Paulson - Kidneys 102 Flashcards
kidney damage or decreased kidney fxn for 3 or more months
ckd
2 mc causes of ckd
DM
HTN
leading cause of death in CKD pt’s
CVD
rf for ckd (lots!)
60 yo or older
htn
DM
CVD
fh ckd
recurrent UTIs
previous AKI
nephrolithiasis
transplant
AI
smoking
creatinine is a product of __ metabolism
and is excreted by __
muscle
kidneys
nl Cr
0.6-1.2 mg/dl
GFR represents
plasma filtration by glomerulus
nl GFR
90 ml/min/1.73 m2 or higher
gs measurement for gfr
inulin clearance
2 equations used for GFR measurement
MDRD
cockroft-gault
which GFR equation should NOT be used in AKI pt’s
MDRD
IBW should be used in GFR equations for (2)
obese
fluid overloaded
all types of proteins that might be in urine
proteinuria
nl proteinuria
less than 150 mg/dl
gold standard proteinuria measurement
24 hr urine → urine protein to creatinine ratio
causes of proteinuria
tubular damage
diabetic nephropathy
glomerulonephritis
rhabdo
bence-jones proteins
exercise
orthostatic proteinuria
acute sickness
proteinuria that is specific to CKD and pathopgnomonic to kidney damage
albuminuria
test that detects early CKD
albuminuria
preferred screening for albuminuria
yearly urine albumin to Cr ratio
nl albuminuria
less than 30 mg/d
microalbuminuria parameter
30-300 mg/day
macroalbuminuria parameter
higher than 300 mg/day
higher albuminuria is associated w.
quicker progression to kidney failure
tx for early detection of moderate-severe albuminuria in diabetics
ACEI
OR
ARB
→ decrease amt of albuminuria
CKD stages factor in (2)
GFR
albuminuria (albumin:Cr ratio)
classification of CKD using GFR and ACR categories gives info about
risk of adverse outcomes
ACR indicative of normal-mildly increased risk
A1: less than 3
ACR indicative of moderately increased risk
A2: 3-30
ACR indicative of severely increased risk
A3: 30 or higher
diagnostic test for CKD
US
normal kidney size on US
10 cm
what US finding suggests CKD
shrunken kidney
US can help differentiate btw __
and __ kidney issues
acute
chronic
common meds that need renal dosing
NSAIDs
contrast
Mg (laxatives)
phosphorous (Fleet’s enemas)
aluminium (maalox, rolaids)
antimicrobials
diabetic meds
decongestants
antihypertensives
opioids
gabapentins
7 complications of ckd
htn
hyperphosphatemia
hyperparathyroidism
anemia
hyperkalemia
acidosis
uremic encephalopahy
tx for hyperphosphatemia (2)
phosphate binders → sevelgmer
diet
tx for hyperprathyroidism
vit D
tx for anemia
erythropoietin
argnesp
iron supplements
goal for hgb in ckd
10-11
tx for hyperkalemia (3)
diet
kayexelate
dialysis
albuterol
Ca
insulin
serum K > __ indicates hyperkalemia
5
sx of hyperkalemia
intestinal colic
diarrhea
muscle weakness
paralysis
ekg findings of hyperkalemia
peaked t waves
cardiac dysrhythmia
indications for dialysis (3)
gfr 10-15
unable to control volume status
hyperkalemia
what is an avf
arteriovenous fistula
avf takes __ months to mature
2
types of dialysis (2)
hemodialysis (HD)
peritoneal (PD)
which dialysis is given 3x/week
HD
types of PD
continuous ambulatory (CAPD)
continuous cyclic (CCPD)
CAPD is given
4-5 x/day
CCPD is given
at night while asleep
squamous epithelial cells on urine microscopy suggest
contaminated sample
renal tubular cells/casts on urine microscopy suggest
ATN or AIN
RBC casts on urine microscopy suggest
glomerulonephritis
AIN
vasculitis
WBC casts in urine microscopy suggest
interstitial nephritis
pyelonephritis
inflammation
fatty casts on urine microscopy suggest
nephrotic syndrome
hyaline casts can be
normal
muddy brown casts on urine microscopy suggest
ATN
quad of nephrotic syndrome
edema
foamy urine → massive proteinuria
hypoalbuminuria
hyperlipidemia
peripheral edema
causes of nephrotic syndrome (4)
DM
minimal change dz
fsgs (focal segmental glomerular sclerosis)
membranous nephropathy
nephritic syndrome triad
htn
hematuria
proteinuria → less than nephrotic syndrome
coca cola urine
glomerulonephritis
oliguria
3 causes of nephritic syndrome
post-infectious glomerulonephritis
IgA nephropathy
membranoproliferative glomerulonephritis
