Oliguria (Selby)

Question 1

anuria

Answer 1

urine output <50-100 ml/day

Question 2

oliguria

Answer 2

urine output < 400-500 ml/day

Question 3

polyuria

Answer 3

urine output >3000 ml/day

Question 4

azotemia

Answer 4

elevated blood urea nitrogen (BUN) without symptoms

Question 5

uremia

Answer 5

elevated BUN with symptoms (N/V, confusion, pruritis, metallic taste in mouth, fatigue, anorexia)
**Sxs are nonspecific with multiple etiologies causing them

Question 6

Criteria for CKD

Answer 6

• either of the following present for >3 months
  1) markers of kidney damage
  2) decreased GFR

Question 7

Difference between AKI and CKD

Answer 7

if it is < 3 months with GFR < 60 ml/min and/or markers of kidney damage present, then the patient has acute kidney injury. After 3 months, then the patient has CKD

Question 8

What causes the majority of CKD?

Answer 8

Diabetes or HTN

Question 9

Clinical presentation CKD

Answer 9

• edema
• HTN
• decreased UOP
• foamy urine
• Asterixis (hand flapping with extension)
• uremic frost

Question 10

3 tests to identify most CKD patients:

Answer 10

1) eGFR
2) urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio
3) urinalysis

Question 11

renal ultrasound findings for CKD (4)

Answer 11

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

Question 12

indications for dialysis

Answer 12

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

Question 13

AKI stage one serum creatinine and urine output

Answer 13

serum creatinine:
1.5-1.9x baseline OR
> 0.3 mg/dl increase

urine output:
<0.5 ml/kg/h for 6-12 hours

Question 14

AKI stage two serum creatinine and urine output

Answer 14

serum creatinine:
2.0-2.9x baseline

urine output:
<0.5 ml/kg/h for >12 hours

Question 15

AKI stage three serum creatinine and urine output

Answer 15

serum creatinine:
3x baseline OR
increase in serum creatinine to >4.0 mg/dl OR
initiation of renal replacement therapy

urine output:
<0.3 ml/kg/h for >24 hours
OR anuria for >12 hours

Question 16

How is AKI staged

Answer 16

on serum creatinine or urine output (whichever is worse)

Question 17

Diagnostic tests for AKI (3)

Answer 17

• UA with microscopy
• urine albumin/cr ratio or protein/cr ratio
• renal ultrasound

Question 18

Pathogenesis of edema in nephrotic syndrome

Answer 18

two theories
1) proteinuria –> hypoalbuminemia –> decreased intravascular oncotic pressure –> edema

2) increased sodium resorption –> water retention –> edema

Question 19

Describe nephritic syndrome urinary sediment

Answer 19

usually have active urinary sediment (hematuria, dysmorphic RBC, RBC casts, WBCs, WBC casts, granular casts)

Question 20

Describe nephrotic syndrome urinary sediment

Answer 20

“bland” urinary sediment

Question 21

what type of glomerular disease if diabetic glomerulosclerosis

Answer 21

nephrotic syndrome

Question 22

urinary pattern of Acute tubular necrosis

Answer 22

renal tubular epithelial cells, transitional epithelial cells, granular casts, or waxy casts

Question 23

urinary pattern of acute interstitial nephritis or pyelonephritis

Answer 23

WBC, WBC cast, or urine eosinophils

Question 24

urinary pattern of vasculitis or glomerulonephritis

Answer 24

dysmorphic RBCs, RBC casts

Question 25

urinary pattern of nephritic syndrome

Answer 25

proteinuria (< 3.5 g/day), hematuria, dysmorphic RBC and RBc casts

Question 26

urinary pattern of nephrotic syndrome

Answer 26

heavy proteinuria (>3.5 g/day), lipiduria, minimal hematuria

Question 27

urinary pattern of pre-renal azotemia

Answer 27

hyaline casts

Question 28

urinary pattern of UTI

Answer 28

WBC, RBC, bacteria