Nephrolithiasis, Pyelonephritis, AKI Flashcards
What is the presenting chief complaint for nephrolithiasis?
flank pain/groin pain, N/V, inheritable/recurrent
What is the presenting chief complaint for pyelonephritis?
flank pain/abd pain, fever/chills, N/V
What is the presenting chief complaint for AKI?
asx, decreased urine output, fatigue, SOB/CP, N/V
What are the sympathetics for the GU tract (includes bladder)?
T10-L2
What are the sympathetics for the upper ureter?
T10-11
What are the sympathetics for the lower ureter?
T12-L2
What are the parasympathetics for the upper ureter?
OA, AA - vagus N
What are the parasympathetics for the bladder and lower ureter?
S2-4
What is the chapmans point for the kidney?
1 in lateral and superior to the umbilicus
What is the chapman point for the ureters?
none
what is the chapman point for the bladder?
umbilicus
AIN is inflammation between the tubules and often a reaction to what?
Drugs such as NSAIDs, Abx, PPIs, diuretics
What BUN Cr ratio suggests pre-renal azotemia?
20:1
What is FeNa?
determines if the nephrons retain the ability to concentrate urine; can differentiate between ATN and pre-renal azotema
FeNA of <1% suggests what?
tubules are intact; pre-renal azotemia
FeNa >2% suggests what?
damaged tubules; ATN
What is the gold standard for kidney imaging?
non constrast CT abd and pelvis
What are the Ddx to rule out for nephrolithiasis?
pyelonephritis, abd organ pathology, ectopic pregnancy
What initial labs/imaging should be performed for nephrolithiasis?
BMP or CMP, UA, beta-hCG (if female) –> non contrast CT if negative but if positive order US
What are the expected lab/imaging results for nephrolithiasis?
Negative BMP +/- elevated BUN/Cr, UA + microscopic blood, - nitrites/leukocyte esterase, non contrast CT + for stone
What DDx need to be ruled out for pyelonephritis?
nephrolithiasis, abd organ pathology, ectopic pregnancy, STIs
What is the initial labs/imaging for pyelonephritis?
BMP or CMP, CBC, UA with culture, beta hCG if female, STI panel
What are the expected lab results for pyelonephritis?
BMP negative +/- elevated BUN/Cr, CBC + leukocytosis, UA + nitrites and leukocyte esterase, culture + likely E coli, abx sensitivities, STI panel negative
What Ddx need to be ruled out for pre-renal AKI?
intrinsic, post renal, CKD
What initial labs/imaging should be performed for pre-renal AKI?
BMP or CMP, CBC, UA with microscopy w/ or w/o FeNa, +/- US
What are the expected lab results for pre-renal AKI?
BMP + 20:1 BUN Cr, CBC -, UA specific gravity >1.030, FeNa <1%, microscopy hyaline casts, US no hydronephrosis or atrophy
What are the Ddx to rule out for intrinsic tubular AKI (ATN)?
pre-renal, post renal, CKD
What are the initial labs/imaging that should be done intrinsic tubular AKI (ATN)?
BMP or CMP, CBC, UA with microscopy with or wo FeNa, +/- US
What are the expected lab results intrinsic tubular AKI (ATN)?
BMP + elevated BUN/Cr, UA microscopy shows tubular epithelial cells (granular casts), FeNa >2%
What Ddx need to be ruled out for intrinsic interstitial AKI (AIN)?
pre-renal, post renal, CKD
What labs/imaging should be done for intrinsic interstitial AKI (AIN)?
BMP or CMP, CBC, Ua with microscopy w or wo FeNa, +/- US
What are the expected lab results for intrinsic interstitial AKI (AIN)?
BMP + elevated BUN/Cr, CBC showing eosinophilia, UA leukocytosis, microscopy WBC casts
What Ddx need to be ruled out for glomerulonephritis?
pre-renal, intrinsic, post renal, CKD
What labs/imaging should be done for glomerulonephritis?
BMP or CMP, CBC, UA with micropscy w or wo FeNA, +/- US
What are the expected lab results for glomerulonephritis?
BMP + elevated BUN Cr, UA hematuria and proteinuria, microscopy RBC casts
What Ddx need to be ruled for post-renal AKI?
pre-renal, intrinsic, CKD
What labs/imaging should be performed for post-renal AKI?
BMP or CMP, CBC, Ua with microscopy w or wo FeNa, +/- US
What are the expected results for post-renal AKI?
BMP + elevated BUN/Cr, US shows hydronephrosis
