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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
Q

Protein in urine is what

A

one of the first signs of kidney dz; glomerulus isn’t filtering protein properly

26
Q

What do RBC casts in microscopic UA indicate

A

Glomerulonephritis***, vaculitis

27
Q

What do WBC casts in microscopic UA indicate

A

Tubulointerstitial dz, *acute pyelonephritis, glomerular disorders

28
Q

What do epithelial cell casts in microscopic UA indicate

A

Acute tubular necrosis (renal azotemia), glomerulonephritis

29
Q

What can crystals in microscopic UA indicate?

A

uric acid, calcium phosphate or calcium oxalate, cystine, Mg ammonium phos (struvite)

30
Q

What organism is the most common cause of UTI

A

E coli

31
Q

What is Urine culture and sensitivity used for

A

identifies causative organism and sensitive and resistant antibiotics

32
Q

Microalbumin is indication of

A

earliest clinically detectable stage of diabetic nephropathy

33
Q

Urine eosinophils are most commonly seen in who? others?

A

Most common: acute interstitial nephritis

others: transplant rejection, pyelonephritis, prostatitis, cystitis, atheroembolic dz, progressive glomerulonephritis

34
Q

When would you use a UPEP (urine immunoelectrophoresis)

A

if you suspect MM, see bence jones protein

35
Q

Nephrotic vs nephritic syndrome

A 
nephrotic = >3 g protein
Nephritis = <3 g protein
36
Q

24 hr collection of urine is good bc

A

provides better quantitative measurement for proteinuria or GFR determination

37
Q

what position would you take an abdominal xray in (KUB or ab plain film)

A

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
Q

What can you find using KUB

A
  • 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
Q

What is nephrolithiasis and what do you see on KUB

A
  • staghorn = stones involving renal pelvis and extending into 2+ calyces
  • Bilateral radiopaque branched staghorn caculi fillin collecting systems
40
Q

Renal US is appropriate initial test in who, and test of choice for what

A

appropriate initial test in pt with renal failure of unknown etiology
*TOC to exclude urinary tract obstruction

41
Q

What can Renal US identify

A

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
Q

Doppler US evaluates what and is used for

A

eval vascular flow

ID: renal v. thrombosis, renal infarction, renal a. stenosis, intrarenal vascular dz, arteriosclerosis

43
Q

Benefits/limitations of US

A

Benefits: non invasive, no contrast
Limits: less sensitive than CT in detecting renal mass

44
Q

How would pyelonephritis (upper UTI) manifest on US

A

hypodense mass with internal echos

45
Q

What is the dx test of choice for nephrolithiasis

A

Non contrast CT (can detect radiolucent stones not seen on KUB)
*contrast can be potentially nephrotoxic

46
Q

Why is CT scan good

A

more detail than US

Helps distinguish bw benign and malignant cysts (eval and stage renal cell carcinoma)

47
Q

What color are kidneys on abdominal CT due to contrast

A

white

*contrast can be nephrotoxic

48
Q

what will bilateral pyelonephritis look like on abdominal CT

A

triangular hypodense streaks spreading from pelvis to renal cortex

49
Q

contraindication for MRI/A

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
Q

What is an Intravenous Pyelogram (IVP) used for

A

to eval size/shape of KUB, eval kidney stones (highly sensitive and specific), and eval obstruction

51
Q

How is an IVP performed

A

contrast dye injected, Xrays taken, excretory function of kidney measured by length of time for passage
- can see obstructions

52
Q

why isn’t IVP used frequently as a dx test

A

requires contrast dye (allergy and or increased Cr)

53
Q

Acute onset of hematuria is…

A

cancer till proven otherwise (usu bladder)

54
Q

what should you order if acute onset hematuria

A

IVP, cystoscopy, cytology

55
Q

Is renal angiography used freq

A

not bc other dx test available but still used for preoperative mapping of renal vasculature if needed

56
Q

What is the classic sign on a renal angiography test for Fibromuscular dysplasia *BOARD QUESTION

A

Classic “string of pearls” appearance on angiography

57
Q

Renal biopsy can be performed how

A

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
Q

How is a cystourethrogram performed

A

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
Q

what is a cystourethrogram used to detect

A

Vesicoureteral reflux (bladder not emptying completely), distortion of bladder (due to tumor), fistula, perforation

Clinical Medicine II (8 decks)

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