Renal Flashcards
UTI -
Inflammation and infection involving the kidneys
UTI - key symptoms
Dysuria Frequency Nocturia Urgency Hematuria
It hurts when I pee
UTI or STD
What is the first test to order for a man with BPH like symptoms?
UA
Lower UTI - labs
UA - pyuria > 10
Nitrate - very -
Esterase - very +
Esterase by dipstick
+ in UTI is very sensitive
LOWER - UTI big gun meds
TMP/SMX
Cipro
Amox/Clav
LOWER - UTI during pregnancy
Amoxicillin
Nitrofurantoin
Cephalexin
10 day FULL course
Upper UTI symptoms
Flank, low back pain
Fever and chills
N/V
Mental status change in elderly
Upper UTI - labs
WBC casts in UA
ESR elevated in pyelonephritis
Upper UTI managment
14 day course versus 6 week course
– TMP/SMX, Cipro, Amox/Clav, aminoglycosides
Pyelonephritis - with N/V
should be hospitalized
Renal insufficiency - causes
HTN glomerulonephritis diabetic nephropathy nephritis polycystic kidney disease
Renal insufficiency -
symptoms
Often asymptomatic until later stages of disease
< 20-25% normal
Renal insufficiency
types (2)
acute
chronic
Renal insufficiency -
acute
- Sudden impairment
- BUN increased out of proportion to creat
- Due to obstruction, ATN, contrast
- Reversible with therapy
Renal insufficiency -
chronic
- Progressive impairment over months - years
- Steady increase BUN/CR 10:1 ratio
- Damage irreversible
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
Criteria for dialysis
AEIOU
A - Acidosis/Azotemia E - Electrolyte (K, Ca) I - Intoxication (weird) O - Oliguria (< 400/day) U - Uremia (urine in blood)
Oliguria
< 400 ml /day
Anuria
< 100 ml /day
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
50
TURP
Transurethral resection of the prostate
