Renal CIS Case 1 Flashcards
the most accurate place to check for skin tenting
forehead
when do acute phase reactants increase
during acute and chronic inflammatory states associated with infection, trauma, infarction, neoplasms
acute phase proteins that go up during infection/inflammation
ESR, CRP, Ferritin, WBC, Haptoglobin, ceruloplasmin
acute phase proteins that decrease during infection inflammation
albumin, transferrin
what is reactive thrombocytosis
thrombocytosis in absence of chronic myeoloproliferative or myelodysplastic disorder in pts who have medical or surgical condition likely to be associated with an incareased platelet count and whom platelet count normalizes after resolution of condition
examples causing reactive thrombocytosis
surgery, bacterial infection, trauma
prerenal Acute kidney injury from
dehyrdation, hypotension
bun/cr 20:1
hypoperfusion from decreased cardiac output and decreased effective aterial blood volume
renal actue kidney injury from
acute glomerulonephritis (inflammation and damage to glomerular membrane)
acute intersitial nephritis (allrgic rxn from drugs)
acute tubular necrosis (nephrotoxic agents, prolonged renal hypoperfusion)`
postrenal acute kidney injury is from
think obstruction, stone, BPH
increase in serum creatinine of ____mg/dL developing over ____ hours or >____% developing over ___ days
(criteria for acute kidney injury)
0.3 mg/dL
48 hours
50%
7 days
urine output of ____hrs
criteria for AKI
0.5 mL for > 6 hrs
how to recognize hyperkalemia
symptoms and caused how
muscle weakness and ventricular arrhythmias
- from increased release from cells
- hyperglycemia, rhabdomyolysis, succinylcholine
-reduced potassium excretion in urine from hypoaldosteronism or renal failure
ecg findings in hyperkalemia
peaked T wave
prolonged PR and QRS interval, small p wave
loss of p wave, prolnoged QRS interval, and
conduction delay as bundle branch or AV nodal block
V fib or asystole can result
what must you exclude before confirming hyperkalemia
pseudohyperkalemia from hemolysis of blood specimen
treating hyperkalemia
give adults calcium chloride or calcium gluconate
give children calcium gluconate
give insulin and glucose
give beta 2 agonist
give sodium bicarb
remove potassium
how to remove potassium from hyperkalemic pt
cation exchange resin (sodium polystyrene sulfonate)
loop or thiazide diuretic
hemodialysis
differential diagnosis of a renal mass
renal cell carcinoma
benign renal tumor: oncocytoma, angiomyolipoma, metanephric adenoma
metastatic disease
xanthogranulomatous pyelonephritis
DDx of atrophic kidney
-in utero
in utero: vascular event, urinary tract abnormaltities, posterior urethral valve, vesicoureteral refulx, ureteropelvic junction obstruction, ACEI use, genetic abnormality
DDx of atrpohic kidney first year of life symptoms
persistent anorexia and vomiting, failure to thrive
DDx of atrophic kidney after 1st year of life symptoms
frequent pyelonephritis, renal scarring disorders, and ESRD
indications for dialysis therapy
fluid overload that is refractory to diuretics
hyperkalemia (over 6.5 mEq/L
metabolic acidosis of pH under 7.1, in whom administration of bicarb not indicated like those with volume overload or those with lactic acidosis or ketoacidisos
signs of uremia like pericarditis, neuropathy
systemic inflammatory resposne syndrome is defined as 2 or more of following conditiosn
SIRS criteria
temp over 38 degrees C or less than 36 degrees C
HR>90
RR >20
PaCO2<32 mm Hg
WBC count > 12,000, <4000 or > 10% immature bands forms
severe sepsis
sepsis associated with organ dysfunction, hypoperfusion or hypotension
septic shock
sepwis induced hypotension
sepsis
systemic response to an infection defined by 2 or more SIRS criteria
Multiple organ dysfunction syndrome
presence of altered organ dysfunciton in an actuely ill pt
what do you always do in a sepsis pt
get blood cultures before antibiotics if possible
most common cause of UTI and pyelonephritis
E coli staph saprophyticus (honeymoon cystitis)
viscero-somatic reflex of kidenys
T10-T11
calculate anion gap
Na- (CL + HCO3)
gravidity
of time woman has been pregnant
parity
of pregnancies that led to birth at or beyond 20 weeks or of an infant weighing more than 500 g
