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Q3 Clin Med II Test 3 (GU) > Renal Failure > Flashcards

Renal Failure Flashcards

1
Q

Assessment of Renal Disease must include?

A

Cause and Severity

UA
GFR
Pre/Post renal or intrinsic
Acute (hrs/days)/Chronic (months/yrs)

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2
Q

Renal Dz UA:

Blood/RBC Casts/Mild Protein?

High Protein/Lipids?

WBC/WBC Casts/Mild Protein?

WBC Casts?

Pyuria?

A

Blood/RBC Casts/Mild Protein = (P) glomerulonephritis

High Protein/Lipids = (P) nephrotic synd

WBC/WBC Casts/Mild Protein = (P) interstitial nephritis

WBC Casts = (P) pyelonephritis

Pyuria = (P) UTI

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3
Q

Proteinuria caused by?

A

1) Fxnl, benign result of illness/exercise
2) Overprdxn of plasma proteins (i.e. Bence Jones in MM)
3) Abnormal glomerular basement memb (U high albumin spike)
4) Proximal Tubule damage (drugs, metabolic disord)

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4
Q

Proteinuria best test?

A

24 hr collection

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5
Q

Cr clearance eqn?

A

Ccr = (140 - age) x weight kg / Pcr x 72

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6
Q

Cr clearance elevated by?

A 
ketoacidosis
drugs (asprin, tagamet, bactrim)
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7
Q

Cr clearance decreased by?

A

old age
wasting from dz
liver dz

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8
Q

BUN/Cr ratio should be?

A

10-15:1

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9
Q

BUN/Cr increased by?

A

dehydration, GI bleed, steroids, CHF

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10
Q

BUN.Cr decreased by?

A

liver dz

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11
Q

Renal US used for?

A

hydronephritis
polycystic kidney dz
kidney size
postvoid residule

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12
Q

Renal IVP (intravenous pyelogram) used for?

Contraindicated?

A

contrast xray of entire urinary tract

DM w/ high Cr
Chronic renal fail
Mult Myeloma

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13
Q

Renal CT used for?

A

neoplasms

retroperitoneal space

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14
Q

Renal MRI used for?

A

loss of corticomedullary fxn

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15
Q

Renal arterio/venography used for?

A

stenotic lesions
aneurysms
renal vein thromb

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16
Q

Renal bx used when?

A

unexplained acute renal failure,
proteinuria,
lesions

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17
Q

Acute Renal Failure presentation?

A 
SUDDEN ↑ BUN or serum Cr
Oliguria
N/V, malaise
Altered sensory
Pericard effus/Heart friction rub
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18
Q

Acute Renal Failure labs findings?

A

hyperK+
Tall T
Anemia (from ↓ erythrop)

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19
Q

Most common cause of Acute Renal Fail?

A

Prerenal Azotemia from renal HYPOperfusion

leads to ischemia -> intrinsic renal fail

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20
Q

↓ Renal Perfusion caused by?

A

↓ intravascular volume (GI loss/pancreatitis/Burns)

Δ in vascular resistance (sepsis, ACE, NSAID, Epi)

↓ CO (CHF, PE, arrhy)

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21
Q

Prerenal Azotemia assessment must involve?

A

Volume status
Drugs
Cardiac fxn

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22
Q

Prerenal Azotemia lab results?

A

UA = vol depletion, tubular casts
BUN/Cr = high
Urine Na+ = low if vol depl, high if acute tub necrosis

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23
Q

Postrenal Azotemia caused by?

A

urinary flow obstruction
(BPH, antichol meds, stones, etc)
*Reversible

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24
Q

Postrenal Azotemia presentation?

A

low abd pain

distended bladder

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25
Q

Postrenal Azotemia lab results?

A

Urine Osmo = high
Urine Na+ = low
BUN/Cr = high

26
Q

Postrenal Azotemia imaging?

A

US or catheterization

If results are normal, do CT or MRI

27
Q

Intrinsic Renal Failure from Acute Tubular Necrosis caused by?

A

EXOGENOUS CAUSES

Ischemia:
from hypoTN, hypoxemia, dehyd, shock/sepsis

Toxins:
aminoglycosides
radiograph contrast
cyclosporine (transplant med)

28
Q

Acute Tubular Necrosis lab results?

A

UA = brown urine, pigmented granular casts

(P) hyperK+, hyperPO4

29
Q

Acute Tubular Necrosis tx?

A

Mitigate vol overload/hyperK+:
loop, ↓ diet protein

Dialysis if:
extreme e- imbal,
tx not working

30
Q

Interstitial Nephritis (U) caused by?

A

Drugs:
PCN, cephalo, sulfa, NSAIDs

Infection:
strep, CMV, histoplasmosis

31
Q

Interstitial Nephritis signs/sxs?

A

fever, rash, arthralgia

32
Q

Interstitial Nephritis lab results?

A

Eosinophilia
UA = RBC, WBC, WBC Casts
Proteinuria if NSAIDs

33
Q

Interstitial Nephritis tx?

A

stop cause

short/high dose prednisone

34
Q

Glomerulonephritis (U) caused by?

A

Immune complexes (post infection, lupus,etc)
Malignant HTN
Hemolytic-uremic Synd

35
Q

Glomerulonephritis signs?

A

HTN

Periorbital/Scrotal edema

36
Q

Glomerulonephritis lab results?

A

Hematuria
Proteinuria
Red Cell Casts

37
Q

Glomerulonephritis tx?

A

high dose steroids

38
Q

Post-Infectious Glomerulonephritis from?

A

group A beta-hemolytic strep

39
Q

Post-Infectious Glomerulonephritis lab results?

A

ASO titer = high

Urine = cola colored

40
Q

Post-Infectious Glomerulonephritis tx?

A

not necessary

41
Q

Glomerulonephritis caused by IgA Nephropathy test?

A

biopsy

42
Q

Membranous Nephropathy caused by?

Signs?

Tx?

A

Immune disorder (SLE, hep B)

neoplasms of lung, stomach, colon

prednisone
transplant

43
Q

Chronic Renal Disease (U) caused by?

A

DM

HTN

44
Q

Chronic Renal Disease presentation?

A

multi-system sxs
uremic fetor (fish breath)
progressive

45
Q

Chronic Renal Disease lab results?

A

BUN/Cr = high

46
Q

Chronic Renal Disease imaging?

A

US = bilat small kidneys (diagnostic)

47
Q

Chronic Renal Disease complications?

A

hyperK+
metabolic acidosis
HTN
CHF

48
Q

Chronic Renal Disease tx?

A

protein/Na+/K+/H2O restriction

dialysis

49
Q

Nephrotic Syndrome is?

A

Urine protein > 3.5 gm/24 hr,
Albumin < 3,
peripheral edema (U Na+ retention)

50
Q

Nephrotic Syndrome caused by?

A

DM
Amyloidosis
SLE

51
Q

Nephrotic Syndrome tx?

A

protein restriction
Na+ restriction and diuretic

If albumin < 2gm, anticoag

52
Q

Diabetic Nephropathy is most C cause of what?

A

end-stage renal dz

53
Q

Always check DM pts for what?

A

microalbuminuria

54
Q

Diabetic Nephropathy tx?

A

glycemic control and HTN tx can slow progression

ACE

55
Q

Tubulointerstitial Disease caused by?

A

Acute:
toxins or ischemia

Chronic:
obstructive uropathy, 
vesicoureteral reflux (U kids), 
analgesics, 
heavy metals
56
Q

Acute Tubulointerstitial Disease tests?

A

UA = hematuria

US, CT

57
Q

Chronic Tubulointerstitial Disease from obstruction caused by?

A

prostatic dz
bilat ureteral calculi
CA of cervix, colon, bladder

58
Q

Chronic Tubulointerstitial Disease signs/sxs?

A

Polyuria (inability to [urine])
hyperK+ (aldost-resistant DCT)
hyperCl- acidosis (reduced NH4+ prdxn)

59
Q

Simple cysts in kidney are benign if?

A

on US or CT they are all three:

1) echo-free
2) sharp demarcation w/ smooth walls
3) enhanced back wall

60
Q

Polycystic Kidney Disease epidemiology?

A

strong family hx
1/2 a/w HTN
(P) Hx of UTI/stones
1/2 progress to end-stage by 60yo

61
Q

Polycystic Kidney Disease presentation?

A

abd/flank pain w/ hematuria

palpable kidney

62
Q

Polycystic Kidney Disease diagnostic?

A

US = multiple cysts

Q3 Clin Med II Test 3 (GU) (6 decks)

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