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ANCC Boards Review > Renal > Flashcards

Renal Flashcards

1
Q

UTI -

A

Inflammation and infection involving the kidneys

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2
Q

UTI - key symptoms

A 
Dysuria
Frequency
Nocturia
Urgency 
Hematuria
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3
Q

It hurts when I pee

A

UTI or STD

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4
Q

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

A

UA

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5
Q

Lower UTI - labs

A

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

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6
Q

Esterase by dipstick

A

+ in UTI is very sensitive

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7
Q

LOWER - UTI big gun meds

A

TMP/SMX
Cipro
Amox/Clav

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8
Q

LOWER - UTI during pregnancy

A

Amoxicillin
Nitrofurantoin
Cephalexin
10 day FULL course

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9
Q

Upper UTI symptoms

A

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

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10
Q

Upper UTI - labs

A

WBC casts in UA

ESR elevated in pyelonephritis

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11
Q

Upper UTI managment

A

14 day course versus 6 week course

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

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12
Q

Pyelonephritis - with N/V

A

should be hospitalized

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13
Q

Renal insufficiency - causes

A 
HTN
glomerulonephritis
diabetic nephropathy
nephritis
polycystic kidney disease
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14
Q

Renal insufficiency -

symptoms

A

Often asymptomatic until later stages of disease

< 20-25% normal

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15
Q

Renal insufficiency

types (2)

A

acute

chronic

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16
Q

Renal insufficiency -

acute

A
  • Sudden impairment
  • BUN increased out of proportion to creat
  • Due to obstruction, ATN, contrast
  • Reversible with therapy
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17
Q

Renal insufficiency -

chronic

A
  • Progressive impairment over months - years
  • Steady increase BUN/CR 10:1 ratio
  • Damage irreversible
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18
Q

Renal insufficiency -

stages (3)

A
  • 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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19
Q

Criteria for dialysis

AEIOU

A 
A - Acidosis/Azotemia
E - Electrolyte (K, Ca) 
I - Intoxication (weird)
O - Oliguria (< 400/day)
U - Uremia (urine in blood)
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20
Q

Oliguria

A

< 400 ml /day

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21
Q

Anuria

A

< 100 ml /day

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22
Q

Renal insufficiency management
acute (1)
chronic (3)

A 
Acute - Determine causes and intervene 
Chronic - 
-- Control HTN/DM
-- Protein < 40 g/day
-- Modify med dosage for creatinine clearance
23
Q 
Renal insufficiency
Treat complications
Overload
Acidosis
Electrolytes
Anemia
Azotemia 
Vasoconstriction
A 
Overload - diuretics/dialysis
Acidosis - bicarb/dialysis
Electrolytes - Ca, K
Anemia - erythropoeitin 
Azotemia (BUN > 100) - Dialysis 
Vasoconstriction - ACE inhibitor
24
Q

Azotemia

A

BUN > 100

25
Q

Normal BUN creatinine ratio

A

10 : 1

26
Q

Acute Renal Failure - Categories

A

Pre-renal
Intra-renal
Post-renal

27
Q

Acute Renal Failure

Pre-renal causes (outside kidneys)

A

Impaired renal perfusion -

    • shock
    • dehydration
    • burns
    • cardiac failure
    • diarrhea
    • sepsis
28
Q

Acute Renal Failure

Intra-renal causes

A 
Hypersensitivity
Obstruction of renal vessel
Nephrotoxic agents
Mismatch blood 
Acute tubular necrosis
29
Q

Acute Renal Failure

Post-renal causes

A 
Mechanical - 
-- calculi
-- tumor
-- strictures
-- BPH 
Functional - 
-- neurogenic bladder
-- diabetic neuropathy
30
Q

Acute Renal Failure

Diagnostics to determine Pre-renal

A 
ratio > 10:1 (DEHYDRATION)
Urine Na < 20 mmol/dL
Specific gravity > 1.015 (CONCENTRATION)
Sediment - few hyaline casts
FEna - < 1
31
Q

Acute Renal Failure

Diagnostics to determine Intra renal

A 
ratio 10:1
Urine Na > 40
Specific gravity < 1.015
Sediment - granular/white casts
FEna >3
32
Q

Acute Renal Failure

Diagnostics to determine Post-renal disease

A 
ratio 10:1
Urine Na > 40 mmol/dL 
Specific gravity < 1.015
Sediment - normal 
FEna >3 (usually)
33
Q

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

A

PRE-RENAL

34
Q

Acute Renal Failure - management for Pre-renal

A

Expand volume

Consider dopamine

35
Q

Acute Renal Failure

management for Intra-renal

A

Maintain perfusion
Stop nephrotoxic drugs
Dialysis as needed

36
Q

Acute Renal Failure

management Post-renal

A

Remove obstruction

    • check foley
    • CT
    • Renal ultrasound
37
Q

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

A

Renal calculi

38
Q

Nephrolithiasis - types

A

calcium
uric acid
struvite
cystine

39
Q

Nephrolithiasis - s/s

A

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

40
Q

Nephrolithiasis versus torsion

A

prehn’s test

41
Q

Nephrolithiasis- management trio

A 
IVF
\+ trio
- Dilauded
- Toradol
- metoclopramide
42
Q

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

A

Tardive dyskinesia

43
Q

Prehn’s sign

A

lifting testical relieves pain + epididymitis

44
Q

BPH - incidences

A

affects 50% of men by 50

> 80% of men 80

45
Q

BPH - causes

A

unknown

46
Q

BPH - s/s

A 
Frequency
Dysuria
Urgency
Nocturia
Incontinence
Hesitancy
Starting and stopping urine flow
Dribbling
Retention
47
Q

BPH - labs/diagnostics

A

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

48
Q

BPH - management

A 
Alpha-blocker
5-alpha-reductase inhibitors
TURP
Saw palmetto
Avoid worsening meds:
-- benadryl
-- sudafed
-- afrin
-- SSRI 
-- diuretics
--narcotics
49
Q

5-alpha-reductase inhibitor

A

BPH - ASTERIDE
finasteride
dutasteride

used to shrink large prostates

50
Q

alpha blocker

A

BPH - OCIN drugs
terazocin
prazocin
tamsulosin

to relax muscles of bladder and prostate

51
Q

Saw palmetto

A

Used to decrease PSA values

no evidence to decrease CA

52
Q

Elevated PSA

A

prostatits
BPH
prostate cancer

53
Q

Prostate screening begins at

A

50

54
Q

TURP

A

Transurethral resection of the prostate

ANCC Boards Review (9 decks)

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