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P3.2 > Renal CIS > Flashcards

Renal CIS Flashcards

1
Q

most accurate place to check for skin tenting

A

-forehead

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2
Q

acute phase reactants

A

(serum proteins)

  • accompanies acute and chronic infl and tissue injury
  • proteins whose serum conc inc or dec by 25% during infl states
  • positive (go up)- ESR, CRP, ferritin, WBC, haptoglobin, ceruloplasmin
  • negative (decrease)- albumin, transferrin
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3
Q

reactive thrombocytosis

A
  • thrombocytosis in absence of a chronic myeloproliferative or myelodysplastic disorder
  • in pts who have a medical or surgical condition, likely to be assoc with an inc platelet count, and the platelet count normalies after resolution of the condition!!
  • recent surgery, bacterial infection, trauma
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4
Q

DDX for acute kidney injury

A
  • prerenal- dehydration, hypotension
  • renal- atrophic kidney makes the other kidney more susceptible, toxins
  • postrenal- obstruction, stone, BPH
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5
Q

diagnostic criteria for acute kidney injury

A
  • KDIGO- inc in serum creatinine of 0.3 over 48 hrs or >50% over 7 days!!
  • urine output < 0.5 mL/kg/hr for >6 hrs
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6
Q

hyperkalemia- clinical features

A

(need baseline EKG with elevated K)

  • peaked T waves
  • symptoms uncommon unless K > 7- m weakness, ventricular arrhythmias
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7
Q

hyperkalemia- treatment

A
  • EKG
  • stabilize cardiac membranes with Ca
  • shift K into cells- insulin and glucose, B-2 agonist, sodium bicarbonate
  • remove K- cation exchange resin, loop/thiazide diuretic, hemodialysis
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8
Q

DDX for renal mass

A
  • renal cell carcinoma
  • benign renal tumors (oncocytoma, angiomyolipoma, metanephric adenoma)
  • metastatic dz
  • xanthogranulomatous pyelonephritis
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9
Q

DDX for atrophic kidney

A
  • in utero
  • first year of life- anorexia, vomiting, failure to thrive
  • after first year of life- frequent pyelonephritis
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10
Q

indications for dialysis therapy

A
  • fluid overload that is refractory to diuretics
  • hyperkalemia (>6.5), or rapidly rising K levels, refractory to medical therapy
  • metabolic acidosis (pH < 7.1) in pts that bicarbonate is not indicated
  • uremia signs- pericarditis, neuropathy, decline in mental status
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11
Q

systemic inflammatory response syndrome (SIRS)

A
  • temp > 38 C (100.4 F)
  • HR > 90
  • Resp rate > 20
  • WBC > 12,000, < 4,000
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12
Q

sepsis

A

2 more SIRS criteria

-systemic response to infection

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13
Q

always get what in sepsis pts?

A

blood cultures!

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14
Q

most common cause of UTI and pyelonephritis

A

E coli!!

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15
Q

cause of honeymoon cystitis

A

-Staph saprophyticus

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16
Q

Anion gap

A

Na - Cl - HCO3

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17
Q

viscero-somatic reflex of kidneys

A

T10-11

18
Q

women’s history- always ask?

A
  • last menstrual period
  • pregnancy on DDx!!
  • ask about contraception
19
Q

woman’s obstetric history- G and P

A
  • Gravidity- # of times pregnant

- Parity- # of births

20
Q

DDx of hemotpysis

A
  • DAH (diffuse alveolar hemorrhage)
  • infectious
  • neoplastic
  • drug (anti-coagulant) or toxin exposure
  • bronchiectasis
  • pulm embolism
  • granulomatosis with polyangiitis
  • mitral valve stenosis
21
Q

DDx of hematuria

A

glomerulonephropathy

  • SLE
  • churg-strauss syndrome
  • post-streptococcal GN
  • IgA nephropathy
  • alport syndrome (hereditary nephritis)
22
Q

goodpasture syndrome

A

(anti-glomerular basement membrane dz)
-ab’s destroy basement membrane in pulm alveoli and glomerular basement membrane
if only kidney is involved- called Anti-GBM dz
-renal + pulmonary- goodpasture syndrome!

23
Q

viscero-somatic reflex of lungs

A

-T2-7

24
Q

viscero-somatic reflex of kidneys

A

T10-11

25
Q

red cell casts =

A

GN

26
Q

f microscopic eval shows no RBCs but positive blood

A
  • myoglobinuria

- rhabdomyolysis

27
Q

SCD and ATP

A

-sequential compression device
-antithrombotic pumps
(same things, just diff names!)

28
Q

types of urinary catheters

A
  • foley (indwelling)- highest risk of infection
  • straight (intermittent, in and out)
  • condom (Texas catheter)- external
  • suprapubic catheter
29
Q

suspected Goodpasture’s- what labs

A
  • anti-GBM ab’s
  • c-ANCA- granulomatosis with polyangiitis
  • p-ANCA- microscopic polyangiitis
30
Q

treatment for Goodpasture’s

A
  • steroid (first treatment- suppress ab formation)
  • look for signs of resp distress
  • blood transfusion (if needed)
  • pulm and nephrology consults
  • CT chest (no contrast due to renal compromise!!)
  • baseline EKG due to AKI and K levels
  • kidney biopsy (if needed)
  • dialysis (if needed)
  • plasmapheresis to clear GBM ab’s!!!
  • No aspirin, NSAIDs, or Cox-2 inhibitors!!
31
Q

blood transfusion- type and screen

A
  • determine ABO and Rh groups of RBCs
  • screen serum for presence of potentially hemolyzing ab’s
  • done when thinking about might have to five blood
32
Q

blood transfusion- type and cross match

A

(after type and screen is done)

  • final step in determining the compatibility of the blood of a donor and recipient before transfusion
  • place the donor’s cells in the recipient’s serum
  • compatibility- absence of agglutination, hemolysis, cytotoxicity
33
Q

red urine- etiologies

A
  • hematuria, vaginal bleeding, nephrolithiasis
  • not always due to RBCs!!
  • discoloration due to Hb or myoglobin, foods (beets), drugs (phenazopyridine, rifampin, isoniazd
34
Q

most common place for edema in kids with nephritis

A
  • periorbital edema

- if extremity edema with nephritis- NON-PITTING!

35
Q

most common cause of glomerulonephritis in kids

A

post strep GN

  • 1/2 are asymptomatic except for urine changes
  • symptomatic- edema, HTN, rank hematuria, non-pitting edema
36
Q

hematuria

A
  • RBCs in urine (> 3 RBCs per high-power field)

- isolated hematuria- urinary RBCs without other urine abnormalities

37
Q

Coca-cola urine

A

-brown!- suggests renal source as opposed to bladder

38
Q

reducing substances- what are they? why checked in pediatric UA?

A

bacteria bi-products (glucose, galactose)

  • UTI or carbohydrate metabolism error
  • used as a screening test for inborn errors of carbohydrate metabolism
39
Q

Acute GN in kids- causes

A
  • Post-strep- most common!!! (50% asymptomatic)- symptoms- hematuria, edema, HTN
  • IgA nephropathy
  • Goodpasture
  • idiopathic rapidly progressive GN
40
Q

Holliday-segar method (4-2-1 of pediatric IVF)

A
  • 4 cc/kg/hr for first 10 kg
  • 2 cc/kg/hr for second 10 kg
  • each additional kg add 1 cc/kg/hr
41
Q

normal urine output, oliguria, anuria

A
  • normal- 1-2 L/day
  • oliguria- <500 mL/day
  • anuria- <50 mL/day

P3.2 (11 decks)

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