Renal Flashcards
- Better measure for renal function (blood test).
- Tests kidney function. Renal function decreases, creatinine
increases. - Male 0.7-1.3, female 0.6-1.1. >5.0 in adults = kidney impairment.
- High levels may indicate dehydration, protein intake, creatine
supplements.
Serum Creatinine
When Renal function decreases ______
creatinine increases and creatinine clearance also decreases
Provides information on how well the kidneys are working.
* Tests proteinuria, albuminuria, microalbuminuria. Renal function decreases, Creatinine clearance also decreases. Reflects renal function
for the past 24 hrs.
Creatinine Clearance (24 hr. urine)
Used to evaluate for kidney disease and stage. Measures the kidney’s
ability to filter toxins and waste from the blood.
* Ranges: >90 mL/min. Renal failure stage 5 if <15 mL/min.
Estimated Glomerular Filtration Rate (eGFR)
Reveals information on how well the kidneys are working, measures kidney’s ability to excrete urea.
* High levels: acute renal failure, high protein diet, hemolysis, CHF, drugs.
Normal ranges 6-24 mg/dL.
Blood Urea Nitrogen
High BUN with normal eGFR =
renal function probably normal
High BUN with low GFR =
higher mortality
Used to evaluate dehydration, hypovolemia, acute renal failure and level of renal failure. used in chemo to evaluate stress on the kidneys
BUN-to-Creatinine Ratio
- Color: yellow, light/pale, amber, red.
- Clarity/turbidity- clear or cloudy
- pH: 4.5-8
- Specific gravity: 1.005-1.025
- Glucose: ≥130 mg/d
- Ketones
- Nitrates
- Leukocyte esterase
UA
WBC casts with proteinuria is observed in _______.
pyelonephritis
+ Nitrites in UTI indicates
Ecoli Infection
What if leukocytes seen in male urine
tx for infection
Protein in the urine…
kidney damage, pyelonephritis.
Presence of bacteria (urine culture growth of 100,000 CFU/mL or more) in the urine without
symptoms of UTI.
* Due to increasing antimicrobial resistance, DO NOT treat.
* Always treat pregnant woman with antibiotics.
Asymptomatic Bacteriuria
(leukocytosis, fever, chills, malaise) is treated as a UTI.
- Symptomatic bacteriuria
Majority caused by E.coli
* Symptoms: dysuria, frequency, frequent urge to void, nocturia, suprapubic
discomfort.
* UA dipstick: large number of leukocytes, + nitrates, may show RBC.
* UTI in males: r/o other causes (STI, anatomical abn…)
* Risk factors
* female, pregnancy, history of recent UTI, history of recurrent infections, DM,
immunocompromised, failure to void post intercourse, spermicide use,
dehydration, poor hygiene, catheterization
Urinary Tract Infection
What if pt symptomatic after 48-72 hrs. from initiating tx
switch tx and order UA and C&S.
Meds to tx uncomplicated UTI
Trimethoprim-Sulfamethoxazole (Bactrim, Septra) BID x 3.
- Sulfa allergic: Nitrofurantoin BID x 5
- Fosfomycin 3g x 1 dose
- Augmentin 875/125 mg BID x 5-7 days
- Phenazopyridine (Pyridium) BID x 2 days PRN, will turn urine orange/yellow.
Meds to tx complicated UTI
Ciprofloxacin (Cipro) 500mg BID or levofloxacin 750mg once a day for 7-10 days
- Trimethoprim-sulfamethoxazole BID or cefixime (Suprax) 400mg BID for 7-10 days.
- Sulfa allergy: Cephalexin (Keflex), Ceclor, Cipro
- Acute bacterial infection of the kidneys.
- Symptoms: high fever, chills, N&V, one-sided flank pain
(costovertebral angle tenderness on one kidney), dysuria, urinary
frequency & urgency. - Shift to the left
- Close follow up 12-24 hrs.
- Refer: pregnancy (fluoroquinolones contraindicated), children, elderly, anatomical abn, DM…
Acute Pyelonephritis
Shift to the left
the presence of immature neutrophils = serious
infection
Tx for acute pyelonephritis
Mild uncomplicated (young healthy adult): Cipro/Levaquin 7 days, Ceftriaxone 1g IM inj, Augmentin 14 days…
- Moderate to severe or immunocompromised might require hospitalization.
AKA: Kidney stones.
* Majority made up of calcium oxalate.
* Size of stone corresponds to level of pain. Location of stone determines location of pain.
* Risk Factors: family hx, low fluid intake, gout, bariatric surgery.
* Symptoms: acute pain on one side, come in waves, pain builds in intensity (pain passes when stone moves or passes), may have N&V with severe pain, hematuria?
* Tests: strain urine, renal US, UA, if stone is too large refer, may need to go to ED.
* Education: hydration. Avoid foods high in oxalate (meats, beets, chocolate, spinach…)
Nephrolithiasis (Urolithiasis)
The majority of kidney stones made up of
Calcium Oxalate
AKA: Acute Renal failure.
* May last hrs. or days. Can be reversible.
* A buildup of waste products can cause a sudden episode of kidney failure or damage.
* Symptoms: oliguria, edema, weight gain (from fluid retention), lethargy, nausea, loss of appetite, itching, confusion.
* Causes: infection, liver failure, medications, heart failure, burns, dehydration…
* Findings: rapid decrease in kidney function, elevated serum creatinine, decline GFR.
Source
AKI
- Blood in the urine.
- Revealed by positive urine dipstick , or gross (visible).
- If dipstick is positive, order a microscopic UA.
- Infection suspected? Order C&S.
- Malignancy suspected? Order urine cytology study.
- R/o: menses, hemorrhoids, food dyes (beets).
Hematuria
Biggest risk factor for bladder cancer
Smoking
- Think cancerous mass: hematuria, pelvic/ lower back/ lower abdominal pain, may or may not have irritative voiding symptoms (dysuria, frequency, nocturia).
- Risk factors: older age, smokers, workplace exposures (industrial chemicals).
- Patients will most likely seek for help after noticing hematuria or blood stains on underwear.
- Treatment: surgery, biological therapy, chemotherapy.
Bladder Cancer
A 24-week pregnant patient has asymptomatic UTI. How would you treat it?
Treat w/ nitrofurantoin 100 mg 4 x daily
