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Infectious disease > MTB Nephrology > Flashcards

MTB Nephrology Flashcards

1
Q

What are the 3 “best initial tests” in nephrology?

A

UA
BUN
creatinine

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2
Q

List the 7 components of UA

A
  1. protein
  2. white cells - direct micro examination
  3. leukocyte esterase - dipstick
  4. red cells
  5. specific gravity
  6. pH
  7. Nitrites - indicates the presence of gram negative bacteria on dipstick
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3
Q

What is damaged in the kidney when you see severe proteinuria?

A

glomerular damage

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4
Q

What does Tamm-Horsfall protein refer to? How much protein is this referring to?

A

Tamm- Horsfall refers to the minimal amount of protein that is secreted by the tubules.
protein levels range form 30-50 mg/hr

note: transient proteinuria is normal in 2-10% of the population

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5
Q

What should be done if prolonged proteinuria occurs in the absence of prolonged standing (orthostatic proteinuria)?

A

kidney biopsy

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6
Q

What are the 2 methods to determine total amount of protein in a day?

A
  • single protein to creatinine ratio –> this is more accurate.
    P/Cr 1 = 1 g/day, 2.5 = 2.5 g/day.
    Faster and easier test than 24 hours collection
  • 24-h urine collection
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7
Q

What does urine dipstick for protein test for?

A

Albumin only

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8
Q

What is normal level of protein excretion from the kidney?

A

> 300 mg/24 hours

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9
Q

When assessing protienuria, what is the best initial test, and what is the more accurate test in determining the amount?

A

best initial test: UA

most accurate determination of protein in urine: protein to creatinine ratio

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10
Q

What can be done to determine the cause of proteinuria?

A

kidney biopsy

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11
Q

Tiny amounts of protein that are too small to detect on the UA are called what?

A

microalbuminuria

  • this is important to detect in diabetics as long term microalbuniuria leads to worsening renal function in a diabetic pt and should be treated.
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12
Q

What is the best initial medication for any sort of proteinuria in a diabetic pt?

A

ACE inhibitor
ARB
they will delay the development of renal insufficiency

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13
Q

What test needs to be done in order to detect Bense Jones bodies seen in myeloma?

A

immunoelectrophoresis

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14
Q

White blood cells in urine indicate what 3 possible etiologies?

A
  1. inflammation
  2. Allergic interstitial nephritis
  3. infection
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15
Q

Are you able to distinguish between eosinophils and neutrophils on a UA?

A

NO

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16
Q

What does urinary eosinophils suggest?

A

allergic interstitial nephritis

17
Q

Does NSAID niduced renal disease show eosinophils?

A

NO

18
Q

What stains detect eosinophils in the urine?

A

Wright and Hansel - allergic interstitial nephritis

19
Q

How many RBCs are normally found under hpf in a urinalysis?

A

> 5

20
Q

List 7 reasons someone might have hematuria.

A
  1. Stones in bladder, ureter, kidney
  2. coagulopathy
  3. Infection - cystitis, pyelonephritis
  4. Cancer - bladder, ureters, kidney
  5. Trauma
  6. medications - cyclophosphamide = hemorrhagic cystitis
  7. Glomerulonephritis
21
Q

What are 2 causes of false positive test for hematuria?

A
  1. hemoglobin

2. myoglobin

22
Q

If dysmorphic RBCs are identified in the urine, what type of renal disorder is most likely present?

A

Glomerulonephritis

23
Q

When would you perform a cystoscopy on a pt with hemauria?

A

When there is no infection and no prior trauma but there is blood in the urine

Cystoscopy is the most accurate test for the bladder

24
Q

What disease is associated with the following urinary casts?

  1. red cell
  2. White cell
  3. Eosinophil
  4. Hyaline
  5. Broad, waxy
  6. Granular, muddy brown
A
  1. glomerulonephriris
  2. pyelonephritis
  3. acute (allergic) interstitial nephritis
  4. dehydration conentrate the urine and the normal Tamm-Horsfall protein precipitates or concentrates into a case
  5. chronic renal disease
  6. Acute tubular necrosis
25
Q

What is acute kidney injury?

A

AKA - acute renal failure
decrease in creatinine clearance and sudden rise in BUN and creatinine
- no specific numbers define AKI

26
Q

What are the 3 classifications of acute kidney injury?

A
  1. prerenal azotemia - decreased perfusion
  2. postrenal azotemia- obstruction
  3. intrinsic renal disease - ischemia and toxins
27
Q

List 8 causes of prerenal AKI

A
  1. hypotension - shock, sepsis, anaphylaxis, bleed, dehydration
  2. hypovolemia - bleed,, dehydration diuretics, burns, pancreatitis
  3. renal artery stenosis - BP is high but the kidney is underperfused
  4. Relative hypovolemia d/t decreased pump function - CHF, constrictive pericarditis, tamponade
  5. Hypoalbuminemia
  6. Cirrhosis
  7. NSAIDs - constrict the afferent arteriole
  8. ACE inhibitors cause efferent vasodilation
28
Q

List 6 causes of postrenal azotemia

A
  1. prostate hypertrophy or cancer
  2. stone in ureter
  3. cervical cancer
  4. Neurogenic bladder (atonic)
  5. Urethral stricture
  6. Retroperitoneal fibrosis - ho bleomycin, radiation, methylsergide
29
Q

What is the major force controlling filtration in the kidney?

A

glomerular hydrostatic pressurein the glomerular capillary

  • if pressure in Bowman’s space rises - you cannot filter fluid
  • both kidneys must be blocked for creatinine to rise
30
Q

What is the most common cause of intrinsic renal disease?

A

acute tubular necrosis from toxin exposure or prolonged ischemia

31
Q

What are some common causes of intrinsic renal disease?

A
  1. acute/allergic interstitial nephritis - from meds like penicillins
  2. Rhabdomyolysis and hemoglobinuria
  3. contrast, aminoglycosides, cisplatin, amphotericin, cyclosporine, NSAIDs
  4. crystals - hyperuricemia, hypercalcemia, hyperoxaluria
  5. protein -bence jones protein from myeloma
  6. poststreprococcal infeciton
32
Q

What is the BUN:creatinine ratio for the 3 different classifications of AKI?

A

prerenal and postrenal - >20:1

intrinsic 10:1

33
Q

What is the best initial test for dx AKI?

A

BUN:creatinine

34
Q

List 4 best initial tests when the cause of AKI is not know.

A
  1. UA (always do this first)
  2. Urine Na UNa
  3. Fractional excretion of sodium FeNa
  4. Urine osmolality
35
Q

What is the urine osmolality of someone with ATN

A

isosthenuria - same as blood - 300 mOsm/L
Because the tubular cells normally absorb water from the tubules - they are now damaged in AKI and cannot reabsorb water, therefore the urine osmolality is abnormally low.

36
Q

What is the effect of dehydration on urine concentration/osmolality?

A

concentrates urine

37
Q

What is the effect on urine Na and water concentration in ATN?

A

When the tubular cells are damaged, they cannot absorb water or Na - so the urine Na concentration will be elevated.
UNa >20
UOsmWater osmolality less than 500

38
Q

What is the only renal manifestation of someone with sickle cell trait - heterozygous for sickle cell.

A

No renal concentrating ability. This results in dilute urine/isosthenuria
these pts will continue to produce inappropriately dilute urine despite dehydration
- make sure pt stays hydrated

39
Q

How does urine specific gravity relate to urine osmolality?

A

f

Infectious disease (5 decks)

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