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Unit 3 Clin Med II > L16: Renal+Urology diagnostics > Flashcards

L16: Renal+Urology diagnostics Flashcards

1
Q

acute kidney injury staging is based on

A

GFR
Creatinine
Urine output

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2
Q

Normal serume creatinine

A

.5-1.2

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3
Q

Serum creatinine measures

A

Measures renal function

Know baseline, may be normal even with poor renal function

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4
Q

From catabolism in skeletal muscle and dietary meat intake→ released into circulation at constant rate→ stable plasma concentration→ freely filtered by glomerulus and excreted by the kidneys

A

serum creatinine

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5
Q

normal BUN

A

10-20

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6
Q

Product of protein catabolism excreted by kidneys

A

BUN

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7
Q

Increased BUN

A

dehydration, GI bleed, use of steroids or tetracyclines

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8
Q

marker for volume status

A

BUN/Creatinine ration

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9
Q

Normal GFR values

A

Males: 130 mL/min/1.73 m2
Females: 120 mL/min/1.73 m2

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10
Q

Stage 1 CKD

A

Kidney damage with normal or increased GFR>90

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11
Q

Stage 2 CKD

A

Kidney damage with normal or decreased GFR 60-89

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12
Q

Stage 3 CKD

A

Moderately decreased GFR 30-59

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13
Q

Stage 4 CKD

A

Severely decreased GFR 15-29

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14
Q

Stage 5 CKD

A

Kidney failure <15

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15
Q

Stage 5D CKD

A

Kidney failure with dialysis, no GFR

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16
Q

GFR is used to

A

Track disease progression/regression
Dosing of medications
Sex/race/body habitus dependent

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17
Q

improves estimates of GFR

A

Cystatin C

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18
Q

Sum of filtration rates of all functioning nephrons→ rough measure of number of functioning nephrons
Cannot be measured directly: Modification of Diet in Renal disease equation

A

GFR

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19
Q

One of the first signs of kidney disease and should not be ignored

A

protein on urinalysis

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20
Q

How to obtain Creatinine clearance

A

By 24-hour-urine collection, Cockcroft-Gault formula

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21
Q

Uses of Creatinine clearance

A

Approximates GFR: choosing/dosing medications

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22
Q

blood on urinalysis may indicate

A 
Calculi
glomerular damage
neoplasm
acute tubular necrosis
trauma
infection
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23
Q

Prostate Specific Antigen uses

A

Glycoprotein found in prostatic lumen

Not recommended in men >70

Screening for early detection of prostate cancer, monitor disease after treatment

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24
Q

Normal Prostate Specific Antigen antigen values

A

<4ng/mL

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25
Q

increased Prostate Specific Antigen may indicate

A

prostate cancer
BPH, prostatitis
following prostate manipulation: ultrasound, biopsy

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26
Q

If you suspect

Systemic lupus erythematosus, order

A

ANA double stranded DNA antibody levels

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27
Q

If you suspect Granulomatosis with Polyangiitis, order

A

C-ANCA and P-ANCA

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28
Q

If you suspect Goodpasture syndrome, order

A

Anti-GBM antibodies

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29
Q

If you suspect Glomerulonephritis, order ______ to narrow down the cause

A

Hep B and C
HIV
Venereal disease research laboratory (VDRL) serology
Serum complement

30
Q

If you suspect Post-streptococcal glomerulonephritis, order

A

Antistreptolysin O

31
Q

If you suspect Multiple myeloma, order

A

Serum and urine protein electrophoresis (SPEP, UPEP)

32
Q

Possible causes of RBC casts

A

Glomerulonephritis

Vasculitis

33
Q

Possible causes of WBC casts

A

Tubulointerstitial disease
Acute pyelonephritis
Glomerular disorders

34
Q

Possible cause of epithelia cell casts

A

Acute tubular necrosis

35
Q

uric acid crystals are

A

radiolucent on Xray, won’t show up

36
Q

struvite crystals are made of

A

magnesium ammonium phosphate

37
Q

Hyaline casts indicate

A

dehydration

38
Q

Better quantitative measurement for proteinuria or GFR determination

A

24 hour urine collection

39
Q

To find bench jones proteins in multiple myeloma

A

Urine protein immunoelectrophoresis (UPEP)

40
Q

Urine eosinophils are seen in

A 
*Acute interstitial nephritis*
Transplant rejection
 pyelonephritis
prostatitis
cystitis
atheroembolic disease
rapidly progressive glomerulonephritis
41
Q

Microalbumin on urine study

A

The earliest clinically detectable sign of diabetic nephropathy or kidney damage

42
Q

Xrays will miss

A

Smaller stones
uric acid stones (radiolucent)
stones overlying bony structure

43
Q

How is a kidney, ureters, and bladder film (KUB) taken

A

supine and upright positions

44
Q

Test of choice to exclude urinary tract obstruction

A

Renal ultrasonography

45
Q

Stones that are visible on KUB film

A

Calcification in the urinary tract:

Calcium containing, struvite, cystine stones

46
Q

staghorn means

A

nephrolithiasis involving renal pelvis and extending into >2 calyces

47
Q

Other things that can be seen on KUB film

A 
Prostatic calculi
Bladder distention
Pancreatic calculi
Calcified arteries
Calcification in biliary tract
Bowel gas pattern
Free air secondary to ruptured viscus
Calcified prostate: the whole prostate is opaque
48
Q

Renal ultrasonography vs CT

A

U/S is less sensitive that CT in initially detecting a renal mass, but doesn’t use contrast

49
Q

test to evaluate renal vascular flow

A

renal doppler ultrasonoography

50
Q

May be seen on renal ultrasonography

A

Obstruction
Nephrolithiasis: appear white
Severity and length of ureteral strictures
Renal cysts (appear black) and masses (grayish tissue color)
Hydronephrosis
Renal or perinephric abscess
Atrophic kidneys
Ureteral diverticuli
Pyelonephritis: hypodense mass with internal echoes

51
Q

can be seen on renal doppler ultrasonography

A 
Renal vein thrombosis
Renal infarction
Renal artery stenosis
Intrarenal vascular disease
Arteriosclerosis
52
Q

test of choice for nephrolithiasis

A

non-contrast CT

-can see stones not visible on KUB

53
Q

On contrast CT, a stone looks like

A

stone in kidney prevents contrast from being normally excreted, dilated ureter

54
Q

CT angiography can show

A

renal artery stenosis

renal vein thrombosis

55
Q

Uses for CT

A

Distinguish benign vs malignant cysts
Evaluate and stage renal cell carcinoma
Bilateral pyelonephritis: triangular hypodense streaks spreading from pelvis to cortex: “stranding”

56
Q

gold standard for Renal vein thrombosis

A

MRI

57
Q

MRA can show

A

Renal artery stenosis

58
Q

contraindications to MRI

A

Gadolinium in GFR<30 (chronic renal failure) or acute renal failure of any severity
→ nephrogenic systemic fibrosis

59
Q

Shows size and shape of kidneys, ureters, bladder
Contrast in injected, then x-rays taken
Excretory function: time it takes for contrast to pass
Not frequently used due to contrast dye

A

Intravenous pyelogram

60
Q

Intravenous pyelogram can show

A

Stones: seen obstructing the flow of contrast in the lumen of the ureter
Obstruction

61
Q

Renal angiography uses

A

Pre-operative mapping of renal vasculature (main use)
Stenosis→ angioplasty and stenting
Fibromuscular dysplasia “sting of pearls”

62
Q

Renal biopsy is used for diagnosis of

A 
Unexplained acute renal failure
Nephrotic syndrome
Acute nephritis syndrome
Renal mass
Assessment for rejection following transplant
63
Q

Bladder filled with contrast→ take x-rays
Can be done while voiding
Better for primary bladder conditions than intravenous pyelogram

A

Cystourethrogram

64
Q

Cystourethrogram can show

A

Vesicoureteral reflux
Distortion of the bladder
Fistula
Perforation

65
Q

Thin fiber-optic tube (flexible vs. rigid) passed through a hollow sheath into the urethra and advanced into the bladder

A

cytoscopy

66
Q

Cytoscopy complications

A

Post-procedure hematuria: expected, passes within 3 voids

sepsis
hemorrhage
perforation of the bladder
post-procedure dysuria

67
Q

Urogynecologic malignancies that can be assessed with cytoscopy

A 
Incontinence with irritative voiding symptoms
Sterile hematuria/pyuria
Recurrent infection
Urethral diverticula
Fistulas
68
Q

Intrinsic bladder diseases that can be assesed with cytoscopy

A

Interstitial cystitis

Bladder tumors, stones, or scarring

69
Q

Uses of testicular ultrasound

A

testicular/scrotal size, pain, masses
Testicular torsion (Doppler)
Location of undescended testes

70
Q

How is a prostate ultrasound and biopsy performed, and on whom

A

transrectally

high PSA to detect prostate cancer

Unit 3 Clin Med II (8 decks)

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