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Clinical Medicine II > Renal Dx > Flashcards

Renal Dx Flashcards

1
Q

What is an upper UTI called

A

acute pyelonephritis

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2
Q

What is a lower UTI called

A

acute cystitis

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3
Q

Where serum creatinine come from (and it’s RR) and what is it used for clinically

A

rr: (0.5-1.2)
Derived from metabolism of creatine in skeletal m and dietary meat intake
Used clinically to measure renal function

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4
Q

What is creatinine used to measure renal function

A
  1. released into circulation at constant rate and stable plasma concentration
  2. freely filtered across glomerulus and excreted by kidney
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5
Q

What is BUN, when is it increased and how is it excreted?

A
  • product of protein catabolsim
  • excreted by kidneys
  • Increased in dehydration, GI bleed or steroid or tetracycline use
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6
Q

What is BUN/Cr ratio used for

A

marker of volume status

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7
Q

GFR is equal to what and used to measure what?

A

GFR = sum of the filtration rates in all the functioning nephrons

  • gives estimation of # functioning nephrons/ level of kidney function
  • used to track kidney dz and dose meds
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8
Q

What is GFR dependent on?

A

sex, race, body size

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9
Q

Can you measure GFR directly? If not, what do we use?

A

No.. use MDRD and Cockcroft-Gault equ

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10
Q

GFR equation and normal values

A

GFR = UV/P
women: 120 mL/min
Men: 130 mL/min

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11
Q

Describe stage 1 kidney dz and GFR level

A

Kidney damage with normal or increased GFR

>90

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12
Q

Describe stage 2 kidney dz and GFR level

A

kidney damage with normal or decreased GFR 60-89

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13
Q

Describe stage 3 kidney dz and GFR level

A

Moderate decrease GFR 30-59

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14
Q

Describe stage 4 kidney dz and GFR level

A

severe decrease GFR 15-29

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15
Q

Decribe stage 5 kidney dz and GFR level

A

kidney failure; GFR <15 or dialysis

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16
Q

Uses for Ccr and how measured

A

creatinine clearance measured via 24 hr collection of Cockcroft Gault formula
*used to approximate GFR, helps in med dose

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17
Q

What is ANA lab test for

A

suspect glomerular dz related to SLE

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18
Q

what is ANCA lab test for

A

if you suspect Wegeners granulomatosis (if bleeding/hematuria)

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19
Q

what is the anti-glomerular basement membane antibody test used for?

A

if you suspect Goodpastures syndrome

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20
Q

What is the Hep B and C serology used for

A

If pt has membranous nephropathy

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21
Q

What is the antistreptolysin O test used for?

A

If you suspect post streptococcal glomerulonephritis

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22
Q

What is RF, complement levels or serum immunoelectrophoresis (SPEP) used for

A

*just says they might be helpful, but if I remember…

Rf - autoimmune?, SPEP: characterize protein ie for Multiple Myeloma “M spike”

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23
Q

What is the Prostate Specific antigen test and what range should it be

A

4 ng/mL

  • glycoprotein found in high concentrations in prostatic lumen
  • used as screening method for early detection of prostate cancer and to monitor dz after tx
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24
Q

When are PSA levels increase (>4ng/mL) in males

A

Prostate cancer, BPH, Prostatitis, following prostate manipulation (DRE, US, biopsy)

25
Protein in urine is what
one of the first signs of kidney dz; glomerulus isn't filtering protein properly
26
What do RBC casts in microscopic UA indicate
Glomerulonephritis***, vaculitis
27
What do WBC casts in microscopic UA indicate
Tubulointerstitial dz, *acute pyelonephritis, glomerular disorders
28
What do epithelial cell casts in microscopic UA indicate
Acute tubular necrosis (renal azotemia), glomerulonephritis
29
What can crystals in microscopic UA indicate?
uric acid, calcium phosphate or calcium oxalate, cystine, Mg ammonium phos (struvite)
30
What organism is the most common cause of UTI
E coli
31
What is Urine culture and sensitivity used for
identifies causative organism and sensitive and resistant antibiotics
32
Microalbumin is indication of
earliest clinically detectable stage of diabetic nephropathy
33
Urine eosinophils are most commonly seen in who? others?
Most common: acute interstitial nephritis others: transplant rejection, pyelonephritis, prostatitis, cystitis, atheroembolic dz, progressive glomerulonephritis
34
When would you use a UPEP (urine immunoelectrophoresis)
if you suspect MM, see bence jones protein
35
Nephrotic vs nephritic syndrome
``` nephrotic = >3 g protein Nephritis = <3 g protein ```
36
24 hr collection of urine is good bc
provides better quantitative measurement for proteinuria or GFR determination
37
what position would you take an abdominal xray in (KUB or ab plain film)
supine and upright * abdominal usually gets both views (bc worry about air fluid levels in bowel), KUB mostly just supine) * used as initial diagnostic tool
38
What can you find using KUB
* Calcification in urinary tract (calcium containing, struvite and cystine stones) *will miss radiolucent/uric acid stones or stones overlying bone * Protstatic calculi, bladder distention, calcified arteries, bowel gas pattern, calcification in biliary tract, free air
39
What is nephrolithiasis and what do you see on KUB
* staghorn = stones involving renal pelvis and extending into 2+ calyces * Bilateral radiopaque branched staghorn caculi fillin collecting systems
40
Renal US is appropriate initial test in who, and test of choice for what
appropriate initial test in pt with renal failure of unknown etiology *TOC to exclude urinary tract obstruction
41
What can Renal US identify
obstruction, nephrolithiasis, severity and length of ureteral strictures, renal cysts (PCKD) and masses, hydronephrosis, renal or perinephric abscesses, atrophic kidneys, ureteral diverticuli *note: best for cysts or hydronephrosis
42
Doppler US evaluates what and is used for
eval vascular flow | ID: renal v. thrombosis, renal infarction, renal a. stenosis, intrarenal vascular dz, arteriosclerosis
43
Benefits/limitations of US
Benefits: non invasive, no contrast Limits: less sensitive than CT in detecting renal mass
44
How would pyelonephritis (upper UTI) manifest on US
hypodense mass with internal echos
45
What is the dx test of choice for nephrolithiasis
Non contrast CT (can detect radiolucent stones not seen on KUB) *contrast can be potentially nephrotoxic
46
Why is CT scan good
more detail than US | Helps distinguish bw benign and malignant cysts (eval and stage renal cell carcinoma)
47
What color are kidneys on abdominal CT due to contrast
white *contrast can be nephrotoxic
48
what will bilateral pyelonephritis look like on abdominal CT
triangular hypodense streaks spreading from pelvis to renal cortex
49
contraindication for MRI/A
gadolinium contrast may increase risk for nephrogenic systematic fibrosis in pt with chronic renal failures GFR<30 or acute renal failure of any severity
50
What is an Intravenous Pyelogram (IVP) used for
to eval size/shape of KUB, eval kidney stones (highly sensitive and specific), and eval obstruction
51
How is an IVP performed
contrast dye injected, Xrays taken, excretory function of kidney measured by length of time for passage - can see obstructions
52
why isn't IVP used frequently as a dx test
requires contrast dye (allergy and or increased Cr)
53
Acute onset of hematuria is...
cancer till proven otherwise (usu bladder)
54
what should you order if acute onset hematuria
IVP, cystoscopy, cytology
55
Is renal angiography used freq
not bc other dx test available but still used for preoperative mapping of renal vasculature if needed
56
What is the classic sign on a renal angiography test for Fibromuscular dysplasia *BOARD QUESTION
Classic "string of pearls" appearance on angiography
57
Renal biopsy can be performed how
US guided or surgical *used to obtain renal sample to help dx: nephrotic syndrome, acute nephritic syndrome, unexplained acute renal failure, renal mass, assessment for transplant rejection
58
How is a cystourethrogram performed
bladder filled with contrast, xrays taken to visualize contrast in bladder (can be taken while pt voiding); *note: primary bladder conditions are better seen with cystourethrogram than IVP
59
what is a cystourethrogram used to detect
Vesicoureteral reflux (bladder not emptying completely), distortion of bladder (due to tumor), fistula, perforation

Clinical Medicine II (8 decks)

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