcards

1
Q

US is usually first choice when imaging kidneys, when should you use CT?

A

when looking for masses or stones

also higher sensitivity for PKD

avoid IV contrast- nephrotoxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What kind of imaging study is preferred in children?

A

radionuclide studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In moderate to advanced KD, gadolinium can lead….

A

severe syndrome of nephrogenic systemic fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the gold standard for RVT?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why isn’t renal arteriography and venography really used?

A

more invasive than CT/MMRI

can see arterial and venous occlusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is IVP used for?

A

High sensitivity and specify for stones

but not really used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for renal biopsy?

A

Nephrotic syndrome: SLE

Acute nephritic syndrome

Unexplained ARF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is renal biopsy NOT indicated?

A

In patient with: Isolated glomerular hematuria,

Low grade proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a page kidney?

A

bleeding under the capsule of the kidney after biopsy , causing compression of the collecting system leading to damage to the kidney, requires removal of the capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is hydronephrosis?

A

Unilateral or bilateral edema of the collecting system

-usually asxs
-poss. pain if obstructive involved
+/- change in UOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some obstructive etiologies for hydronephrosis?

A

Bladder outlet obstruction consider GI and GYN masses, stones, BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Imaging for hydronephrosis?

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some non-obstructive etiologies for hydronephrosis?

A

Large diuresis can distend intrarenal collecting system (ie. Diabetes insipidus).

CT if US not indicative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx for hydronephrosis?

A

stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is AKI (ARF)?

A

Abrupt (within 48hrs) decline in renal filtration function

Usually reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Labs consistent with ARF?

A

decreased in GFR and UOP (UOP less than 0.5ml for >6hrs)

increased Urea

Increased Creatinine (Azotemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is considered pre-renal?

A

Anything that happens above the kidney. Ex. Renal Hypoperfusion, hypovolvemia, poor fluid intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is considered intrinsic AKI?

A

Damage within the kidneys themselves, ex. Damage to glomeruli, tubular or interstitium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is considered post-renal AKI?

A

Damage after the kidney. Urology problem. Ex. Obstructive nephropathy, prostatic hyperplasia, bladder tumors, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most AKI are due to?

A

Pre-renal causes. Hypoperfusion leading to decrease in renal perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In AKI due to pre-renal causes will show…on labs

A

Increased BUN/Cr ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Tx for pre-renal AKI?

A

Maintain euvolemia, give fluids. Avoid nephrotoxic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

64 y/o M with chronic systolic HF. BUN 41mg/dL. Cr 1.4 mg/dL. What is likely cause of elevated BUN/Cr ratio?

  • Acute tubular necrosis
  • Bilateral ureteral obstruction
  • Renal hypoperfusion
  • Fe deficiency anemia
A

Renal Hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What would the BUN/Cr ratio be in ATN?

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Bilateral ureteral obstruction is a….

A

Post renal problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Rhambdomylysis is a…process

A

ATN

myoglobin clogs up the tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are some causes of AKI due to intrinsic causes?

A

ATN, Intersisital. Glomerular, vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

causes for post renal AKI?

A

Obstructive:

BPH, urolithiasis, bladder dysfunction (anticholinergic drugs), bladder CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Sxs of post renal AKI? Dx?

A

lower abd pain

bladder US
labs: elevated BUN: Cr ration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tx for postrenal AKI?

A

catheter, stent, surg depending on etiology

remove what ever is causing the back up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do you correct prerenal AKI?

intrarenal?

Postrenal?

A

IVF- normal hemodynamics

Avoid nephrotoxic agents

removal of obstruction

for all: consider short term dialysis

32
Q

What will you see on UA in ATN?

A

Muddy brown casts. ATN makes up 85% of intrinsic AKI

33
Q

Is AKI reversible?

A

YES

can do dialysis

34
Q

HD can be done via

A

fistula > graft (due to risk of infx)

tunneled line

35
Q

When should you dialyze?

A

Weight

Physical exam/fluid overload

electrolytes imbalance?

UOP/uremic complications

Unresponsive acidosis
pH<7.1

36
Q

What is ATN?

A

Tubular damage due to ischemia or nephrotoxins

37
Q

What are some nephrotoxins?

A

Aminoglycosides, Amp B, Vanco, contrast, CNI

38
Q

Tx for ATN?

A

o Avoid volume overload, avoid hyperK, protein restrict, +/- diuretics

39
Q

What can you use to renally protect from IV contrast?

A

Give N-acetylcystine/IVF with bicarb

40
Q

What is AIN?

A

Inflammatory response leading to edema and possible tubular cell damage. Usually caused by nephrotoxic drugs but can also be infectious or autoimmune

41
Q

What will you see on UA in AIN?

A

Eosinophiluria

42
Q

Tx for AIN?

A

Steroids +/- dialysis

43
Q

What causes intrinsic GN?

A

IgA nephropathy, post infectious strep GN, MPGN, Goodpastures

44
Q

What will you see on UA in intrinsic GN?

A

RBC casts

45
Q

Tx for intrinsic GN?

A

steroids and plasma exchange

46
Q

Renal function in ESRD?

A

<15 or dialysis

47
Q

What is GFR?

A

Glomerular filtration rate:

  • Degree of impairment
  • Varies by age, gender, and body size
  • Measurement via MDRD
48
Q

What is creatinine?

A

Waste product of creatinine phosphate from muscle which passes in the blood and through kidneys

Dependent on muscle mass

49
Q

What is Azotemia?

A

Nitrogen in the blood

Occurs when renal function can no longer efficiently clear metabolites

Results from renal parenchymal damage

50
Q

How do you determine Azotemia?

A

by measures of BUN and Cr

leads to uremia

51
Q

How do you monitor for uremia?

A

with blood urea nitrogen (BUN), urea produced by liver, excreted by urine

52
Q

At what stages of CKD will you see uremia?

A

3-5

53
Q

Sxs of uremia?

A

Malaise, N/V, dyspnea, impaired mentation, RLS, pruritus, weakness, insomnia, muscle cramping. Can lead to spontaneous bleeding, cardiac arrest, coma, seizure

weight loss/muscle wasting, HTN, ecchymosis, asterixis, kussmaul respirations

54
Q

Work up for CKD?

A

GFR*

Labs: BUN and Cr elevated, proteinuria present, +/-microalbuminuria

Abn H &H, lytes, UA

consider bx

55
Q

Tx for CKD?

A

ACE/ARBs- slows progression

Tx underlying condition: Epo, Fe, antiplatelets

low protein diet, fluid restriction

Ca/ Vit D supplements

consider dialysis/transplant

56
Q

What causes hypervolemia?

A

Hyponatremia with hypervolemia usually CHF, nephrotic syndrome, ESRD or ESLD

57
Q

Labs in CKD during hypervolemia?

A

Hgb and Hct decreased

58
Q

Tx for hypervolemia?

A

Fluid restrict

+/- diuretics

+/- dialysis

59
Q

What causes hypovolemia?

A

lost from EC compartment, GI tract, kidneys, “third spacing” skin/injured tissues

60
Q

Labs for CKD pt with hypovolemia?

A

H&H increased

urine Na decreased

Urea increase

61
Q

Tx for hypovolemia?

A

give isotonic IVFs

62
Q

What are some causes of ESRD/CKD?

A

PKD,DM, glomerulonephritis. HTN, SLE, nephrolithiasis

63
Q

Describe PKD

A

multiple bi cysts

reduction of renal mass reduces kidney func.

mostly genetic (75%) Autosomal Dominant

64
Q

Sxs of PKD?

A

hematuria, infx, pain from rupture, nephrolithiasis, nocturia

also assoc. with hepatic and pancreatic cysts

65
Q

How do we eval for PKD?

A

US

66
Q

Tx for PKD?

A

pain management

ACE/ARB

aggressive abx is sxs

Transplantation

67
Q

Half of ESRD causes are due to…

A

DM

these patient also have increased risk of CV and stroke due to large vessel atherosclerosis

68
Q

When should Metformin should be avoided?

A

in pts with Cr greater than 1.4 in women and 1.5 in men who need CT imaging

should hold Metformin day of scan and 2 days after

this is to avoid lactic acidosis

69
Q

95% of renal artery stenosis is due to..

A

atherosclerosis

70
Q

How do we dx renal artery stenosis?

A

Gold standard: renal angiogram

Start with: Dopple US

71
Q

Tx of renal artery stenosis?

A

angioplasty

+/- stenting

72
Q

Epidemiology of SLE?

A

9x more in females

African americans > caucasians

nephritis with proteinuria

73
Q

What is the most common type of renal stone? What does it look like on imaging?

A

calcium (75-85%)

radiopaque

74
Q

Major causes of death for dialysis pts?

A

CV disease, infx, withdrawal from dialysis

75
Q

What is KDRI?

A

kidney donor risk index, summarizes risk of graft failure

high percentage = higher chance of graft failure

76
Q

What makes someone more likely to have a rxn to transplant?

A

previous transplant

pregnancy

blood transfusions

77
Q

possible post transplant s/s?

A 
Hyper/hypoglycemia 
HTN/hypotension
N/V/D
Wound complications
Anemia
Watch for hyper/hypovolemia

new meds and drug-drug interaction

Foundations II- Nephrology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions