Renal CIS Flashcards
most accurate place to check for skin tenting
-forehead
acute phase reactants
(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
reactive thrombocytosis
- 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
DDX for acute kidney injury
- prerenal- dehydration, hypotension
- renal- atrophic kidney makes the other kidney more susceptible, toxins
- postrenal- obstruction, stone, BPH
diagnostic criteria for acute kidney injury
- 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
hyperkalemia- clinical features
(need baseline EKG with elevated K)
- peaked T waves
- symptoms uncommon unless K > 7- m weakness, ventricular arrhythmias
hyperkalemia- treatment
- 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
DDX for renal mass
- renal cell carcinoma
- benign renal tumors (oncocytoma, angiomyolipoma, metanephric adenoma)
- metastatic dz
- xanthogranulomatous pyelonephritis
DDX for atrophic kidney
- in utero
- first year of life- anorexia, vomiting, failure to thrive
- after first year of life- frequent pyelonephritis
indications for dialysis therapy
- 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
systemic inflammatory response syndrome (SIRS)
- temp > 38 C (100.4 F)
- HR > 90
- Resp rate > 20
- WBC > 12,000, < 4,000
sepsis
2 more SIRS criteria
-systemic response to infection
always get what in sepsis pts?
blood cultures!
most common cause of UTI and pyelonephritis
E coli!!
cause of honeymoon cystitis
-Staph saprophyticus
Anion gap
Na - Cl - HCO3
viscero-somatic reflex of kidneys
T10-11
women’s history- always ask?
- last menstrual period
- pregnancy on DDx!!
- ask about contraception
woman’s obstetric history- G and P
- Gravidity- # of times pregnant
- Parity- # of births
DDx of hemotpysis
- DAH (diffuse alveolar hemorrhage)
- infectious
- neoplastic
- drug (anti-coagulant) or toxin exposure
- bronchiectasis
- pulm embolism
- granulomatosis with polyangiitis
- mitral valve stenosis
DDx of hematuria
glomerulonephropathy
- SLE
- churg-strauss syndrome
- post-streptococcal GN
- IgA nephropathy
- alport syndrome (hereditary nephritis)
goodpasture syndrome
(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!
viscero-somatic reflex of lungs
-T2-7
viscero-somatic reflex of kidneys
T10-11
red cell casts =
GN
f microscopic eval shows no RBCs but positive blood
- myoglobinuria
- rhabdomyolysis
SCD and ATP
-sequential compression device
-antithrombotic pumps
(same things, just diff names!)
types of urinary catheters
- foley (indwelling)- highest risk of infection
- straight (intermittent, in and out)
- condom (Texas catheter)- external
- suprapubic catheter
suspected Goodpasture’s- what labs
- anti-GBM ab’s
- c-ANCA- granulomatosis with polyangiitis
- p-ANCA- microscopic polyangiitis
treatment for Goodpasture’s
- 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!!
blood transfusion- type and screen
- 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
blood transfusion- type and cross match
(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
red urine- etiologies
- hematuria, vaginal bleeding, nephrolithiasis
- not always due to RBCs!!
- discoloration due to Hb or myoglobin, foods (beets), drugs (phenazopyridine, rifampin, isoniazd
most common place for edema in kids with nephritis
- periorbital edema
- if extremity edema with nephritis- NON-PITTING!
most common cause of glomerulonephritis in kids
post strep GN
- 1/2 are asymptomatic except for urine changes
- symptomatic- edema, HTN, rank hematuria, non-pitting edema
hematuria
- RBCs in urine (> 3 RBCs per high-power field)
- isolated hematuria- urinary RBCs without other urine abnormalities
Coca-cola urine
-brown!- suggests renal source as opposed to bladder
reducing substances- what are they? why checked in pediatric UA?
bacteria bi-products (glucose, galactose)
- UTI or carbohydrate metabolism error
- used as a screening test for inborn errors of carbohydrate metabolism
Acute GN in kids- causes
- Post-strep- most common!!! (50% asymptomatic)- symptoms- hematuria, edema, HTN
- IgA nephropathy
- Goodpasture
- idiopathic rapidly progressive GN
Holliday-segar method (4-2-1 of pediatric IVF)
- 4 cc/kg/hr for first 10 kg
- 2 cc/kg/hr for second 10 kg
- each additional kg add 1 cc/kg/hr
normal urine output, oliguria, anuria
- normal- 1-2 L/day
- oliguria- <500 mL/day
- anuria- <50 mL/day
