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Maddy - CPR III > Oliguria and Proteinuria > Flashcards

Oliguria and Proteinuria Flashcards

1
Q

anuria

A

urine output < 50-100 mL/day

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2
Q

oliguria

A

urine output < 400-500 mL/day

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3
Q

polyuria

A

urine output < 3,000 mL/day

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4
Q

azotemia

A

elevated BUN w/o symptoms

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5
Q

uremia

A

elevated BUN w/ symptoms

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6
Q

sx of uremia

A
  • n/v
  • confusion
  • pruritus
  • metallic taste in mouth
  • fatigue
  • anorexia
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7
Q

how to differentiate b/w classifying AKI and CKD

A

AKI: less than 3 months w/ GFR <60 mL/min and/or markers of kidney damage present

CKD: after 3 months

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8
Q

describe CKD stage 1

A

GFR is > or equal to 90 (normal or high GFR)

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9
Q

describe CKD stage 2

A

GFR is b/w 60-89 (mild decrease)

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10
Q

describe CKD stage 3

A

GFR is b/w 45-59 (mild to moderate decrease)

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11
Q

describe CKD stage 4

A

GFR is b/w 30-44 (moderate to severe decrease)

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12
Q

describe CKD stage 5

A

GFR is b/w 15-29 (severe decrease)

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13
Q

vast majority of CKD cases are caused by:

A

diabetes or HTN

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14
Q

signs and sx of CKD

A
  • edema
  • HTN
  • decreased urine output
  • foamy urine (proteinuria)
  • uremia
  • pericardial friction rub
  • asterixis
  • uremic frost
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15
Q

how does creatinine affect estimated GFR

A

eGFR is not accurate in the setting of rapidly changing creatinine (like in AKI)

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16
Q

what are the 3 simple tests to identify most CKD patients

A
  • eGFR
  • urine albumin-to-creatinine ratio or protein-to-creatinine ratio
  • urinalysis
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17
Q

what is the crockcroft-gault formula for estimating creatinine clearance

A

creatinine clearance = [(140-age) x lean body weight)/(serum creatinine x 72)

*x 0.85 if female

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18
Q

why does measuring creatinine clearance tend to overestimate GFR

A

b/c creatinine is freely filtered at the glomerulus but is also secreted by the tubules, making urine creatinine concentration higher than expected

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19
Q

purpose of using doppler renal US

A

evaluate for renal artery stenosis or renal vein thrombosis or resistive index

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20
Q

on a doppler renal US, high resistive indices (>0.7-0.8) indicate:

A

indicates resistance to arterial flow within the kidney

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21
Q

advantages of abdominal CT

A

better at detecting masses and kidney stones

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22
Q

purpose of abdominal MRI scan

A

can evaluate for renal artery stenosis, renal vein thrombosis, or renal masses

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23
Q

what are the renal US findings in a patient with CKD

A
  • atrophic or small kidneys
  • cortical thinning
  • increased echogenicity
  • elevated resistive indices
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24
Q

what are the indications for dialysis

A

A: severe acidosis
E: electrolyte disturbance (usually hyperkalemia)
I: ingestion (ethylene glycols, methanol, etc.)
O: volume overload
U: uremia

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25
how to treat proteinuria in CKD patients
- low salt diet - BP control - ace inhibitors, ARBs, aldosterone antagonists, renin inhibitors, non-dihydropyridine CCB
26
what is the goal BP of CKD patients with and without proteinuria
w/ proteinuria: 140/90 | w/o proteinuria: 130/80
27
treatment for hyperlipidemia in CKD patients
statin therapy
28
treatment for anemia in CKD patients
- oral or IV iron | - erythropoietin stimulating agents (ESA)
29
treatment for metabolic acidosis in CKD patients
bicarbonate supplementation if HCO3- is <22
30
treatment for hyperkalemia in CKD patients
- renal failure diet (low salt, low K+, low phosphorus) - diuretics - sodium polystyrene sulfonate (kayexelate) or patiromer (veltassa)
31
treatment for CKD-BMD (previous renal osteodystrophy) in CKD patients
- renal failure diet (low salt, low K+, low phosphorus) - phosphorus binder (lowers phos absorption in gut) - vitamin D supplementation - calcimimetics (lowers PTH)
32
treatment for volume overload in CKD patients
- diuretics - fluid restriction - dialysis
33
what are the components of renal replacement therapy
- hemodialysis - peritoneal dialysis - renal transplant
34
how does staging work based on serum creatinine and urine output in patients with AKI
the staging is based on whichever (serum creatinine or urine output) is worse
35
describe AKI stage 1
1 of the following: - serum creatinine 1.5-1.9x the baseline - >0.3 mg/dl increase OR <0.5 mL/kg/h urine output for 6-12 hours
36
describe AKI stage 2
serum creatinine 2-2.9x the baseline OR <0.5 mL/kg/h urine output for > 12 hours
37
describe AKI stage 3
1 of the following: - serum creatinine 3x the baseline - increase in serum creatinine >4 mg/dl - initiation of renal replacement therapy - decrease eGFR <35 ml/min in pts <18 OR 1 of the following: - <0.3 ml/kg/h for >24 hours - anuria for > 12 hours
38
causes of prerenal AKI
- hypotension - hypovolemia - reduced CO (HF, tamponade, massive PE) - systemic vasodilation (sepsis, SIRS, hepatorenal syndrome)
39
causes of postrenal AKI
- bladder outlet obstruction (BPH, cancer, strictures, blood clots) - ureteral obstruction (bilateral or unilateral obstruction, stones, malignancy, retroperitoneal fibrosis) - renal pelvis (papillary necrosis (NSAIDs), stones)
40
causes of intrinsic AKI
- tubular necrosis - interstitial nephritis (10% cases) - glomerulonephritis (5% cases)
41
causes of tubular necrosis
- 50% ischemia - 35% toxins (idk about the other 15%)
42
labs to obtain on all patients with AKI
- urinalysis w/ microscopy | - urine albumin/creatinine ratio or urine protein/creatinine ratio
43
3 common diagnostic tests to diagnose AKIA
1. UA w/ microscopy 2. urine albumin/creatinine ratio or protein/creatinine ratio 3. renal US
44
what is the fractional excretion of sodium (FeNa) for prerenal azotemia and acute tubular necrosis
prerenal azotemia: <1% | ATN: >2%
45
what BUN/creatinine ratio is indicative of prerenal azotemia
>20:1
46
what is the fractional excretion of urea (FeUrea) for prerenal azotemia and acute tubular necrosis
prerenal azotemia: <35% | ATN: >50%
47
when do you perform a renal biopsy on a pt suspected of AKI
reserved for severe AKI of unclear etiology
48
electrolyte abnormality complications of AKI
- hyperkalemia - hyperphosphatemia - hypocalcemia - hypermagnesemia
49
complications of AKI due to hypervolemia
- pulmonary edema | - HF
50
tx for prerenal AKI patients
IV fluids
51
tx for acute tubular necrosis AKI patients
supportive care
52
tx for glomerulonephritis AKI patients
immunosuppression or plasmapharesis
53
tx for acute interstitial nephritis AKI patients
discontinuation of offending agent and/or steroids
54
5 characteristics of nephrotic syndrome
- proteinuria (>3.5 g/day) - hypoalbuminemia - peripheral edema - hyperlipidemia - lipiduria
55
what does normal serum albumin mean in the setting of nephrotic range proteinuria
then the patient does NOT have true nephrotic syndrome, but instead has nephrotic-range proteinuria - helps w/ differential (possibly secondary FSGS)
56
why are nephrotic syndrome pts prone to infections
urinary loss of IgG | - occasionally have to supplement w/ IVIG
57
etiology of increased thrombosis in nephrotic syndrome patients
- urinary loss anti-thrombotic factors (antithrombin III, plasminogen, protein S, etc.) - increased levels of procoagulant factors (fibrinogen, factors 2, 5, 7, 10, 13)
58
why does nephrotic syndrome cause anemia
urinary loss of transferrin and erythropoietin
59
why does nephrotic syndrome cause vitamin D deficiency
urinary loss of vitamin D binding protein
60
compare the underfill and overfill theories of edema in nephrotic syndrome
underfill: low intravascular oncotic pressure causes edema overfill: renal sodium retention causes edema
61
clinical presentation of nephrotic syndrome
- new onset HTN - new onset edema - proteinuria - lipiduria - hyperlipidemia - minimal hematuria
62
diagnostic studies for diagnosing nephrotic or nephritic syndrome (6)
- serum creatinine w/ eGFR - urinalysis w/ microscopy - urine albumin/creatinine ratio and urine protein/creatinine ratio - 24 hour urine total protein collection - glomerulonephritis serologic evaluation - renal biopsy
63
tx of proteinuria in nephrotic syndrome patients
- lower BP - ace inhibitors or ARB - alternative antiproteinuric meds (nondihydropyridine CCB, aldosterone antagonist, renin inhibitors)
64
tx for hyperlipidemia in nephrotic syndrome patients
statins
65
tx for throbosis in nephrotic syndrome patients
- heparin or warfarin | - consider prophylactic anticoagulation for serum albumin < 2.5 g/dL
66
3 signature characteristics of nephritic syndrome
- proteinuria (usually less than 3.5g/day) - hematuria - HTN
67
key characteristic of nephritic syndrome
usually has an active urinary sediment (hematuria, dysmorphic RBC, RBC casts, WBCs, WBC casts, granular casts, etc.)
68
compare urinary sediments b/w nephrotic and nephritic syndromes
nephrotic: bland urinary sediment nephritic: active urinary sediment
69
clinical presentation of nephritic syndrome
- new onset HTN - new onset hematuria - AKI - proteinuria
70
when measuring complement levels when diagnosing nephritic syndrome, what does a low C4 and C3 indicate, and what does just a low C4 indicate
low C3 and C4: activation of classical pathway | low C4: activation of alternative pathway
71
what are your ddx in nephritic syndrome patients with a low complement level
- lupus nephritis - post-infectious GN - MPGN - cryoglobulinemia - atypical HUS - endocarditis - cholesterol embolus - HIV associated immune complex dz
72
if the urine shows renal tubular epithelial casts, transitional epithelial cells, granular casts, or waxy casts, what is the probably kidney dz
acute tubular necrosis (ATN)
73
if the urine shows WBCs, WBC casts, or eosinophilsm what is the probably kidney dz
acute interstitial nephritis (AIN) or pyelonephritis
74
if the urine shows dysmorphic RBCs and RBC casts, what is the probably kidney dz
vasculitis or glomerulonephritis
75
if the urine shows proteinuria (<3.5g/day), hematuria, dysmorphic RBCs, and RBC casts, what is the probably kidney dz
nephritic syndrome
76
if the urine shows heavy proteinuria (>3.5g/day), lipiduria, and minimal hematuria, what is the probably kidney dz
nephrotic syndrome
77
if the urine shows hyaline casts, what is the probably kidney dz
non-specific, prerenal azotemia
78
if the urine shows WBCs, RBCs, and bacteria, what is the probably disorder
UTI

Maddy - CPR III (1 decks)

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