Renal and Metabolic Diseases II

Question 0

What is the most common bacterial cause of UTIs?

Answer 0

E. coli

Question 1

This group of disorders usually involves infections and inflammatory conditions

Answer 1

interstitial disorders

Question 2

This disorder is known as a lower UTI or bladder infection; includes burning and pain in urination, dysuria, and increased frequency of urination (mental confusion in elderly)

Answer 2

Cystitis

Question 3

What are common lab findings in cystitis?

Answer 3

Normal BUN/Crea, postive urine culture; URinalysis: Leukocyte Esterase pos, bacteria small to large, no casts

Question 4

This disorder is an infection of the tubules and interstitium; caused by ascending movement of bacteria from a lower UTI or from reflux nephropathies; symptoms include burning during urination, flank and lower back pain, nausea and headache

Answer 4

acute pyelonephritis

Question 5

What are common lab findings in acute pyelonephritis?

Answer 5

Urine culture positive; urinalysis: leukocyte esterase usually positive, WBC casts present, bacteria small to large

Question 6

What is the prognosis of acute pyelonephritis?

Answer 6

proper antibiotic treatment should resolve the problem without permanent damage to tubules

Question 7

This disorder occurs when persistent inflammation of the renal tissue causes permanent scarring that involves the renal calyces and pelvis; most common cause is reflux nephropathies

Answer 7

Chronic pyelonephritis

Question 8

What are common lab findings in chronic pyelonephritis?

Answer 8

Increased BUN, Urine culture positive; urinalysis: leukocyte esterase positive, WBC Casts, Granular/Waxy/Broad Casts, blood present

Question 9

What is the prognosis for chronic pyelonephritis?

Answer 9

Usually diagnosed in childhood, 10-15% will end in renal failure requiring dialysis

Question 10

This disorder is caused by inflammation of the renal interstitium followed by inflammation of the renal tubules; often caused by allergic reactions to medications; usually presents with a skin rash, oliguria, and/or edema

Answer 10

acute interstitial nephritis

Question 11

What are common lab findings in acute interstitial nephritis?

Answer 11

Increase BUN, GFR, and crea; fever; Urinalysis: WBCs numerous with NO bacteria seen, Eosinophils, mild to mod proteinuria

Question 12

This group of disorders results from any conditions which reduces the blood flow to the kidneys

Answer 12

vascular disorders

Question 13

This disorder is characterized by a SUDDEN onset, decrease in GFR, azotemia, and has a high mortality

Answer 13

Acute Renal Failure

Question 14

what are the three stages of acute renal failure?

Answer 14

pre-renal, renal, and post-renal

Question 15

This mechanism of acute renal failure is caused by decrease in blood flow below 80 mmHg, decreased cardiac output, blood loss, severe diarrhea, and vomiting

Answer 15

pre-renal

Question 16

This mechanism of acute renal failure is due to damage to the glomerulus or tubular regions, usually in acute tubular necrosis

Answer 16

renal

Question 17

This mechanism is due to obstructions in urine flow such as crystalline deposition (calculi) or neoplasms

Answer 17

post-renal

Question 18

What is the prognosis for acute renal failure?

Answer 18

high mortality rate, usually caused by simultaneous infection or potassium intoxication; monitor electrolytes and fluids along with dialysis to control azotemia

Question 19

Common lab findings in acute renal failure

Answer 19

urine osmo greater than serum osmo, BUN increased, GFR decreased, edema, oliguria

Question 20

This disorder is caused by a gradual loss of function caused by glomerulonephropathies, diabetic nephropathy, chronic pyelonephritis, and hypertension

Answer 20

chronic renal failure

Question 21

Common lab findings in chronic renal failure

Answer 21

azotemia, decreased GFR, bleeding, electrolyte imbalance; urinalysis: isotenuria, mk’d protein, all types of casts (ESPECIALLY waxy and broad)

Question 22

This disorder is caused by renal calculi as they form in the calyces and pelvis of the kidney, ureters, and bladder; 75% are composed of calcium oxalate or calcium phosphate

Answer 22

renal lithiasis

Question 23

What factors affect the formation of kidney stones?

Answer 23

supersaturation of chemical salts in urine, optimal urinary pH, urinary stasis, nucleation or initial crystal formation

Question 24

What are some common sympotms of kidney stones?

Answer 24

pain radiating from kidney and continuing down to genitalia and legs, nausea, vomiting, sweating, increased urge to urinate, bloody urine

Question 25

What is the GFR historical reference method?

Answer 25

inulin clearance

Question 26

What is the most common assessment of glomerular function?

Answer 26

creatinine clearance

Question 27

this is the use of high energy waves to break stones into smaller pieces

Answer 27

lithotripsy

Question 28

Describe the creatinine clearance test

Answer 28

not affected by urine flow rate, not reabsorbed by tubules, not affected by diet, produced at a constant rate, dependent on muscle mass

Question 29

How is a creatinine clearance tested?

Answer 29

Timed specimen is necessary (24 hour urine collection); avg production of crea= 1.2 mg/day, make sure to preserve because bacteria can lower crea

Question 30

What is considered a normal GFR?

Answer 30

120 mL/min (if >90 mL/min patient is considered normal)

Question 31

This calculation uses serum crea, age, gender, and ethnicity; typically reported in patients with <60 mL/min GFR

Answer 31

estimated GFR

Question 32

this assessment of glomerular function is a more sensitive indicator of a decrease in GFR than crea clearance; not reliable in patients with immunologic disorders or malignancy; good test to assess tubular function; it dissociates from the membrane of nucleated cells at a constant rate and is rapidly filtered by the glomerulus and reabsorbed and catabolized by the tubules

Answer 32

Beta2-Microglobulin

Question 33

This is produced at a constant rate by all nucleated cells; readily filtered by the glom and reabsorbed and broken down by tubules; recommended test for peds, elderly, diabetics, and critically ill; INDEPENDENT of muscle mass

Answer 33

Cystatin C

Question 34

What are the 3 treatment options for renal failure?

Answer 34

Hemodialysis, Peritoneal dialysis, and renal transplant

Question 35

In this treatment, the patient’s blood is cleansed as particles diffuse across a semipermeable membrane into a commercially available dialysis solution; preferred access point is through a fistula

Answer 35

Hemodialysis

Question 36

This treatment involves using a sterile solution of dialysis solution allowing it to drain into the peritoneal cavity; the peritoneal membrane acts as a selectively permeable membrane that allows diffusion and osmosis of wastes into the dialysis solution; this solution is then drained and discarded

Answer 36

peritoneal dialysis