Renal Flashcards by KaLee Dahmer

UTI -

Inflammation and infection involving the kidneys

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UTI - key symptoms

Dysuria
Frequency
Nocturia
Urgency 
Hematuria

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It hurts when I pee

UTI or STD

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What is the first test to order for a man with BPH like symptoms?

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Lower UTI - labs

UA - pyuria > 10
Nitrate - very -
Esterase - very +

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Esterase by dipstick

+ in UTI is very sensitive

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LOWER - UTI big gun meds

TMP/SMX
Cipro
Amox/Clav

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LOWER - UTI during pregnancy

Amoxicillin
Nitrofurantoin
Cephalexin
10 day FULL course

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Upper UTI symptoms

Flank, low back pain
Fever and chills
N/V
Mental status change in elderly

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Upper UTI - labs

WBC casts in UA

ESR elevated in pyelonephritis

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Upper UTI managment

14 day course versus 6 week course

– TMP/SMX, Cipro, Amox/Clav, aminoglycosides

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Pyelonephritis - with N/V

should be hospitalized

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Renal insufficiency - causes

HTN
glomerulonephritis
diabetic nephropathy
nephritis
polycystic kidney disease

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Renal insufficiency -

symptoms

Often asymptomatic until later stages of disease

< 20-25% normal

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Renal insufficiency

types (2)

acute

chronic

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Renal insufficiency -

acute

Sudden impairment
BUN increased out of proportion to creat
Due to obstruction, ATN, contrast
Reversible with therapy

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Renal insufficiency -

chronic

Progressive impairment over months - years
Steady increase BUN/CR 10:1 ratio
Damage irreversible

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Renal insufficiency -

stages (3)

Diminished Renal Reserve - 50% nephron loss, creatinine doubles
Renal insufficiency - 75% nephron loss, mild azotemia
ESRD - 90% nephron damage - azotemia, metabolic alterations

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Criteria for dialysis

AEIOU

A - Acidosis/Azotemia
E - Electrolyte (K, Ca) 
I - Intoxication (weird)
O - Oliguria (< 400/day)
U - Uremia (urine in blood)

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Oliguria

< 400 ml /day

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Anuria

< 100 ml /day

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Renal insufficiency management
acute (1)
chronic (3)

Acute - Determine causes and intervene 
Chronic - 
-- Control HTN/DM
-- Protein < 40 g/day
-- Modify med dosage for creatinine clearance

Renal insufficiency
Treat complications
Overload
Acidosis
Electrolytes
Anemia
Azotemia 
Vasoconstriction

Overload - diuretics/dialysis
Acidosis - bicarb/dialysis
Electrolytes - Ca, K
Anemia - erythropoeitin 
Azotemia (BUN > 100) - Dialysis 
Vasoconstriction - ACE inhibitor

Azotemia

BUN > 100

Normal BUN creatinine ratio

10 : 1

Acute Renal Failure - Categories

Pre-renal Intra-renal Post-renal

Acute Renal Failure | Pre-renal causes (outside kidneys)

Impaired renal perfusion - - - shock - - dehydration - - burns - - cardiac failure - - diarrhea - - sepsis

Acute Renal Failure | Intra-renal causes

``` Hypersensitivity Obstruction of renal vessel Nephrotoxic agents Mismatch blood Acute tubular necrosis ```

Acute Renal Failure | Post-renal causes

``` Mechanical - -- calculi -- tumor -- strictures -- BPH Functional - -- neurogenic bladder -- diabetic neuropathy ```

Acute Renal Failure | Diagnostics to determine Pre-renal

``` ratio > 10:1 (DEHYDRATION) Urine Na < 20 mmol/dL Specific gravity > 1.015 (CONCENTRATION) Sediment - few hyaline casts FEna - < 1 ```

Acute Renal Failure | Diagnostics to determine Intra renal

``` ratio 10:1 Urine Na > 40 Specific gravity < 1.015 Sediment - granular/white casts FEna >3 ```

Acute Renal Failure | Diagnostics to determine Post-renal disease

``` ratio 10:1 Urine Na > 40 mmol/dL Specific gravity < 1.015 Sediment - normal FEna >3 (usually) ```

Which type of renal disease pre, intra, post has an BUN/creat ratio > 10:1

PRE-RENAL

Acute Renal Failure - management for Pre-renal

Expand volume | Consider dopamine

Acute Renal Failure | management for Intra-renal

Maintain perfusion Stop nephrotoxic drugs Dialysis as needed

Acute Renal Failure | management Post-renal

Remove obstruction - - check foley - - CT - - Renal ultrasound

Nephrolithiasis - 10 % of population will have one in their lifetime

Renal calculi

Nephrolithiasis - types

calcium uric acid struvite cystine

Nephrolithiasis - s/s

acute, painful colic-like flank pain - with increasing intensity radiation to groin - lower 1/3 *men testicular pain

Nephrolithiasis versus torsion

prehn's test

Nephrolithiasis- management trio

``` IVF + trio - Dilauded - Toradol - metoclopramide ```

What is a major side effect of using metoclopramide long term.

Tardive dyskinesia

Prehn's sign

lifting testical relieves pain + epididymitis

BPH - incidences

affects 50% of men by 50 | > 80% of men 80

BPH - causes

unknown

BPH - s/s

``` Frequency Dysuria Urgency Nocturia Incontinence Hesitancy Starting and stopping urine flow Dribbling Retention ```

BPH - labs/diagnostics

UA - to r/o UTI PSA > 4 ng/ml = abnormal Transrectal US if palpable nodule/ Elevated PSA

BPH - management

``` Alpha-blocker 5-alpha-reductase inhibitors TURP Saw palmetto Avoid worsening meds: -- benadryl -- sudafed -- afrin -- SSRI -- diuretics --narcotics ```

5-alpha-reductase inhibitor

BPH - ASTERIDE finasteride dutasteride used to shrink large prostates

alpha blocker

BPH - OCIN drugs terazocin prazocin tamsulosin to relax muscles of bladder and prostate

Saw palmetto

Used to decrease PSA values no evidence to decrease CA

Elevated PSA

prostatits BPH prostate cancer

Prostate screening begins at

TURP

Transurethral resection of the prostate