Proteinuria, Oliguria and Polyuria

Question 1

Anuria

Answer 1

UOP <50-100 ml/day

Question 2

Oliguria

Answer 2

UOP <400-500 ml/day

Question 3

Polyuria

Answer 3

UOP >3000 ml/day

Question 4

Azotemia

Answer 4

Elevated BUN without symptoms

Question 5

Uremia

Answer 5

Elevated BUN w/ symptoms such as:

• N/V
• Confusion
• Pruritus
• Metallic Taste
• Fatigue
• Anorexia

Question 6

CKD Criteria

Answer 6

1. Markers of Kidney damage: Albuminuria, increased urine sediment, electrolyte/Renal Tubular disorder, kidney transplant
2. Decreased GFR <60 ml/min/1.73m^2

Either or both for minimum 3 months

Question 7

How would you distinguish CKD from AKI?

Answer 7

Time of symptoms:
<3 months= AKI
>3months= CKD

Question 8

Briefly describe the stages of CKD

Answer 8

1-5: 1 is mild with >90 GFR; 5 is ESRD with <15 GFR

If GFR is between 60-90 (stage 1-2) but no symptoms, it’s not CKD

Question 9

Top 4 RF for CKD

Answer 9

1. DM
2. HTN
3. CVD
4. AKI

Notable: NSAID use, Age>65, AA population

Question 10

Clinical presentation of CKD

Answer 10

Edema
HTN
Oliguria/Anuria
Proteinuria
Uremia
Asterixis
Uremic Frost

Question 11

3 tests to identify CKD

Answer 11

1. eGFR
2. Urine Albumin:Creatinine Ratio or PRO:Creatinine Ratio
3. Urinalysis

Question 12

What U/S findings are indicative of CKD?

Answer 12

Atrophic/small kidneys (normal= fist)
Cortical thinning (normal= >1cm)
Increased echogenicity
Elevated resistive index (renal artery stenosis)

Question 13

Indications for dialysis

Answer 13

AEIOU: 
Acidosis
Electrolyte disturbance
Ingestion of toxins (GOLDMARK and ME DIE)
Overload volume
Uremia

Question 14

2 tests to determine AKI

Answer 14

Serum Creatinine- increased
Urine Output- decreased

do not need to memorize stages, but know that Serum creatinine 1.5-1.9x starts and/or UO <0.5ml/kg/h starts stage 1

Question 15

Common causes of prerenal AKI

Answer 15

Hypotension
Hypovolemia
Reduced CO (HF)
Systemic vasodilation (sepsis)

Question 16

Causes of Postrenal AKI

Answer 16

Any obstruction

Question 17

What causes 85% of intrinsic AKI

Answer 17

ATN- ischemic or toxic

Question 18

What labs should you obtain on ALL AKI patients?

Answer 18

Urinalysis with microscopy

Urine albumin:creatinine ratio or pro:creatinine ratio

Question 19

How can FeNa help determine cause of AKI?

Answer 19

FeNa<1% is prerenal

FeNa>2% is ATN (intrinsic)

Question 20

When is FeUrea used over FeNa?

Answer 20

In patients on diuretics/fluids

Question 21

Urine Microscopy findings in ATN

Answer 21

epithelial cells, granular casts, waxy casts

Question 22

Urine Microscopy findings in AIN

Answer 22

WBC/WBC casts, eosinophils

Question 23

Complications associated with AKI

Answer 23

Hypervolemia
Electrolyte imbalance
Hyperuricemia
Acidosis

Question 24

Nephrotic syndrome definition

Answer 24

Proteinuria >3.5 g/day
Hypoalbuminemia
Edema
Hyperlipidemia
Lipiduria

Question 25

Important pathogenic cause of Nephrotic syndrome

Answer 25

Low renal perfusion leads to over activation of RAAS and increased Na+ and H2O retention

Question 26

Nephrotic Syndrome Ddx

Answer 26

1. Diabetic Nephropathy 2. Minimal Change Dz (children) 3. FSGS (adults and some children) 4. Membranous Nephropathy (adults)

Question 27

Nephritic Syndrome definition

Answer 27

Proteinuria <3.5 g/day Hematuria HTN Active urinary sediment (RBC and casts)

Question 28

Nephritic Syndrome Ddx

Answer 28

1. IgA nephropathy 2. Thin BM Nephropathy 3. MPGN 4. Lupus Nephritis 5. RPGN 6. APGN (post-infectious)

Question 29

What labs would you order???

Answer 29

Just wanted to put in here that I'm sure we'll get questions that lead us to a diagnosis and then ask what lab test to order. For example: Pt looks like they have FSGS and are sexually active, order and HIV test

Question 30

Describe the 2 types of Diabetes Insipidus

Answer 30

1. Central- lack of ADH in circulation. Corrects with administration of Vasopressin. 2. Nephrogenic- lack of response to ADH. Does NOT correct with Vasopressin.

Question 31

MoA of ADH

Answer 31

Binds V2R on basolateral collecting duct cell and increases cAMP which drives insertion of AQP2 and Urea channels on apical membrane. Effect: Increased Water resorption & urea (BUN:creatinine increased)

Question 32

Allison is prescribed Lithium because she's unhinged. What can this possibly lead to?

Answer 32

Nephrogenic Diabetes Insipidus due to increased degradation of AQP2 channels.

Question 33

How does Calcium levels affect resorption?

Answer 33

Hypercalcemia leads to activation of Ca-sensor on basolateral membrane of TAL. This inhibits ROM-K channel which decreased NKCC2. Similar to loop diuretic and Bartter Syndrome

Question 34

Explain results of Water Deprivation test for central and nephrogenic Diabetes Insipidus

Answer 34

Central: low urine osmolality that corrects with ADH Nephrogenic: low urine osmolality that does not correct Normal person: high urine osmolality that does not change with ADH administration.

Question 35

Treatment for Nephrogenic DI

Answer 35

Decrease solute intake Thiazide diuretic NSAIDs (inhibit PG's because PG's inhibit ADH)