Nephrology Flashcards
Urinalysis measures?
Protein WBC or Leuk esterase RBCs Specific gravity and pH Nitrites
Pyuria +Nitrates=
UTI
3 UTI organisms not measured on nitrates
Enterococcus
Staph saprophyticus
Group B Strep
1+ proteinuria = g/day
1 g/day
less than
is normal protein loss in 24 hours
30-50 mg
work up for proteinuria?
UA/Dip
Urine protein: creatinine or 24 hour urine
Renal biopsy
Dipstick only measures what kind of protein?
albumin
Dipstick is important for what patient?
the Diabeetus pt
What detects eosinophils in urine?
Wright and hansel stains
Dysmorphic RBCs
glomerulonephritis
Hematuria w/o infection w/o trauma
tests to order?
Ultrasound/CT if it shows nothing order
cystoscopy is the most accurate
Red cell think?
glomerulonephritis
White cell think?
Pyelonephritis
Eosinophils think?
Acute interstitial nephritis
Hyaline think?
Dehydration
Broad, waxy think?
Chronic renal disease
Granular, “muddy-brown”
Acute tubular necrosis (are dead tubular casts)
AKI
Acute Kidney injury
decrease in creatinine clearance
sudden rise in BUN and creatinine
Prerenal Azotemia
Decreased perfusion
Hypotension (sepsis, anaphylaxis, bleeding, dehydration)
Hypovolemia (Diuretics, burns, pancreatitis, dec. in pump function, low albumin, cirrhosis)
Postrenal Azotemia
Obstruction
BPH/Prostate cancer Ureteral stone Cervical cancer urethral stone Neurogenic bladder Retroperitoneal fibrosis (chemo or XRT)
Intrinsic Renal disease
ischemia and toxins
ATN: Toxins (NSAIDs, AG, ampho, CIsplastin, cyclophosphamide), Prolonged ischemia
AIN: PCN, sulfa Rhabdo/hemoglobinuria Contrast Crystals Bence Jones protein Post Strep Infection
AKI tests?
Initial? BUN/Creat
image?
unclear: U/A, UNa, FEUrea, Urine osmolality
Prerenal Azotemia Labs will show??
BUN/creat: >20:1 low UNa (below 20) Low FENa (500 mOsmo/kg
Acute Tubular Necrosis Labs will show?
BUN/creat: 1%)
Urine osmolality
Increase risk of toxic/insult ATN
hypoperfusion of kidney
Renal insuff (HTN, diabetes)
older age
ATN causes by time
(5-10 days)
(24-48 hrs)
5-10 days: Drugs related injury–aminoglycosides, amphotericin, cisplatin, vancomycin, acyclovir, cyclosporine
24-48 hrs: Contrast media- prevent with saline
Rhabdomyolysis
Causes
trauma, prolonged immobility, snake bites, seizures, crush injuries
Rhabdo initial test?
UA (dipstick and microscopic analysis)
Blood positive no RBCs seen
rhabdo most specific test?
urine myoglobin
Rhabdo other lab findings on CMP?
Increased cpk hyperkalemia hyperuricemia hyperphosphatemia hypOcalcemia
Tx Rhabdomolysis
Saline hydration
mannitol
bicarbonate
Txs THAT DO NOT HELP WITH ATN
low dose dopamine
diuretics
mannitol
steroids
Dialysis Indications
Acidosis Electrolytes Intoxications Overload Uremia
Furosamide SE
SE damages inner hair cell
Hepatorenal syndrome
Sever liver disease
new onset renal failure with no other explanation
very low urine sodium (>10-15 mEq/dL)
FeNa 20:1)
Acute Interstitial Nephritis
antibodies and eosinophils attack cell linings
Reaction to drugs, infection and autoimmune disorders
Papillary Necrosis
onset a few hours necrotic material in urine Urine culture: negative CT scan : bumby contour of kidney interior Tx: no treatment
Glomerular disease all have
UA with hematuria Dysmorphic red cells Red cell casts urine sodium and FENA are low Proteinuria
Goodpasture
Lung and kidney only
ANA antibodies
best test : lung or kidney biopsy: linear deposits
Goodpasture tx
plasmapheresis, steroids,cyclophosphamide
IgA Nephropathy (Berger Disease)
MCC of acute glmoerulonephritis
1 to 2 days after URI
increased IgA levels (>50%)
no tx unless severe and you give steroids and ACEI
Postinfectious Glomerulonephritis
MC infection is streptococcus
follows throat infection or skin infection by 1-3 weeks
Presentation:
cola colored urine, edema, HTN, Oliguria
Test: UA, ASO titers, anti-DNAse antibody titers, biopsy
Postinfectious glomerulonephritis
tx: antibiotics, diuretics to control fluid overload
Alport syndrome
Type 4 collagen defect
Hearing loss, visual problems, glomerular problems
No treatment
Polyarteritis Nodosa
systemic vasculitis of small and medium sized arteries
spares the lung
associated with Hep B
Polyarteritis Nodosa
Labs and treatment
anemia and leukocytosis Increased ESR and c-reactive protein biopsy most accurate Tx: Prednisone, cyclophosphamide treat the Hep B
Lupus Nephritis
any degree of renal involvement: membraneous glomerulonephritis, glomerulosclerosis “scars kidney”
Biopsy
tx: steroids, cyclophosphamide, mycophenolyate
Amyloidosis
Abnormal protein produced by
myeloma, chronic inflammatory disease, rheumatoid arthritis, inflammatory bowel disease, chronic infections
Accurate test for Amyloidosis
tx?
apple-green birefringence with congo-red staining
tx: control underlying disease
2nd line: melphalan and prednisone
Nephrotic Syndrome
definition
protein >3.5g/24 hr
edema
hyperlipidemia
thrombosis
Nephrotic syndrome
most common cause
pt & associations
diabetes and HTN assoc. cancer: membranous children: minimal change IVDU/AIDS: focal segmental NSAID: minimal change disease and membranous SLE: any of them
Nephrotic Syndrome Tx:
1st: Glucocorticoids
2nd: cyclophosphamide
ACEI or ARB
salt restriction/ diuretics
Statins
End Stage Renal Disease
Loss of renal function defined by symptoms and abnormalities that are collectively known as uremia.
Uremia signs
Metabolic acidosis Fluid overload encephalopathy hyperkalemia Pericarditis
Treatment of hyperphosphatemia
calcium acetate
calcium carbonate
Use the following when Ca is high:
sevelamer
lanthanum
Aluminum causes dementia which is why
you never use aluminum containing phosphate binders to lower hyperphosphatemia
HLA-identical, related donor kidneys last 24 yrs on average
Kidney transplant
TTP and HUS
TTP is assoc with HIV, cancer, drugs
HUS is assoc w/E coli
TTP
Tx: plasmapheresis
if not an option treat with FFP
Steroids don’t help and you don’t give platelets (b/c it is consumptive problem)
Simple Cyst
echo free
smooth, thin walls
sharp demarcation
transmission good through to back
Complex Cyst
mixed echogenicity
irregular, thick walls
lower density on back wall
debris in cyst
Polycystic Kidney Disease
Autosomal dominant disorder
Pain, hematuria, stones, infection, HTN
Central DI
loss of ADH production
CNS disorders: stroke, tumor, trauma, hypoxia, infection
Nephrogenic DI
Loss of ADH effect
Lithium, demeclocycline, chronic kidney disease, hypokalemia, hyperkalemia
CDI Treatment
ADH replacement
NDI Treatment
Correct the potassium and calcium
stop lithium or demeclocycline
Given HCTZ or NSAID
Cerebral edema
sodium levels brought down too rapidly
Addison disease
loss of adrenal function –> loss of aldosterone
hypervolemia hyponatremia
CHF
Nephrotic syndrome
cirrhosis
Euvolemic hyponatremia
Pseudohyponatremia
psychogenic polydipsia
hypothyroidism
SIADH
Hyponatremia symptoms
confusion, lethargy, disorientation, seizures, coma
Central pontine myelinolysis
if the sodium level is brought up to normal too rapidly
Hyperkalemia
3 types
Pseudohyperkalemia
decreased excretion
increased release from tubules
Hyperkalemia order which test first
EKG
peaked Twaves, wide QRS, PR interval prolongation
Treatment Hyperkalemia
Calcium chloride or calcium gluconate Bicarb/beta agonist Insulin Glucose Kayexalate D
Hypokalemia presentation
weakness, paralysis, loss of reflexes
Hypokalemia EKG findings
U waves ventricular ectopy (PVC), flattened t waves and ST depression
Anion gap calculation
Na - ( CL+ HCO3)
normal gap is 6-12
Nonanion gap calculation
causes
RTA and diarrhea
Nephrolithiasis most common type
calcium oxalate
forms in alkaline urine
Nephrolithiasis most common risk factor
overexcretion of calcium in urine
Diagnostic test for nephrolithiasis
CT scan
how do you manage cystine stones?
alkalinze the urine
