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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
Q

how to treat proteinuria in CKD patients

A
  • low salt diet
  • BP control
  • ace inhibitors, ARBs, aldosterone antagonists, renin inhibitors, non-dihydropyridine CCB
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26
Q

what is the goal BP of CKD patients with and without proteinuria

A

w/ proteinuria: 140/90

w/o proteinuria: 130/80

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27
Q

treatment for hyperlipidemia in CKD patients

A

statin therapy

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28
Q

treatment for anemia in CKD patients

A
  • oral or IV iron

- erythropoietin stimulating agents (ESA)

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29
Q

treatment for metabolic acidosis in CKD patients

A

bicarbonate supplementation if HCO3- is <22

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30
Q

treatment for hyperkalemia in CKD patients

A
  • renal failure diet (low salt, low K+, low phosphorus)
  • diuretics
  • sodium polystyrene sulfonate (kayexelate) or patiromer (veltassa)
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31
Q

treatment for CKD-BMD (previous renal osteodystrophy) in CKD patients

A
  • renal failure diet (low salt, low K+, low phosphorus)
  • phosphorus binder (lowers phos absorption in gut)
  • vitamin D supplementation
  • calcimimetics (lowers PTH)
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32
Q

treatment for volume overload in CKD patients

A
  • diuretics
  • fluid restriction
  • dialysis
33
Q

what are the components of renal replacement therapy

A
  • hemodialysis
  • peritoneal dialysis
  • renal transplant
34
Q

how does staging work based on serum creatinine and urine output in patients with AKI

A

the staging is based on whichever (serum creatinine or urine output) is worse

35
Q

describe AKI stage 1

A

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
Q

describe AKI stage 2

A

serum creatinine 2-2.9x the baseline

OR

<0.5 mL/kg/h urine output for > 12 hours

37
Q

describe AKI stage 3

A

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
Q

causes of prerenal AKI

A
  • hypotension
  • hypovolemia
  • reduced CO (HF, tamponade, massive PE)
  • systemic vasodilation (sepsis, SIRS, hepatorenal syndrome)
39
Q

causes of postrenal AKI

A
  • 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
Q

causes of intrinsic AKI

A
  • tubular necrosis
  • interstitial nephritis (10% cases)
  • glomerulonephritis (5% cases)
41
Q

causes of tubular necrosis

A
  • 50% ischemia
  • 35% toxins
    (idk about the other 15%)
42
Q

labs to obtain on all patients with AKI

A
  • urinalysis w/ microscopy

- urine albumin/creatinine ratio or urine protein/creatinine ratio

43
Q

3 common diagnostic tests to diagnose AKIA

A
  1. UA w/ microscopy
  2. urine albumin/creatinine ratio or protein/creatinine ratio
  3. renal US
44
Q

what is the fractional excretion of sodium (FeNa) for prerenal azotemia and acute tubular necrosis

A

prerenal azotemia: <1%

ATN: >2%

45
Q

what BUN/creatinine ratio is indicative of prerenal azotemia

46
Q

what is the fractional excretion of urea (FeUrea) for prerenal azotemia and acute tubular necrosis

A

prerenal azotemia: <35%

ATN: >50%

47
Q

when do you perform a renal biopsy on a pt suspected of AKI

A

reserved for severe AKI of unclear etiology

48
Q

electrolyte abnormality complications of AKI

A
  • hyperkalemia
  • hyperphosphatemia
  • hypocalcemia
  • hypermagnesemia
49
Q

complications of AKI due to hypervolemia

A
  • pulmonary edema

- HF

50
Q

tx for prerenal AKI patients

51
Q

tx for acute tubular necrosis AKI patients

A

supportive care

52
Q

tx for glomerulonephritis AKI patients

A

immunosuppression or plasmapharesis

53
Q

tx for acute interstitial nephritis AKI patients

A

discontinuation of offending agent and/or steroids

54
Q

5 characteristics of nephrotic syndrome

A
  • proteinuria (>3.5 g/day)
  • hypoalbuminemia
  • peripheral edema
  • hyperlipidemia
  • lipiduria
55
Q

what does normal serum albumin mean in the setting of nephrotic range proteinuria

A

then the patient does NOT have true nephrotic syndrome, but instead has nephrotic-range proteinuria
- helps w/ differential (possibly secondary FSGS)

56
Q

why are nephrotic syndrome pts prone to infections

A

urinary loss of IgG

- occasionally have to supplement w/ IVIG

57
Q

etiology of increased thrombosis in nephrotic syndrome patients

A
  • urinary loss anti-thrombotic factors (antithrombin III, plasminogen, protein S, etc.)
  • increased levels of procoagulant factors (fibrinogen, factors 2, 5, 7, 10, 13)
58
Q

why does nephrotic syndrome cause anemia

A

urinary loss of transferrin and erythropoietin

59
Q

why does nephrotic syndrome cause vitamin D deficiency

A

urinary loss of vitamin D binding protein

60
Q

compare the underfill and overfill theories of edema in nephrotic syndrome

A

underfill: low intravascular oncotic pressure causes edema
overfill: renal sodium retention causes edema

61
Q

clinical presentation of nephrotic syndrome

A
  • new onset HTN
  • new onset edema
  • proteinuria
  • lipiduria
  • hyperlipidemia
  • minimal hematuria
62
Q

diagnostic studies for diagnosing nephrotic or nephritic syndrome (6)

A
  • 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
Q

tx of proteinuria in nephrotic syndrome patients

A
  • lower BP
  • ace inhibitors or ARB
  • alternative antiproteinuric meds (nondihydropyridine CCB, aldosterone antagonist, renin inhibitors)
64
Q

tx for hyperlipidemia in nephrotic syndrome patients

65
Q

tx for throbosis in nephrotic syndrome patients

A
  • heparin or warfarin

- consider prophylactic anticoagulation for serum albumin < 2.5 g/dL

66
Q

3 signature characteristics of nephritic syndrome

A
  • proteinuria (usually less than 3.5g/day)
  • hematuria
  • HTN
67
Q

key characteristic of nephritic syndrome

A

usually has an active urinary sediment (hematuria, dysmorphic RBC, RBC casts, WBCs, WBC casts, granular casts, etc.)

68
Q

compare urinary sediments b/w nephrotic and nephritic syndromes

A

nephrotic: bland urinary sediment
nephritic: active urinary sediment

69
Q

clinical presentation of nephritic syndrome

A
  • new onset HTN
  • new onset hematuria
  • AKI
  • proteinuria
70
Q

when measuring complement levels when diagnosing nephritic syndrome, what does a low C4 and C3 indicate, and what does just a low C4 indicate

A

low C3 and C4: activation of classical pathway

low C4: activation of alternative pathway

71
Q

what are your ddx in nephritic syndrome patients with a low complement level

A
  • lupus nephritis
  • post-infectious GN
  • MPGN
  • cryoglobulinemia
  • atypical HUS
  • endocarditis
  • cholesterol embolus
  • HIV associated immune complex dz
72
Q

if the urine shows renal tubular epithelial casts, transitional epithelial cells, granular casts, or waxy casts, what is the probably kidney dz

A

acute tubular necrosis (ATN)

73
Q

if the urine shows WBCs, WBC casts, or eosinophilsm what is the probably kidney dz

A

acute interstitial nephritis (AIN) or pyelonephritis

74
Q

if the urine shows dysmorphic RBCs and RBC casts, what is the probably kidney dz

A

vasculitis or glomerulonephritis

75
Q

if the urine shows proteinuria (<3.5g/day), hematuria, dysmorphic RBCs, and RBC casts, what is the probably kidney dz

A

nephritic syndrome

76
Q

if the urine shows heavy proteinuria (>3.5g/day), lipiduria, and minimal hematuria, what is the probably kidney dz

A

nephrotic syndrome

77
Q

if the urine shows hyaline casts, what is the probably kidney dz

A

non-specific, prerenal azotemia

78
Q

if the urine shows WBCs, RBCs, and bacteria, what is the probably disorder

Maddy - CPR III (1 decks)

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