Nephro/Urology Flashcards
what is acute renal failure
is a syndrome of rapidly deteriorating GFR with accumulation of (Urea,Creatinine) referred to azotemia
serum creatinine rises .5mg/dl or more than 50% over baseline
what two disease cause ARF or AKI
reduced renal perfusion or actue tubular necrosis
what are clinical features of ARF
nausea, vomiting, diarrhea, pruritus, drowsiness, dizziness, SOB
distended bladder, CVA tenderness, enlarged prostate
what is GFR
is a key parameter to measure renal function, serum creatinine or blood urea nitrogen is less reliable
BUN
provides an estimate of renal function but is more sensitive to dehydration, catabolism, diet, renal perfusion and liver disease
what are prerenal causes for ARF
hypovolemia
hypotension (systolic BP less than 90mmHg
CHF,Cirrhosis, nephrotic syndrome, early sepsis
Aortic aneursym
Renal Artery stenosis
decreased renal perfusion from NSAID, ACE
intrinsic causes of ARF
ATN, Nephrotoxins (NSAID, Aminoglycosides
SLE, Polyarteritis nodosa
post renal causes
tubular obstruction
urolithiasis, BPH, bladder outlet obstruction
what does a prerenal UA, BUN/CR FENa Urine Osmolality urine sodium
Hyaline casts
BUN/CR >20:1
FENa500mOsm
Urine Sodium
what does a intrinsic UA, BUN/CR FENa Urine Osmolality urine sodium
abnormal casts
BUN/CR 2-3%
250-300mOsm
urine sodium>40
what do RBC indicate
glomerular disease
what do WBC cast indicate
renal parenchymal inflammation
what do muddy brown casts indicate
ATN
what is the most common cause of CKD
diabetes
what is CKD
loss of kidney function (GFR)
CKD1 GFR
kidney damage with normal or increased GFR>90
CKD2 GFR
kidney damage with 60-89 GFR
CKD3 GRF
30-59
ckd4
15-29
ckd 5
GFR
lab findings with CKD
Elevated BUN Elevated Cr Hyperkalemia Hyperphosphatemia Hypocalcemia Metabolic acidosis
what are the most common causes of CKD
DM, HTN, hlomerulonephritis and PKD
treatment of CKD
ACE and ARBs slow progression of disease
managing co-morbid condition like DM or HTN
Erythropoetin and iron to maintain Hgb
Dietary management( restrict protein intake, calcium and Vit D supplements
what is glomerularnephritis
refers to damage of the renal glomeruli by deposition of inflammatory protein in the glomerular membranes as the result of an immunologic response
when is glomerular nephritis most common
2-12yrs
what are clinical features of glomerularnephritis
hematuria and tea colored urin
oligouria or anuria is present
edema of the face and eyes is present in the morning and edema of the feet and ankles
lab findings
ASO titer is increased in 60-80% should be considered of a recent streptococcal infection
UA shows >3RBC/HPF
red blood cells will be misshaped acanthocytes
Renal biopsy to determine exact diagnosis or severity of the disease
what is the treatment for glomerularnephritis
steriods and immunosuppressive drugs for PSGN
Salt and fluid intake should be decreased
dialysis for symptomatic azootemia
ACE