Renal CIS Flashcards
Most accurate place to check for skin tenting
Forehead
Markers whose serum concentrations increase or decrease by at least 25% during inflammatory states and tissue injury
Acute phase reactants
Positive acute phase reactants (go up during infection/inflamm)
ESR CRP Ferritin WBC Haptoglobin Ceruloplasmin
Negative acute phase reactants (go donw during infection/inflamm)
Albumin
Transferrin
Increased platelet count in the absence of a chronic myeloproliferative or myelodysplastic disorder, in pts who have a medical or surgical condition likely to be associated with an increased platelet count, and in whom platelet count normalizes or is expecte dto normalize after resolution of this condition
Reactive thrombocytosis
[examples are recent surgery, bacterial infxn, and trauma]
Ddx for prerenal AKI
Dehydration, hypotension (BUN/CR of 20:1 think more dehydration)
Intrarenal ddx for AKI
Anatomic abnormalities (atrophic kidney), toxins (environmental, medications like NSAIDs)
Postrenal ddx for AKI
Obstruction, stone, BPH
KDIGO diagnostic criteria for AKI
Increase in serum Cr of >0.3mg/dL within 48 hrs or >50% within 7 days
OR
Urine output of <0.5 mL/kg/hr for >6 hrs
First step to management of hyperkalemia
Need to get baseline EKG with elevated K
Clinical features of hyperkalemia
S/s uncommon, occur only when serum K is >7 — can include weakness and ventricular arrhythmias
What type of hyperkalemia does not produce ECG changes?
Pseudohyperkalemia
2 major mechanisms of hyperkalemia
Increased K release from cells — severe hyperglycemia, rhabdomyolysis
Reduced K excretion in urine — hypoaldosteronism, renal failure
ECG findings with hyperkalemia
Tall peaked T waves
Shrinking then loss of P waves
Widening of QRS interval and then sine wave, ventricular arrhythmia, and asystole
What do you give pts with a hyperkalemic emergency?
Calcium gluconate over 2-3 mins
Insulin and glucose
Give therapy to remove K from body if needed — hemodialysis, diuretics, GI cation exchanger like patiromer
Note: sodium polystyrene sulfonate should NOT be given unless there areno other options to effectively remove K from body in timely fashion
What is included on UA?
Leukocytes Nitrite Urobilinogen Protein pH Blood Specific gravity Ketones Bilirubin Glucose
Catheters should be used only for appropriate indications and left in place only as long as needed. Who is especially high risk for catheter use?
Women, elderly, pts with impaired immune systems
Also avoid use in pts and nursing home residents for management of incontinence
Examples of appropriate indications for indwelling urethral catheter use
Pt has acute urinary retention or bladder outlet obstruction
Need for accurate measurements of urinary output in critically ill pts
Perioperative use for selected surgical procedures — urologic, prolonged duration, large volume infusions or diuretics anticipated, intraoperative urine output monitoring
Assist in healing open sacral or perineal wounds in incontinent pts
Pts who require prolonged immobilization (unstable spine fracture, multiple trauma such as pelvis fracture)
Improve comfort for end of life care as needed
Ddx of renal mass
RCC
Benign renal tumor — oncocytoma, angiomyolipoma, metanephric adenoma
Metastatic disease
Xanthogranulomatous pyelonephritis
Ddx of atrophic kidney in terms of in utero vs. first year of life vs. later
In utero — vascular events, urinary tract abnormalities like posterior urethral valves, VUR, UPJO, ACEI use, genetic abnormality, hyperglycemia/DM in mother, maternal vit A def, intrauterine growth retardation
First year of life — persistent anorexia and vomiting, FTT
After first year of life — frequent pyelo, other d/o that lead to renal scarring and ESRD
Indications for dialysis in patients with AKI
Fluid overload that is refractory to diuretics
Hyperkalemia > 6.5mEq/L or rapidly rising K levels refractory to other medical therapy
Metabolic acidosis pH < 7.1, for pts in whom admin of bicarb is not indicated (such as volume overload) or those with lactic acidosis or ketoacidosis in whom bicarb has not been shown to be effective
Signs of uremia such as pericarditis, neuropathy, or otherwise unexplained decline in mental status
Differentiate SIRS criteria from sepsis
Sepsis = systemic response to an infection defined by 2 or more SIRS criteria as a result of an infection
SIRS response is manifested by 2+ of the following:
Temp > 38 or < 36
HR > 90 bpm
RR > 20/min or PaCO2 <32 mmHg
WBC > 12,000/uL, <4000/uL, or >10% immature (band) forms
What should you ALWAYS get in sepsis pts before starting abx?
Blood cultures
MCC of UTI and pyelo
E.coli
Staph saprophyticus — honeymoon cystitis
Note that previous urine cultures can clue you in, pt likely has same organism
Anion gap calculation
Na - (Cl + HCO3)
Viscerosomatic reflex of the kidneys
T10-T11
Important considerations for female pts
Always ask LMP
Have pregnancy on DDx of all women of childbearing age
Ask about contraception including IUDs, OCPs
Begin to think of Gs and Ps of woman’s obstetric hx
Anterior chapmans reflex 2 inches above and 1 inch lateral to umbilicus
Adrenals
Anterior chapmans point 1 inch above and 1 inch lateral to umbilicus
Kidney/ureter
Anterior chapmans point in periumbilical region
Bladder
Anterior chapmans point at inner edge of pubic ramus near symphysis
Urethra
Posterior chapmans point at intertransverse spaces between T11-12
Adrenals
Posterior chapmans point at intertransverse spaces between T12-L1
Kidney
Posterior chapmans point at intertransverse spaces between L1-2
Ureters
Posterior chapmsn point at superior edge of L2 TP
Bladder/urethra
