Oliguria (Selby) Flashcards
anuria
urine output <50-100 ml/day
oliguria
urine output < 400-500 ml/day
polyuria
urine output >3000 ml/day
azotemia
elevated blood urea nitrogen (BUN) without symptoms
uremia
elevated BUN with symptoms (N/V, confusion, pruritis, metallic taste in mouth, fatigue, anorexia)
**Sxs are nonspecific with multiple etiologies causing them
Criteria for CKD
- either of the following present for >3 months
1) markers of kidney damage
2) decreased GFR
Difference between AKI and CKD
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
What causes the majority of CKD?
Diabetes or HTN
Clinical presentation CKD
- edema
- HTN
- decreased UOP
- foamy urine
- Asterixis (hand flapping with extension)
- uremic frost
3 tests to identify most CKD patients:
1) eGFR
2) urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio
3) urinalysis
renal ultrasound findings for CKD (4)
- atrophic or small kidneys
- cortical thinning
- increased echogenicity
- elevated resistive indices
indications for dialysis
A: severe acidosis E: electrolyte disturbance (usually hyperkalemia) I: ingestions (glycols, methanol) O: volume overload U: uremia
AKI stage one serum creatinine and urine output
serum creatinine:
1.5-1.9x baseline OR
> 0.3 mg/dl increase
urine output:
<0.5 ml/kg/h for 6-12 hours
AKI stage two serum creatinine and urine output
serum creatinine:
2.0-2.9x baseline
urine output:
<0.5 ml/kg/h for >12 hours
AKI stage three serum creatinine and urine output
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
How is AKI staged
on serum creatinine or urine output (whichever is worse)
Diagnostic tests for AKI (3)
- UA with microscopy
- urine albumin/cr ratio or protein/cr ratio
- renal ultrasound
Pathogenesis of edema in nephrotic syndrome
two theories
1) proteinuria –> hypoalbuminemia –> decreased intravascular oncotic pressure –> edema
2) increased sodium resorption –> water retention –> edema
Describe nephritic syndrome urinary sediment
usually have active urinary sediment (hematuria, dysmorphic RBC, RBC casts, WBCs, WBC casts, granular casts)
Describe nephrotic syndrome urinary sediment
“bland” urinary sediment
what type of glomerular disease if diabetic glomerulosclerosis
nephrotic syndrome
urinary pattern of Acute tubular necrosis
renal tubular epithelial cells, transitional epithelial cells, granular casts, or waxy casts
urinary pattern of acute interstitial nephritis or pyelonephritis
WBC, WBC cast, or urine eosinophils
urinary pattern of vasculitis or glomerulonephritis
dysmorphic RBCs, RBC casts
urinary pattern of nephritic syndrome
proteinuria (< 3.5 g/day), hematuria, dysmorphic RBC and RBc casts
urinary pattern of nephrotic syndrome
heavy proteinuria (>3.5 g/day), lipiduria, minimal hematuria
urinary pattern of pre-renal azotemia
hyaline casts
urinary pattern of UTI
WBC, RBC, bacteria
