Lecture 1: Approach to Renal and GU Complaint Flashcards
What is chronic kidney disease?
Longstanding kidney disease for more than 3 months
- GFR < 60
- Kidney damage
What are markers for kidney damage?
- Protein in urine
- Abnormal urinary sediment
- Abnormal kidney biopsy
- Abnormal renal imaging
- Electrolyte abnormalities
- History of kidney transplantation
If there is an absence of kidney damage, what is the minimum CKD stage the patient will be in?
Stage 3 (GFR < 60)
What percentage of US adults has CKD?
15% of US adults
What are major risk factors for CKD?
Diabetes mellitus Hypertension CVD Acute Kidney Injury Nephrotoxic agents
What are examples of nephrotoxic agents?
NSAIDs
PPIs
Antibiotics
Heavy metals
What are signs and symptoms of CKD?
- Edema
- Decreased urine output
- Foamy urine
- Hematuria
- Uremia
- Pericardial friction rub
- Asterixis
- Uremic frost
What does foamy urine indicate?
Proteinuria
What is asterixis?
Tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings
What three tests are used to identify most CKD patients?
1) Estimated GFR
2) Urinalysis
3) Urine albumin to creatinine ratio OR urine protein to creatinine ratio
What are some renal ultrasound findings in CKD patients?
- Atrophic or small kidneys
- Cortical thinning
- Increased echogenicity
- Elevated resistive indices
- Presence of hydronephrosis (obstruction)
What are some complications caused by CKD?
- CVD
- Electrolyte Imbalance: Hypocalcemia, Hyperkalemia, Hyperphosphatemia
- Vit D deficiency
- Metabolic Acidosis
- Uremia
- HTN
What are some ways to control or treat CKD?
- Low salt, potassium, and phosphorus diet
- Diuretics
- ACE inhibitors, ARB, aldosterone antagonist, renin inhibitor
- Renal Replacement Therapy
What are indications for dialysis?
Severe Acidosis Electrolyte disturbance Ingestion Volume Overload Uremia
What is azotemia?
Elevated BUN (blood urea nitrogen) w/o symptoms
What is uremia?
Elevated BUN w/ symptoms:
- nausea/vomiting
- confusion
- pruritus
- metallic taste in mouth
- fatigue
- anorexia
What is hemodialysis?
Use of a machine and a filter to remove waste products and water from the blood
What is acute kidney injury?
Sudden episode of kidney failure or kidney damage
What two criteria determines AKI?
- Serum creatinine levels
- Urine Output
What are major risk factors for AKI?
- Old age
- Proteinuria
- CKD
- Hypertension
- Diabetes
- CVD
- Exposure to nephrotoxins
- Cardiac surgery
- Fluid overload
- Sepsis
What main drugs can lead to AKI?
- Antibiotics
- NSAIDs
- PPIs
What are complications of AKI?
- Development and progression of CKD
- End stage renal disease
- CVD
What are signs and symptoms of AKI?
- Edema
- Hypertension
- Decreased urine output
- Foamy urine
- Uremia
- Pericardial friction rub
- Asterixis
- Uremic frost
What labs/imaging are important to obtain for patients with AKI?
- Urinalysis with urine microscopy
- Urine albumin to creatinine ratio OR urine protein to creatinine ratio
- Renal ultrasound
What urinary patterns suggests nephritic syndrome and nephrotic syndrome?
Both: Proteinuria
Nephritic: Hematuria
Nephrotic: Lipiduria
What urinary pattern suggests urinary tract syndrome?
WBCs
RBCs
Bacteria
What is the purpose of ordering FeNa or FeUrea?
Differentiate prerenal azotemia from intrinsic renal inury
FeNa or FeUrea is only valid in which type of patients, oliguric or non-oliguric?
Oliguric
If a patient is non-oliguric does that mean they are prerenal or not?
Not prerenal
How is AKI treated?
Supportive:
- avoid HTN
- stop nephrotoxins
- renal replacement
