Renal diagnostics

Question 0

BUN/Cr ration measure

Answer 0

volume status

BUN/Cr ration >20 is dehydration

Question 1

Serium Creat (.5-1.2)
BUN 10-20

Answer 1

Bun is product of protein catabolism, excreted by kidney,

can be high in dehydration, GI bleed, steroid use or tetracyclines

Question 2

Stages of kid dz

Answer 2

stage 1: kid damage with normal or high GFR >90
stage 2: kid damage with normal or low GFR 60-89
stage 3: Moderate low GFR 30-59
stage 4: sever low GFR 15-25
Stage 5: kid failure <15 or dialysis

Question 3

creatinine clearance is determined by

Answer 3

24 hr urine

helpful for dosing of a med

Question 4

Ana

Answer 4

if lupus
ANCA - if granulomatotis with polyangitis
Anti GMB antibody - if Goodpastures
Hepatitis B and C serology - may cause membranous nephropathy (liver dz - check liver)
Antistreptolysin O - if poststrep GN
RF, complement levels, serum immunoelelctrophoresis

PSA prostate spec angitgen - screening for prostate CA and monitor dz
PSA is in all men but high = CA, BPH, prostatitis, after DRE!!!

Question 5

UA

Answer 5

pH, spec gravity: reflects ability of kid to concentrate or dilute urine.
Glucose, ketones - due to dehydration.
protein - one of first signs of kid dz
Blood - calculi, glomerular damage, CA neoplasm, Acute tubular necrosis, trauma, infection
Nitrite, leukocyte esterase - infection, contamination
WBC, bilirubin, urobilinogen (liver)

Question 6

Microscopic uA

Answer 6

RBC casts = GN, vasculitis
WBC casts = pyelonephritis, glomerular dz
Epithilial cell casts = acute tubular necrosis, GN
Crystals: stones: Uric Acie (gout), Ca phosphate or Ca oxalate = pseudogout, cysteine, Mg.

Question 7

Earliest clin detectable stage of diabetic nephropathy is

Answer 7

microalbumin

Question 8

urine eosinophils are most often seen in

Answer 8

interstitial nephritis; transplant rejection, pyelonephritis, prostatitis, cystitis, rapid progressive GN (he never ordered)

Question 9

24 hr urine provides

Answer 9

a better quantitative measurement for proteinuria or GFR

Question 10

Urine immunoelectrophoresis (UPEP)

Answer 10

Bence Jones protein - if suspect Mult myeloma MM

Question 11

Bence Jones protein in UPEP is a sign of

Answer 11

Mult Myeloma

Question 12

which stone is radiolucent (can’t see on xray)

Answer 12

URIC acid

Question 13

huge bilat staghorn calculi are a sign of

Answer 13

urinary retention

Question 14

Test of choice to exclude urinary tract obstruction

Answer 14

Renal US

• first step in pt with renal failure due to unknown
• can ID abscesses, renal cysts PCKD and masses, diverticuli, stones

Question 15

Doppler US vs Renal US

Answer 15

Doppler checks flow
consult regarding which one to order
US - doesn’t require CONTRAST
less selective than CT in inital detection of renal mass

Question 16

What is the dx test of choice for nephrolithiasis (kid stones)

Answer 16

NON-CONTAST CT - can detect radioluscent stones not see on KUB

Question 17

CTA CT angiography

Answer 17

used to ID vascular problems

Question 18

CT provides

Answer 18

more detail than US

helps distinguish between benign and malignant: eval and stage renal CA

Question 19

When to do MRI

Answer 19

when can’t do CT becuase of contrast in kid failure (if GFR <30)

Question 20

MRI CI

Answer 20

Gadoliunium may increase risk for nephrogenic systemic fibrosis in pts with chronic or acute renal failure

Question 21

Intravenous Pyelogram IVP

Answer 21

Not used anymore
eval size and shape of kid, ureters, and bladde
kid stones (high sens and spec)
obstruction
requires contrast dye and not used as frequently.

Question 22

REnal angio and renal biopsy

Answer 22

US guided biopsy

Question 23

CystoUrethrogram

Answer 23

bladder filled with contrast
xrays taken to see contrast in bladde - can take while voiding.
Primary bladder conditions seen better than in IVP intravenous pyelogram
used to detect VESICOURETERAL REFLUX: reflux back in ureter
perforations, fistula, tumor related distortion

Question 24

what is used to id VESICOURETERAL REFLUX

Answer 24

CystoUrethgram

Question 25

Cystoscopy is used to assess bladder and ureteral CA

Answer 25

incontinence, to Dx interstitial cystitis, bladder turmors, stones, scarring

Question 26

if find mass on DRE, do which test

Answer 26

TRUS trans rectal US and biopsy