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Nayla Foundations Exam 5 > Nephro guest lecture > Flashcards

Nephro guest lecture Flashcards

1
Q

What is important renal anatomy

A

L renal vein is longer
R kidney is lower
Kidneys are retroperitoneal (not held by mesentary)

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2
Q

What is the safest and easiest way to look at kidneys

A

US (best for obstructive disease): renal for proximal-ureter, pelvic for distal
Doppler US: vascular flow in RAS, RVT
*US is less sensitive for renal masses

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3
Q

What is gold standard imaging for renal stones

A

CT
also used to evaluate tumors and diagnosing RVT
-avoid contrast if possible (nephrotoxic)

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4
Q

What primary imaging is preferred in kids

A

Radionuclide studies- less radiation than a CT

-can eval obstructive or not, hydronephrosis, and renal function

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5
Q

What is gold standard for RVT evaluation

A

MRI (also for renal masses)

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6
Q

What happens if you give gandolinium to someone in renal failure (GFR <30)

A

Nephrogenic system fibrosis: thick skin of trunk and extremities- fibrosis of dermis, muscle, fascia, lung, and heart

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7
Q

When would you use renal arteriography/venography

A

artery/vein occlusions
polyarteritis nodosa
(but not used often bc more invasive than CT/MRI)

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8
Q

What is an IV pyelogram used for

A

recurrent stones- tells you where the stone is, size and shape of kidney
but not really used bc of radiation and contrast

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9
Q

What are indications for a renal biopsy

A

Nephrotic/Nephritic syndrome
SLE
idiopathic ARF

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10
Q

What are contraindications to a renal biopsy

A

glomerular hematuria

mild proteinuria

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11
Q

What are the types of biopsies

A

open renal
transjugular
percutaneous (MC, but local anesthesia)

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12
Q

What can go wrong with a kidney biopsy

A

Page kidney (bleeding under the capsule causing increased pressure)

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13
Q

What is hydronephrosis

A

edema of collecting system (associated with stones)

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14
Q

What are Sx of hydronephrosis

A

Asymptomatic

If obstructed: pain, +/- change in UO (relieved by stent)

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15
Q

What are obstructive etiologies of hydronephrosis

A

GI/Gyn masses
stones
BPH (obstructed urine flow)

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16
Q

What imaging should you get if you suspect obstructive hydronephrosis

A

US- obstruction will look white (radiopaque)

If US not indicative, get a CT

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17
Q

What are non-obstructive causes of hydronephrosis

A

Large diuresis (diabetes insipidus) distends intrarenal collecting system

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18
Q

What is Acute Kidney Injury

A

Abrupt decrease in GFR (usu. reversible)- <48 hrs

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19
Q

What is Acute renal failure

A

Decrease in GFR and UOP (<5ml for >6hr)

Increased urea and creatinine (SrCr increase >50%// Cr increase >0.3 in 48 hr)

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20
Q

Explain RIFLE

A

Defines the severity of AKI; Risk, Injury, Failure, Loss, ESRD
Risk for dysfxn if GFR decreases >25%, or UOP decreases <0.5 for 6 hrs
Injury if GFR decreases >50%, or UOP decreases <0.5 for 12 hrs
Failure if GFR decreases >75%, or UOP decreases <0.5 for 24 hrs
Loss of kidney fxn if >4 weeks
ESR if >3 months

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21
Q

What can cause AKI/ARF

A

*pre-renal AKI (MC)
Intrinsic AKI
Post renal AKI

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22
Q

What are Pre-renal causes of AKI

A

hypoperfusion; decrease in intravascular volume, change in vascular resistance, low cardiac output

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23
Q

Low renal perfusion + low cardiac output cause

A

increased BUN:Cr ratio (> 20:1 )

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24
Q

How do you treat hypoperfusion (pre-renal)

A

maintain Euvolemia and avoid nephrotoxic agents (NSAID, ACE-I, Digoxin)

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25
Q

What are intrinsic causes of AKI

A

Acute Tubular Necrosis *
acute interstitial nephrosis
glomerular nephrosis
vascular

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26
Q

What is acute tubular necrosis

A

Tubular damage due to ischemia or nephrotoxins (ampho B, vanco, contrast) causing prolonged hypotension and hypoxemia

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27
Q

How do you treat ATN

A

avoid volume overload
avoid K
protein restriction
+/- diuretics

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28
Q

What do you do if someone with ATN needs imaging

A

give N-acetylcystein + Bicarb to renally protect them

29
Q

What is Acute Interstitial nephrosis

A

Inflammatory response leading to edema and tubular damage

2/2 Nephrotoxic drugs, strep, CMV, RMSF, AI (SLE, sjogrens, sarcoidosis)

30
Q

How do you diagnose and treat AIN

A

US: eosinophilia

good prognosis with steroids +/- dialysis

31
Q

What is Glomerulonephritis

A

Immune complex deposits (IgA nephropathy, good pasteur’s, post infectious strep, Wegener’s)

32
Q

How do you diagnose and treat Glomerulonephritis

A

US: RBC casts (coca cola pee) d/t bleeding kidneys

Treat with steroids or plasma exchange

33
Q

What are post-renal causes of AKI

A

obstructions (BPH, urolithiasis, cancer, bladder dysfunction, anticholinergic drugs) all leading to lower Abd pain

34
Q

How do you diagnose and treat post renal AKI

A

US and increased BUN:Cr

Treat by decreasing pressure w/ cath, stent, or surgery

35
Q

How do you manage ARF/AKI

A

identify and reverse source

+/- short term dialysis

36
Q

What are indications for hemodialysis

A 
Weight (gain) 
Edema (fluid overload) 
Messed up electrolytes 
decreased UOP 
unresponsive acidosis (pH <7.1)
37
Q

When someone is on hemodialysis what do they need to be cautious about

A

K+ containing foods (tomatoes, potatoes)

38
Q

What are the ways you can get hemodialysis

A

Fistula
graft
tunneled line

39
Q

What happens if an AKI kidney is put into a new body

A

it will function like normal! AKI is reversible

40
Q

At what stage of kidney disease do we develop ESRD

A

Stage 5; GFR <15, or on dialysis

41
Q

What does GFR measure

A

Degree of impairment, varies by age, gender, and body size

measured by MDRD; modification of diet in renal disease

42
Q

What is creatinine

A

Waste product of creatinine phosphate from muscle breakdown

dependent on muscle mass- it passes thru muscle and kidneys

43
Q

What is Azotemia

A

Nitrogen in the blood that occurs when kidneys cant clear metabolites d/t renal parenchymal damage, leads to uremia

44
Q

How is azotemia measured

A

BUN:Cr (uremia)

45
Q

What is uremia

A

Urea in the blood
urea is normally made by the liver and peed out
in stage 3-5 of CKD, urea cant be processed and excreted by kidneys so it gets into blood

46
Q

What are Sx of uremia

A 
Malaise 
N/V 
dyspnea 
cramping 
bleeding 
Sz 
cardiac arrest 
-HTN, muscle waisting, ecchymosis, Kussmaul breathing
47
Q

What test diagnoses CKD

A

GFR!!
also increased BUN:Cr, proteinuria, microalbuminuria
(consider a renal biopsy)

48
Q

How do you treat CKD

A

ACE/ARB (slow progress), Epogen, Fe, antiplatelets (get Hgb to 11-12)
low protein diet
fluid restrict
Calcium/vitamin D

49
Q

What is hypervolemia

A

low Na and increased volume (CHF, ESRD, ESLD, nephrotic syndrome)
decreased Hgb/Hct

50
Q

How do you treat hypervolemia

A

fluid restrict, consider diuretics or short term dialysis

51
Q

What is hypovolemia

A

volume loss from ECF > intake (2/2 GI tract, kidneys, 3 spacing, skin/injured tissues)
high Hgb/Hct, high urea, low Na
If Na and volume both low, GI or renal source

52
Q

How do you treat hypovolemia

A

Isotonic IVF (but dont correct too fast, can cause central pontine myelinolysis)

53
Q

What are some causes of CKD/ESRD

A 
PKD 
DM
GMN 
HTN
SLE
Nephrolithiasis
54
Q

What is PKD

A 
many bilateral cysts= decreased renal mass= decreased renal function 
Autosomal dominant (FHx) 
associated with hepatic and pancreatic cysts
55
Q

What are symptoms of PKD

A

hematuria, infection, stones, nocturia, pain (if rupture)

leads to weight loss, early satiety, N/V

56
Q

How do you diagnose and treat PKD

A

US is choice (but CT shows it better)

Tx: pain management, ACE/ARB, aggressive Abx is symptomatic

57
Q

What are diabetic glucose levels

A

fasting glucose: >126

HgbA1C: >6.5

58
Q

What are complications of DM

A

retinopathy
nephropathy
neuropathy
increased risk of CV disease and stroke

59
Q

Explain metformin and kidney CT scans

A

Avoid Metformin if Cr >1.4 (w) or >1.5 (m)
Hold metformin the day of the scan and 2 days after
–to avoid lactic acidosis
Avoid metformin in decompensated HF, liver failure, or alcohol use

60
Q

What is RAS

A

usually d/t atherosclerosis
diagnose with renal angiogram* (or doppler)
treat with angioplasty, +/- stenting

61
Q

What is renal secondary HTN

A

2 episodes of SBP >140, or DBP >90

62
Q

How do you treat renal secondary HTN

A 
lifestyle modifications 
then meds (thiazide, ACE, CCB)
63
Q

What is SLE

A

autoimmune d/o where autoantibodies attack healthy tissue, leading to nephritis and proteinuria
+ ANA
MC in young females and african americans

64
Q

What are the types of renal stones

A

Calcium (radiopaque)
Uric acid (radiolucent)
Cystine (radiolucent)
Struvite (radiopaque)

65
Q

Struvite stones are made of

A

Calcium
Magnesium
Ammonia (from UTI/catheters)

66
Q

How is nephritic syndrome treated

A

Diuretics
salt and water restriction
dialysis

67
Q

What is the prognosis of renal failure

A

most AKI recover (early recognition is key!)

OR, CKD/ESRD

68
Q

What reversible processes can decrease renal function

A

Hypovolemia
Infection
NSAID’s
ACE-I

69
Q

Major causes of death in dialysis patients include

A
  1. CV disease
  2. Infection (Staph aureus)
  3. Withdrawal

Nayla Foundations Exam 5 (7 decks)

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