Quiz 2 real Flashcards
Main symptoms of Diabetic Nephropathy?
- Albuminuria
- Occult hematuria
- Diabetic symptoms
What test must you do to monitor diabetic nephropathy
- Microalbumin
- can also run HbA1c
Treatment approaches for Diabetic Nephropathy
- Ginkgo
- Flax/Pumpkin Seed
- Curcumin
- Guggul
- Chromium
- Alpha lipoid acid
Major cause of hypertensive nephropathy?
-Atherosclerosis
What steps should be taken to prevent Hypertensive Nephropathy
- Lifestyle
- Exercise
- Loose weight
- Dietary
- Sodium Intake
Past medical history of PN, urolithiasis, hydronephrosis, radiation to the abdomen and Wilms tumor suggests what?
- Hypertensive Nephropathy
- Nephrosclerosis
Sx that suggest HTN Nephropathy
- Ha
- Fatigue
- Confusion
- Vision Changes
- Angina like chest pain
- Heat failure
- Hematuria
- Epistaxis
- Irregular heartbeat
- ear buzzing
- Pulmonary edema
- Difficulty to control HTN
- Sudden aggravation of earlier well-controlled HTN in elderly
What are signs of complications in HTN nephropathy or nephrosclerosis
- Left ventricular hypertrophy
- hypertensive retinopathy
- abdominal bruits
What labs suggest a high clinical suspicion of HTN Nephropathy
- UA
- EKG
- Plasma Renin
- Catopril challenge test
- elevated creatinine
What imaging should you order on a patient with HTN Nephropathy or Nephrosclerosis?
- Renal arteriography
- Doppler US of renal arteries
- MR angiography
- CT
Treatment for HTN nephropathy or Nephrosclerosis?
- Blood pressure meds
- Guggal, garlic EFA, B vit
- bioflavonoids
- vaccinium
What is nephroptosis
kidney drops > 5 cm when moving from supine to standing
-Severe Abdominal Pain
-Costovertebral flank pain
-Vomiting in upright position
-Pain relieved with upward movement of the kidney
suggest what?
Nephroptosis
What is Dietl Crisis
- Severe Colicky Flank Pain
- Nausea
- Vomiting
- Chills
- Tachycardia
- Oliguria
- Hematuria
- Proteinuria
What physical exam finding suggests nephroptosis
-Kidney palpable in ipsilateral lower abdomen
What Labs should you run if you suspect Nephroptosis?
- Renal US
- IV urography
- Look for hydronephrosis
- Flank or back pain
- Intermittent and dull
- Fever and malaise (if infection present)
- Abdominal mass
What does this suggest?
Cyst in the kidney
What labs must you run if you suspect kidney cysts
What are the findings?
- UA: Normal
- U/S: Echo-free, sharp demarcated, smooth walls, enhanced back wall indicates good transmission
- CT: Smooth thin wall, sharply demarcated, does not enhanced with contrast media
Age of DX and requirements Autosomal Dominant Polycystic Kidney Disease?
15-39 yo: 3 cysts in both kidneys
40-59 yo: 2 cysts
Both must have positive FHx
- Pain over both kidneys
- Gross hematuria
- HTN
- Nocturia
- Palpable nodular kidney
- HA
- N&V
- Weight loss
Suggests what?
Autosomal Dominant Polycystic Kidney Disease
Labs for Autosomal Dominant Polycystic Kidney Disease
- Increased erythropoietin
- Increased HGB and HCT
- Proteinuria
- Anemia
- Increased Bun and Creatinine
Imaging for Polycystic Kidneys
KUB—enlarged renal shadows up to 5X size
CT—95% accurate for dx, can detect cysts from 0.5cm
US—can detect cysts from 1-1.5cm (Most cost effective, usu start here)
MRI can differentiate Renal Cell Carcinoma (RCC) from cysts
General Measures for Polycystic Kidneys
- Low protein diet
- Fluids!
- No caffeine
- Flax Oil
- Reasonable physical activity
- HTN treatment
What are risk factors for RCC and RCA
Cigarette smoking, chronic analgesic use, ADPKD, obesity, toxin exposure (Cd, Pb, asbestos, PAHs), coffee, animal fat diet, dialysis, hysterectomy, contrast IVU, Von Hippel-Landau dz
