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renal diseases Flashcards

1
Q

What is acute renal failure?

A

Syndrome of rapidly deteriorating GFR with accumulation of nitrogenous wastes(urea, creatinine).

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2
Q

What is azotemia?

A

accumulation of nitrogenous wastes(urea, creatinine)

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3
Q

What happens to serum creatinine with ARF?

A

acutely increases by more than 0.5 mg/dL or more than 50% over baseline levels

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4
Q

GFR and UO criteria for “risk of renal dysfunction”

A

GFR: increased serum Cr 1.5 fold or GFR decreases more than 25% UO: UO less than 0.5 mL/kg/hr for 6 hours

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5
Q

GFR and UO criteria for “injury to kidney”

A

GFR: increased serum Cr 2 fold or GFR decrease more than 50%

UO less then 0.5ml/kg/hr for 12 hours

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6
Q

2 diseases that account for the majority of cases of ARF

A

reduced renal perfusion and acute tubular necrosis

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7
Q

3 possible signs of post renal causes

A

distended bladder, CVA tenderness, enlarged prostate

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8
Q

key parameter to measure renal function

A

GFR

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9
Q

what is an estimate of renal function, but sensitive to dehydration, catabolism, diet, renal perfusion, and liver disease

A

BUN

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10
Q

UA shows a few hyaline casts, but essentially normal

A

prerenal or postrenal causes of ARF

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11
Q

metallic taste, hiccups, N/V, fatigue, malaise, anorexia, dyspnea, orthopnea, impaired mentation, insomnia, irritability, mm cramps, RLS, weakness, pruritis, easy bruising, altered consciousness, delirium, seizures, coma, “pericarditis”

A

think uremia symptoms

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12
Q

what is the marker for kidney damage

A

proteinuria

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13
Q

what med can slow down the progression of renal dysfunction

A

ACE And ARBS

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14
Q

what drugs are renoprotective

A

ACE, reduce urinary protein loss

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15
Q

Minimal change disease tx

A

Lipoid nephrosis, do steroids

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16
Q

wegeners granulonatosis dx

A

it is a vasculitide, dx is ANCA

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17
Q

goodpastures syndrome

A

affects basement membrane of kidneys and lungs; has hematuria and hemoptysis

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18
Q

main cause of prerenal ARF

A

inadequate perfusion!

decreased blood flow to kidney

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19
Q

main cause of postrenal ARF

A

obstruction

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20
Q

eosinophils in urine

A

malignant HBP

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21
Q

what is increased in ARF

A

BUN/Cr, K++, phosphate, Mg

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22
Q

what is decreased in ARF

A

pH, bicarb(metabolic acidosis)

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23
Q

BUN/Cr ratio >20/1, urine osmolalitiy high, FENa low

A

prerenal ARF

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24
Q

common causes of CRF

A

DM mainly, PKD, HTN, glomerulonephritis

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25
Q

what is increased in CRF

A

BUN, Cr, K++, phosphate, Mg

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26
Q

what is decreased in CRF

A

pH, bicarb, Ca(vit D made by kidney), Hct(no erythropoietin)

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27
Q

PTH controlled by what

A

calcium level

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28
Q

what is azotemia

A

accumulation of nitrogenous wastes(urea, Cr both increased)

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29
Q

kidney smaller than 10cm on renal ultrasonography

A

chronic problem

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30
Q

Urine Na, FE Na, urine osmolality, Bun to plasma ratio in prerenal

A

Na low, FE Na <1%, osmolality 500, Bun to Cr ratio is 20:1

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31
Q

Urine Na, FE Na, urine osmolality, Bun to plasma ratio in an intrinsic cause

A

Na high, FE Na > 1-2%, osmolality 250-300, Bun to plasma ration <15:1

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32
Q

criteria for dx ESRD or ESKD

A

complete loss of kidney function for more than 3 months

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33
Q

ARF account for what percentage of hosptalized patients and critical care patients

what is the overall mortality rate

A

5%

30%

10-50% depending on pt comorbidities and clinical setting

34
Q

name 5 contributing factors to ARF

A

HTN, HypoTN, volume loss, CHF, DM

35
Q

ARF symptoms

A

general symptoms: N/V, diarrhea, pruritis, drowsiness, dizziness, hiccups, SOB, anorexia, hematochezia

36
Q

Signs of prerenal causes of ARF

A

tachycardia and hypoTN

37
Q

Serum Cystatin C

sensitivity & specificity

A

new serum biomarker for detecting AKI.

87% to 97& sensitive

85% to 100% specific

38
Q

HTN, HypoTN, volume loss, CHF, DM

A

name 5 contributing factors to ARF

39
Q

general symptoms: N/V, diarrhea, pruritis, drowsiness, dizziness, hiccups, SOB, anorexia, hematochezia

A

ARF symptoms

40
Q

tachycardia and hypoTN

A

Signs of prerenal causes of ARF

41
Q

a distended bladder, CVA tenderness, or enlarged prostate

A

Signs of postrenal causes of ARF

42
Q

What is helpful for monitoring renal insufficiency and provide clues to cause

A

BUN and Cr

43
Q

Urea

A

reabsorbed in the nephron during stasis, which causes false elevations of BUN and therefore not a reliable indicator of renal function

44
Q

Granular casts, WBC & casts, RBC & casts, proteinuria, tubular epithelial cells

45
Q

reabsorbed in the nephron during stasis, which causes false elevations of BUN and therefore not a reliable indicator of renal function

46
Q

ARF UA

A

Granular casts, WBC & casts, RBC & casts, proteinuria, tubular epithelial cells

47
Q

2 urine biomarkers for detecting AKI

A

interleukin-18(IL-18) and kidney injury molecule(KIM-1)

48
Q

Percentages of prerenal, intrinsic renal, and post renal causes

A

60-70% prerenal

25-40% intrinsic renal

5-10% post renal

49
Q

5 causes of prerenal causes of ARF

A

hypovolemia

hypoTN

ineffective circulating volume

aortic aneurysm

renal artery stenosis or embolic disease

50
Q

examples of ineffective circulating volume

A

CHF, cirrhosis, nephrotic syndrome, early sepsis

51
Q

5 causes of intrinsic renal ARF

A

ATN

nephrotoxins

interstitial disease(SLE, infection, acute interstitial nephritis)

glomerulonephritis

vascular diseases(polyarteritis nodosa, vasculitis)

52
Q

nephrotoxins

A

NSAIDs, aminoglycosides, radiologic contrast, metformin

53
Q

2 postrenal causes of ARF

A

*the kidney is having the problem

tubular obstruction

obstructive uropathy(urolithiasis, BPH, bladder outlet obstruction)

54
Q

prerenal vs intrinsic renal

1) urine Na
2) Fractional excretion of Na
3) urine osmolality
4) BUN to plasma Cr ratio
5) urine specific gravity

A
  • a)prerenal vs b)intrinsic renal
  • 1) urine Na
  • a) less than 20mEq/L
  • b) increased greater then 40
  • 2) Fractional excretion of Na
  • a) less than 1%
  • b) greater than 1-2%
  • 3) urine osmolality
  • a) greater than 500mOsm/kg
  • b) 300-500
  • 4) BUN to plasma Cr ratio
  • a) elevated 20:1
  • b) decreased (< 15:1)
  • 5) urine specific gravity
  • a) greater than 1.020
  • b) 1.010 to 1.020
55
Q

what if the presentation is unknown with respect to an acute episode vs a chronic problem

A

renal ultrasonography to measure renal size.

a kidney smaller than 10cm indicates a chronic problem.

56
Q

metabolic acidosis, hyperkalemia, azotemia, decreased Cr clearance, loss of renal function

A

other abnormal findings in ARF

57
Q

treatment of prerenal states of ARF

A

achievement of normal hemodynamics: IV fluids, improving cardiac output

58
Q

treatment of intrarenal states of ARF

A

adjustment and avoidance of medications and nephrotoxic agents

59
Q

treatment of postrenal states of ARF

A

relief of urinary tract obstructions

60
Q

when to do short term dialysis

A

AEIOU-Cr

acidosis

electrolyte abnormalities

ingestions

overload(fluid)

uremic symptoms

when serum Cr exceeds 5-10 mg/dL.

61
Q

CKD criteria

A

GFR less than 60mL/min/1.73 m2 or presence of kidney damage(proteinuria, glomerulonephritis, or structural damage from PCOS) for > or equal 3 months.

62
Q

GFR in 5 stages of CKD

A

1) greater than 90 and persistant albuminuria
2) 60-89
3) 30-59
4) 15-29
5) less than 15

63
Q

symptoms of stage 1 and 2 of CKD

A

generally asymptomatic without an increase in BUN or serum Cr

64
Q

symptoms of stage 3 of CKD

A

remain asymptomatic however serum Cr and BUN increase. other hormones become abnormal(PTH, erythropoietin, calcitrol)

65
Q

symptoms of stage 4 of CKD

A

symptomatic with anemia, acidosis, hyperkalemia, hypocalcemia, hyperphosphatemia

66
Q

What stage is a pt a candidate for kidney replacement therapy

67
Q

ACE and ARBS

A

slow the progression of renal disease, particularly in proteinuric pts

68
Q

survival rate of CRF

69
Q

when does uremic symptoms develop in CRF

70
Q

cachexia(wasting away), wt loss, mm wasting, pallor, HTN, ecchymosis, sensory deficits, asterixis(tremor), kussmaul respirations

A

signs of CKD

71
Q

CKD

1) gold standard
2) marker for kidney damage
3) what appears early in the disease

A

1) GFR
2) proteinuria
3) microalbuminuria

72
Q

CKD treatment

BP, HbA1c, LDL, HDL, Tg

A

BP under 130/80

HbA1c 6.5-7.5%

LDL under 100

HDL over 50

Tg under 150

wt control and smoking cessation

73
Q

what to give in CKD to maintain hemoglobin 11-12

what if it is over 12-13

A

erythropoietin, iron supplements, antiplatelet therapy.

increased risk of stroke

74
Q

dietary management of CKD

A

restriction of protein, adequate caloric intake, calcium and vitamin D supplements, limitation of water/Na/K++/phosphorus

75
Q

what vaccine is recommended for CKD

A

pneumococcal

76
Q

broad, waxy casts

A

microscopic urine examination for CKD

77
Q

hypocalcemia, hyperphosphatemia, secondary hyperparathyroidism

78
Q

tx for abnormal bleeding in CKD

A

desmopressin (DDAVP)

79
Q

oral phosphate binders

A

calcium acetate, calcium carbonate, sevelamer, lanthanum,

80
Q

what to give for renal osteodystrophy

A

oral phosphate binders and calcitriol

81
Q

hydronephrosis

1) causes
2) acute sx
3) gradual sx

A

1) abnormal anatomy or obstruction
2) severe pain
3) N/V, UTI

82
Q

hydronephrosis

1) tests
2) tx

A

1) renal u/s during prenatal testing, urine culture, u/s, CT/MRI
2) remove obstruction or ureteric stents

nephrology & urology (7 decks)

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