Renal complaint Flashcards
Proteinuria
Protein in the urine
Glucosuria
Glucose in urine
Hematuria
Blood in the urine
Dysuria
Painful urination
Polyuria
Frequent Urination
Uremia
Elevated levels of BUN
BUN
BUN: Blood Urea Nitrogen
–Urea nitrogen is a waste product, created when the liver breaks down proteins
–Urea nitrogen travels from liver to kidneys and is excreted as waste product
–BUN is blood test that allows clinicians to gauge kidney function
Cr
Cr: Creatinine
–Waste product of muscle break down
–Created constantly and properly functioning kidneys excrete this waste product
–Cr is a blood test that allows clinician to gauge kidney function
AKI
Acute Kidney Injury - Impairment of renal filtration and excretory function over days to weeks that results in retention of nitrogenous and other waste products, normally cleared by the kidney.
AKI may progress to Chronic Kidney Disease (CKD) if the renal dysfunction is not resolved in ______
AKI may progress to Chronic Kidney Disease (CKD) if the renal dysfunction is not resolved in 3 months.
Pre-Renal AKI
Insult/injury occurring ”upstream to the kidney”
–Ex: Hypotension
Intrinsic AKI
Insult/injury occurring at the level of the kidney
–Ex: Glomerulonephritis (conditions leading to inflammation of the glomerulus)
Post-Renal AKI
Insult/injury occurring “down-stream to the kidney”
–Ex: Bladder outlet obstruction
Labs to obtain on all patients with AKI
Basic Metabolic Panel*
–Increase in Cr 1.5x the patient’s baseline OR > 0.3mg/dL increase
–BUN:Cr>20:1 suggestive of prerenal AKI
•Urinalysis with urine microscopy*
–Protein? Blood? Glucose?
•Other tests that may be useful
–Urine Albumin/creatinine ratio or urine protein/creatinine ratio
–Renal Ultrasound
–Renal Biopsy
Treatment of AKI
–Pre-Renal patients need IV fluid
–Intrinsic renal patients need underlying cause of disease addressed
–Post-Renal patients need obstruction removed
Chronic Kidney Disease (CKD)
Definition (either present for 3 months):
1. GFR < 60 ml/min/1.73m2
- Markers of Kidney Damage:
–Protein in urine *
–Abnormal Urinary Sediment•ex: RBC cast, WBC cast, etc…
–Abnormal Kidney Biopsy
–Abnormal Renal Imaging
–Electrolyte Abnormalities from tubular disorders
–History of kidney transplantation
Several risk factors for CKD - major ones :
- Diabetes mellitus
- Hypertension
- Cardiovascular disease (CVD)
- Acute Kidney Injury
Three Simple test to identify most CKD patients
1.Glomerular filtration rate (GFR)
–Limitations:
•Not reliable when GFR > 60 m/min
•Not reliable in Acute Kidney Injury (rapidly changing creatinine)
•Not reliable in low muscle mass (cachexia, paraplegia, etc..)
2.Proteinuria–Urine albumin to creatinine ratio or urine protein to creatinine ratio
•Random, spot urine sample so easy to collect
–24 hour urine total protein collection
3.Urinalysis with microscopy
Indications for dialysis:
A: Severe Acidosis
E: Electrolyte disturbance (usually hyperkalemia)
I: Ingestion (ex: ethylene glycols, methanol, etc…)
O: Volume overload
U: Uremia
Asymptomatic Bacteriuria
(UTI) Presence of bacteria without symptoms
Cystitis
(UTI) Symptomatic bladder infection
Prostatitis
(UTI) Symptomatic prostate inflammation due to infection
Pyelonephritis
(UTI) Symptomatic infection of the kidneys
UTI - common strain, common causes?
Most commonly E. Coli (70-90% of the time)
•Most common causes of UTI:
–Fecal contamination
–Outflow obstruction (benign prostatic hyperplasia, urethral stricture etc)
–Sexual activity
–Catheterization
Diagnostic Approach for Cystitis
History and Physical exam are important!
•Basic Labs
–CBC, BMP, Urinalysis, Urine culture
•Look for > 100,000 cfu/mL on urine culture
Diagnostic Approach for Pyelonephritis
H&P
Basic Labs
Imaging
-Mild - not necessary
-Severe cases: Sepsis, septic shock, concern for obstruction (decreased urine output) or no improvement in symptoms after 48 hours of antibiotics therapy warrant imaging.
•CT scan of the abdomen and pelvis is the gold standard
Nephrolithiasis
“Kidney Stones”
Caused by precipitation of minerals in the kidney and ureters that were soluble in the blood
Types of Stones:
–Calcium Oxalate (80%) >>>> Calcium phosphate
–Uric Acid
–Struvite
–Cystine
Diagnostic Approach for Nephrolithiasis
H&P
Basic Labs (plus stone composition analysis)
Imaging:
–Non-Contrast CT: Preferred imaging study for patients with nephrolithiasis
–Ultrasound: Preferred for patients where radiation is contraindicated: pregnant women, children
GU Autonomics - Bladder
Sympathetics?
Parasympathetics?
S: T10-L2
P: S2-S4 (sacrum)
GU Autonomics - Ureter - upper
Sympathetics?
Parasympathetics?
S: T10-T11
P: Vagus n. (OA, AA)
GU Autonomics - lower Ureter
Sympathetics?
Parasympathetics?
S: T12-L2
P: S2-S4 (sacrum)
Chapman’s Reflex Points can be manipulated to reduce ___
Can be manipulated to reduce adverse sympathetic influence of a particular organ or visceral system
