Introduction to Renal Disease

Question 1

Acute renal disease staging

Answer 1

All focused on serum creatinine level and urine output

Stage 1:
- 1.5-1.9 times increase in creatinine
or > 0.3 mg/dL
- urine output = <0.5 mL/h (for 6-12 hrs)

Stage 2:

• 2.0-2.9 times increase in creatinine
• urine output = <0.5 mL/h (for >12 hrs)

Stage 3: 
- >3.0 times increase in creatinine 
Or > 4.0 mg/dL total serum creatinine 
- urine output = <0.3 mL/h (>24 hrs) 
Or 
Anuria for >12 hrs

Question 2

Chronic renal disease staging

Answer 2

Based on GFR rates (mL/min/1.73)

stage 1: >90

Stage 2: 60-89

Stage 3a: 45-59

Stage 3b: 30-44

Stage 4: 15-29

Stage 5 (renal failure): <15 and/or requires dialysis daily

Question 3

3 Renal disease categorization based on what is the underlying pathology

Answer 3

1) prerenal
- related to hypoperfusion

2) intrinsic/intracranial
- vascular/tubular/interstitial disease

3) postrenal
- urinary obstruction

Question 4

Brown urine causes

Answer 4

Pathological:
- bile pigments and myoglobin in urine

Food and drug causes:

• favs beans
• levodopa, metronidazole, nitrofuratoin, antimalarial drugs

Question 5

Black urine causes

Answer 5

Pathological:

• bile pigment build up
• methemoglobin in urine
• melanin in urine

Food and drug causes:
- levodopa, Methyldopa and senna use

Question 6

Green/blue urine causes

Answer 6

Pathological:

• pseudomonas UTI
• build up of biliverdin

Food and drug causes:

• favs beans
• amitriptyline, cimetidine promethazine, methylene blue, indigo carmine use

Question 7

Orange color urine

Answer 7

Pathological:
- bile pigments

Food and drug causes:
- pehnothiazines and pyridium

Question 8

Red urine causes

Answer 8

Pathological:
- hematuria, hemoglobinuria, myoglobinuria, porphyria

Food and drug causes:
- beets, blackberries, rhubarb, phenolphthalein, rifampin

Question 9

Yellow urine causes

Answer 9

Pathological:
- dehydrated urine

Food and drug causes:
- excess carrot consumption

Question 10

What is normal urgent output in children infants and adults

Answer 10

Infant

• normal = 1.5-2 mL/hr
• oligouria = <1mL/hr for 6 hrs

Child

• normal = 1 mL/hr
• oligouria = <0.5 mL/hr

Adult

• normal = 0.5-1 mL/hr
• oligouria = <0.3-0.5 mL/hr

Question 11

Dietary lifestyle changes in renal disease

Answer 11

Smoking cessation
- CKD Disease progression is hastened in patients who smoke

Dietary sodium reduction
- enhances affects of ACEIs and ARBs in order to lower albuminuria

Dietary protein restriction
- normal or increased protein consumption increases the rate of CKD progression

Weight management

Physical acitrivtiy increase
- lowers chance of CKD progression

Question 12

What is nephrotic syndrome

Answer 12

A disorder that often occurs in severe kidney injury/disease in which the small vessels get destroyed in some way

Leads to the following complications:

• severe edema
• hypoalbuminemia
• proteinuria
• fatigue blood clot formation
• Hyperlipidemia (liver tries to compensate for poor albuminemia and also produces lots of triglycerides and cholesterol)
• malnutrition of especially vitamin D
• HTN

Question 13

What is the normal BUN/creatinine ratio?

Answer 13

10:1

Lower:

• liver disease of some sort
• malnutrition

Increased:

• renal disease of some sort
• extreme dehydration

Question 14

Sex and racial differences in GFR?

Answer 14

Black patients have high overall GFR

Females have higher overall GFR than males

Question 15

Causes of false negatives for leukocyte esterase and nitrates

Answer 15

Leukocyte esterase

• elevated specific gravity
• glycosuria
• ketonuria
• proteinuria
• nitrofurantoin use
• tetracycline use
• high levels of vitamin C

Nitrites

• elevated urobillinogen levels
• urine pH < 6.0
• high levels of vitamin C