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Year 1: 2020 PCM II Final > Lecture 1: Approach to Renal and GU Complaint > Flashcards

Lecture 1: Approach to Renal and GU Complaint Flashcards

1
Q

What is chronic kidney disease?

A

Longstanding kidney disease for more than 3 months

  • GFR < 60
  • Kidney damage
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2
Q

What are markers for kidney damage?

A
  • Protein in urine
  • Abnormal urinary sediment
  • Abnormal kidney biopsy
  • Abnormal renal imaging
  • Electrolyte abnormalities
  • History of kidney transplantation
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3
Q

If there is an absence of kidney damage, what is the minimum CKD stage the patient will be in?

A

Stage 3 (GFR < 60)

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4
Q

What percentage of US adults has CKD?

A

15% of US adults

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5
Q

What are major risk factors for CKD?

A 
Diabetes mellitus
Hypertension
CVD 
Acute Kidney Injury
Nephrotoxic agents
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6
Q

What are examples of nephrotoxic agents?

A

NSAIDs
PPIs
Antibiotics
Heavy metals

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7
Q

What are signs and symptoms of CKD?

A
  • Edema
  • Decreased urine output
  • Foamy urine
  • Hematuria
  • Uremia
  • Pericardial friction rub
  • Asterixis
  • Uremic frost
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8
Q

What does foamy urine indicate?

A

Proteinuria

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9
Q

What is asterixis?

A

Tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings

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10
Q

What three tests are used to identify most CKD patients?

A

1) Estimated GFR
2) Urinalysis
3) Urine albumin to creatinine ratio OR urine protein to creatinine ratio

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11
Q

What are some renal ultrasound findings in CKD patients?

A
  • Atrophic or small kidneys
  • Cortical thinning
  • Increased echogenicity
  • Elevated resistive indices
  • Presence of hydronephrosis (obstruction)
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12
Q

What are some complications caused by CKD?

A
  • CVD
  • Electrolyte Imbalance: Hypocalcemia, Hyperkalemia, Hyperphosphatemia
  • Vit D deficiency
  • Metabolic Acidosis
  • Uremia
  • HTN
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13
Q

What are some ways to control or treat CKD?

A
  • Low salt, potassium, and phosphorus diet
  • Diuretics
  • ACE inhibitors, ARB, aldosterone antagonist, renin inhibitor
  • Renal Replacement Therapy
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14
Q

What are indications for dialysis?

A 
Severe Acidosis
Electrolyte disturbance 
Ingestion
Volume Overload 
Uremia
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15
Q

What is azotemia?

A

Elevated BUN (blood urea nitrogen) w/o symptoms

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16
Q

What is uremia?

A

Elevated BUN w/ symptoms:

  • nausea/vomiting
  • confusion
  • pruritus
  • metallic taste in mouth
  • fatigue
  • anorexia
17
Q

What is hemodialysis?

A

Use of a machine and a filter to remove waste products and water from the blood

18
Q

What is acute kidney injury?

A

Sudden episode of kidney failure or kidney damage

19
Q

What two criteria determines AKI?

A
  • Serum creatinine levels

- Urine Output

20
Q

What are major risk factors for AKI?

A
  • Old age
  • Proteinuria
  • CKD
  • Hypertension
  • Diabetes
  • CVD
  • Exposure to nephrotoxins
  • Cardiac surgery
  • Fluid overload
  • Sepsis
21
Q

What main drugs can lead to AKI?

A
  • Antibiotics
  • NSAIDs
  • PPIs
22
Q

What are complications of AKI?

A
  • Development and progression of CKD
  • End stage renal disease
  • CVD
23
Q

What are signs and symptoms of AKI?

A
  • Edema
  • Hypertension
  • Decreased urine output
  • Foamy urine
  • Uremia
  • Pericardial friction rub
  • Asterixis
  • Uremic frost
24
Q

What labs/imaging are important to obtain for patients with AKI?

A
  • Urinalysis with urine microscopy
  • Urine albumin to creatinine ratio OR urine protein to creatinine ratio
  • Renal ultrasound
25
Q

What urinary patterns suggests nephritic syndrome and nephrotic syndrome?

A

Both: Proteinuria
Nephritic: Hematuria
Nephrotic: Lipiduria

26
Q

What urinary pattern suggests urinary tract syndrome?

A

WBCs
RBCs
Bacteria

27
Q

What is the purpose of ordering FeNa or FeUrea?

A

Differentiate prerenal azotemia from intrinsic renal inury

28
Q

FeNa or FeUrea is only valid in which type of patients, oliguric or non-oliguric?

A

Oliguric

29
Q

If a patient is non-oliguric does that mean they are prerenal or not?

A

Not prerenal

30
Q

How is AKI treated?

A

Supportive:

  • avoid HTN
  • stop nephrotoxins
  • renal replacement

Year 1: 2020 PCM II Final (8 decks)

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