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NURS 503 > Renal disorders > Flashcards

Renal disorders Flashcards

1
Q

What is the most common symptom of bladder cancer?

A

Hematuria

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2
Q

What is the definition of proteinuria?

A

Urinary protein excretion of >150 mg/day (10-20 mg/dL)

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3
Q

What is the hallmark of renal disease?

A

Proteinuria

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4
Q

What is microalbuminuria?

A

Excretion of 30-150 mg/day of protein

  • A sign of early renal disease (especially in patients with DM)
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5
Q

True/false: Proteinuria clinical presentations may vary from patient to patient due to exercise (causing excretion of albumin) to an advanced diabetic with nephrotic syndrome

A

True

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6
Q

Proteinuria physical exam components

A
  • Complete personal and family history (especially renal and DM)
  • Assess: chronic illness, surgery, diagnostic procedures (especially those requiring contrast media), urinary frequency or symptoms suggesting infection, risk factors, HIV infection
  • Medications → prescription and OTC
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7
Q

Proteinuria diagnostic studies

A
  • Urine dipstick
  • UA and culture
  • 24 hour urinary protein excretion or spot urinary protein/creatinine ratio
  • Microscopic exam of urinary sediment, urinary protein electrophoresis, assess renal function
  • CBC w/ diff, Bence Jones proteins, FBG, A1c, lipid profile
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8
Q

When collecting a 24 hour urinary protein excretion or spot urinary protein/creatinine ratio, what value is considered nephrotic syndrome?

A

Excretion rate of 3.5 g/day or more

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9
Q

Proteinuria management

A
  • Treat the underlying disease
  • Eliminate known trigger medications
  • ACE inhibitors and ARBs
  • Sodium and protein restricted diets
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10
Q

How do ACE inhibitors and ARBs reduce proteinuria?

A

Inhibit the RAAS which reduces proteinuria by decreasing systemic arterial pressure and intraglomerular filtration rate

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11
Q

What is nephrotic syndrome?

A

Kidney disorder that causes your body to pass too much protein in the urine

Symptoms:

  • Proteinuria
  • Hypoalbuminemia
  • Edema
  • Hyperlipidemia
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12
Q

What is the definition of hematuria?

A

3+ RBCs per hpf

  • Can be transient (exercise induced) or persistent (suggesting serious illness)
  • May be a result of an acute infection (UTI) or complex disease (diabetic nephropathy, glomerular, or interstitial cystitis)
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13
Q

What are the two types of hematuria?

A
  • Microscopic hematuria
  • Gross hematuria
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14
Q

What is Goodpasture syndrome?

A

Autoimmune disordered characterized by a group of acute illness that affect the lungs and kidneys (hemoptysis and hematuria)

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15
Q

Hematuria clinical presentation

A
  • Often accompanied by clinically significant symptoms or by abnormalities in the urinalysis that can aid in identifying the source of bleeding
  • Consider age, gender, level of physical activity
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16
Q

Symptoms suggestive of Goodpasture syndrome

A
  • Hemoptysis
  • Acute renal failure
  • Hematuria
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17
Q

Hematuria physical exam components

A
  • Obtain thorough personal and familial history (especially renal and DM)
  • Pelvic exam
  • Prostate exam
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18
Q

Hematuria diagnostic studies

A
  • Obtain catheterized urine specimen if clean-catch cannot be obtained
  • Urine and urinary sediment analysis (may see RBC casts)
  • Intravenous urography (IVU)
  • Ultrasound
  • CT scan
  • Cystoscopy
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19
Q

Hematuria management

A
  • Identify and diagnosis of the problem
  • Urological referral
  • Surgery
  • Encourage smoking cessation
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20
Q

What is renal failure also referred to as?

A
  • End stage renal disease (ESRD)
  • Stage 5 chronic kidney disease (CKD)
  • AKI and CKD can progress to kidney failure or the absence of kidney function
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21
Q

What is the GFR in the early stages of renal failure?

A

>35 mL/min

22
Q

Hallmark clinical signs of renal failure

A
  • Decreased GFR
  • Increased serum creatinine and albuminuria
23
Q

What is the most common cause of kidney failure in the U.S.?

A
  • DM
  • HTN
24
Q

For patients who develop AKI, what are identifiable risk factors?

A
  • CKD
  • Advanced age
  • Liver disease
  • DM
  • Vascular disease
25
Q

What are the goals of physical examination for patients with kidney failure?

A
  • Identify primary diseases that contribute to kidney damage
  • Broader examination that evaluates the effects of kidney disease
  • Stage or categorize kidney damage
26
Q

Renal failure physical exam components

A
  • BP (including orthostatic)
  • Fundoscopic exam → arteriovenous nicking, diabetic retinopathy, papilledema
  • Cardiac → pericarditis, pleural effusion
  • Abdominal exam
  • Rectal exam in males
  • Skin assessment → ecchymosis, rashes, uremic frost
  • MSS
27
Q

What is the most important labs to obtain when assessing for renal failure?

A
  • Serum creatinine
  • Estimated GFR
  • First morning or random urine sample (albuminuria screening)
28
Q

What other diagnostic studies can be obtained when assessing for renal failure?

A
  • Serum nystatin C
  • Urinalysis
  • CMP
  • A1c
  • Lipid profile
  • CBC w/ diff
  • Renal ultrasound
29
Q

AKI management goals

A
  • Removal of offending toxin (e.g. contrast media, drugs)
  • Correct electrolyte imbalances (especially hyperkalemia)
30
Q

What medication can be given to patients with CKD for HTN management?

A

ACE inhibitors

31
Q

Indications for early nephrology consult based on CKD risk factors

A
  • AKI or abrupt sustained decrease in GFR
  • GFR <30 mL/min
  • Albuminuria >300 mg/g
  • Urine RBC >20/hpf
  • HTN refectory to treatment with 4+ agents
  • Persistent abnormalities to serum potassium or low serum albumin
  • Hereditary kidney disease
32
Q

Where in the urinary tract can stones form?

A
  • Kidneys
  • Urinary system
  • Ureters
  • Lower urinary tract (bladder, urethra)
33
Q

Renal stone risk factors/triggers

A
  • Genetics
  • Diet (e.g salt, oxalate, calcium)
  • Dehydration
  • High mineral content drinking water
  • Tea, grapefruit/apple juice, cola, sports/energy drinks
  • Sedentary lifestyle
  • Family history
  • Gout, primary hyperparathyroidism, short bowel syndrome, hyperinsulinism
34
Q

What are the five different types of stones?

A
  • Calcium oxalate
  • Calcium phosphate
  • Uric acid

Less common -

  • Struvite
  • Cystine
35
Q

Kidney stone clinical presentation

A
  • Acute renal or ureteral colic
  • N/V
  • Hematuria
  • Fever and chills
  • Dysuria
  • Increased urinary frequency
  • Vague abdominal, flank, or groin pain
36
Q

Foods high in calcium oxalate

A
  • Rhubarb
  • Nuts
  • Cocoa
  • Tea
  • Beans
  • Lime peel
  • Green leafy vegetables
37
Q

Kidney stone physical exam

A
  • Obtain detailed personal and family history, medical and medication history, occupation, dietary habits, fluid intake history
  • Abdominal exam → often soft, contender, non distended abdomen
38
Q

Kidney stone diagnostic studies

A
  • Urinalysis, urine culture and sensitivity, urine pH
  • Strain urine for stones/sediment
  • 24 hour urine collection
  • CBC (if fever), serum chemistry
  • Serum calcium and vitamin D
  • KUB, IVP ultrasound, CT scan
39
Q

Can kidney stones be managed conservatively?

A

Yes - oral hydration (>2 L/day), pain management, expectant stone passage

40
Q

How would the provider manage a kidney stone <8 mm?

A

Conservative management

  • Oral hydration
  • Pain relief
  • Expectant stone passage
41
Q

How would the provider management a kidney stone >8 mm?

A

Surgical management

  • Extracorporeal shock wave lithotripsy (ESWL)
  • Percutaneous nephrolithotomy (PCNL)
  • Ureteroscopy (URS)
  • Monitor/lifestyle adaptations, ongoing pH surveillance
42
Q

How can pH findings drive kidney stone management?

A

Urine pH >7 = urea (need to obtain urine culture to rule out UTI)

Urine pH <5.4 = uric acid lithiasis (metabolic acidosis)

43
Q

What are the four hallmarks of nephrotic syndrome?

A
  • Hypoalbuminemia
  • Hyperlipidemia
  • Edema
  • Excessive proteinuria
44
Q

Nephrotic syndrome clinical manifestations

A
  • Urine looks foamy
  • Edema → periorbital edema, dependent areas (tight shoes or underwear), lax tissues (puffy eyes)
    • If blood vessels of the kidney are damaged, and they leak proteins (e.g. albumin) there will be third spacing → fluid leaves the blood and enters the interstitial → edema
  • Low urine production
45
Q

True/false: Patients with nephrotic syndrome have a high risk of clotting

A

True - inability of glomeruli to filter blood properly can lead to loss of blood proteins

46
Q

What causes nephrotic syndrome?

A

Usually due to underlying cause (e.g. patients with DM more likely to develop nephrotic syndrome)

47
Q

Nephrotic syndrome treatment/management

A
  • Diuretics for edema
  • Statins, nutrition for hypoalbuminemia (will leak calcium and protein that binds vitamin D, so need to supplement with both)
  • In pediatrics, treated with steroids (if they respond well, they have a good prognosis) → Prednisone 2 mg/kg/day to induce remission for 4-6 weeks
48
Q

What is glomerulonephritis?

A
  • PSGN is immune response to group A beta-hemolytic strep or pharyngeal streptococcal infection (1-4 weeks post infection)
    • Most common form of nephritis
49
Q

Glomerulonephritis clinical manifestations

A
  • Periorbital and pedal edema
  • Elevated BP
  • UA shows RBCs, protein, and RBC casts
  • Cola/tea colored urine
50
Q

Glomerulonephritis treatment/management

A

No specific treatment

  • Antihypertensives, calcium supplementation, diuretics, low sodium diet
  • Will have gross hematuria for 1-2 weeks and urine can be abnormal for 6-12 weeks, but will resolve

NURS 503 (10 decks)

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