Nephro Flashcards
What are some important hematuria mimics to r/o
Menstrual blood, rhabdomyolysis, hemoglobinuria, porphyria, beets, fictious
What are the immune-complex mediated glomerular causes of hematuria
IgA nephropathy, igA vasculitis, lupus, infectious-related
What are the non-immune-complex mediated glomerular causes of hematuria
AntiGBM (goodpasture’s), ANCA asculitis, genetic disorders
What are the non-glomerular kidney causes of hematuria
Pyelonephritis, RCC, PCKD, Medullary sponge kidney
Whart are the most common causes of gross hematuria?
Cancer, UTI, stone, or stricture (also think trauma or recent procedure or rads) - also think about the level anatomically
What are the important features to characterize on history?
Hematuria in relation to urine (e.g. if later then suggests prostate source, if beginning then urethra/bladder), onset and frequency
Accompanying urinary Sx
Associated Sx esp. fever, flank/groin pain, const / autoimmune
Triggers (trauma, exercise)
Iatrogenic tactors
Risk factors / exposures (especially dye or dye industry, analgesia, kidney stones, FH)
Pregnancy
What workup do you send for hematuria?
Urinalysis + microscopy + culture + urine ACr
CBC / lytes / cr / INR/PTT, betaHCG
Viral screen (HIV, HBV, HCV)
C3/C4 + autoimmune (ANCA, antiGBM, anti-dsDNA)
+/- renal biopsy
How do you distinguish between glomerular and non-glomerular bleeding?
Look for RBC casts and proteinuria (clots tends to indicate non-glomerular bleeding)
When do you refer people to urology for hematuria?
Gross hematuria all patients >40 (need to r/o malignancy)
When do you send to nephrology referral for hematuria?
Elevated Cr, proteinuria, casts or dysmorphic RBCs or >= 5 WBC/hpf without evidence of infection
In a patient with a foley, where should you look to assess hematuria?
Look at the foley tubing; not the bag.
What size foley do you need for CBI
3-way 20 French or 22 french (ideal)
What is this cast
Renal tubular epithelium
What is this cast
RBC cast
What is this cast
Fatty cast
What is this cast
Hyaline cast
What is this cast
WBC cast
If you have patients at risk of bladder Cx what is the appropriate follow-up?
Repeat U/A yearly, if 3x +ve for microscopic hematuria or recurrence of gross hematuria, repeat full workup.
What is the differential for papillary necrosis
Pyelonephritis, obstrution, sickle cell disease / trait, NSAIDs, Tuberculosis, systemic vasculitis, (rarely DM / liver failure)
How do you differentiate nephritic vs nephrotic
Nephritic = blood (rbc cast or dysmorphic) + 1-3G protein per day
Nephrotic syndrome = prot >3.5 + edema + serum albumin < 35 + hypercholestérolémia + hypercoag + inf
What is the differential for GN
ANCA, GBM (also associated with DAH)
Vs immune complex (IGA, complément déposition, lupus, infection HepB/HepC/HIV (incl sepsis or endocarditis)
I what protein is picked il on dipstick
Albumin (not other proteins)
What is normal proteinuria
150mg day
Albumin 30
When do you suspect glomerulonephritis?
Aki cr rise that is slow
Blood / protein in urine
Failed fluid challenge
Not obstructive.