Renal goal 3 clinical presentation of medical renal disease

Question 1

creatinine level

Answer 1

surrogate to estimate GFR

Question 2

GFR relation to Ucr and Pcr

Answer 2

directly related to Ucr, inversely to Pcr

Question 3

no symptoms till GFR is

Answer 3

less than 15 ml/min

Question 4

azotemia

Answer 4

retention of nitrogenous waste such as urea

Question 5

azothemia next steps

Answer 5

urinalysis, ultrasound of abdomen
if hydronephrosis relieve obstruction, urologic evaluation
if not, small kidneys–>chronic, less than 3.5 g protein/24 hr= isosthenuria
normal–>acute

Question 6

acute renal failure next steps

Answer 6

normal urine analysis–>urine electrolytes
FeNa <1%; Uosm>500mOsm/L->prerenal azotemia
FeNa>1%; Uosm<350mOsm/L->Acute tubular necrosis

normal urine analysis–>
bacteria: pyelonephritis
WBC casts, eosinophils: Interstitial nephritis
rbc: renal artery/vein occlusion->angiogram
rbc casts, proteinuria: renal biopsy->glomerulonephritis or vasculitis
muddy brown casts: acute tubular necrosis

Question 7

prostaglandins

Answer 7

dilates aa
if nsaids inhibit pgdn, acute rf

Question 8

AT2

Answer 8

constricts ea
if ACEI inhibits AT2, acute rf
don’t admin ACEI to renal artery stenosis patient

Question 9

pre renal azotemia

Answer 9

decreased bl v (hemorrhage, burns, diarrhea, diuretics)
volume sequestration (pancreatitis, peritonitis, rhabdomyolysis)
dec. eff. arterial vol (shock, sepsis)
red. CO from periph vasodilation (sepsis, drugs)
red. CO from renal vasoconstrict (hf, NSaIDS, hepatorenal syn)

Question 10

intrinsic renal disease

Answer 10

ischemic atn (surgery, trauma, burns)
nephrotic atn
drug induced interstitial nephritis
occlusion of large renal arteries (thromoemboli, aortic dissection, vasculitis)
diseases of glomeruli (vasculitis)
diseases of renal microvasculature (hus, ttp, malignant htn)

Question 11

post renal azotemia

Answer 11

urinary tract obstruction (urethra or bladder outlet, bilateral ureteral)

Question 12

bun/cr ratio

Answer 12

normal is 15,
if resorption is high, bun/cr >15 (pre renal azotemia)
no resorption; bun/cr <15, renal azotemia
obstruction; bun/cr>15 postrenal azotemia

Question 13

oliguria

Answer 13

24 hr urine output<400ml

Question 14

anuria

Answer 14

24 hr urine output<100ml

Question 15

urine sodium

Answer 15

normal 25meq/L
prerenal disease: below 20
acute tubular necrosis: above 40
SIADH: normovolemic, na excretion in steady state is eq to intake, urine na conc is above 40

Question 16

FeNa

Answer 16

reabsorption of filtered sodium
prerenal disease <1%
atn >2% (resorption impaired)
FeNa(%): (UNaPcr)/(PnaUcr)*100

Question 17

what does dipstick measure

Answer 17

albumin, not protein
multiple myeloma can be missed on dipstick
more exact proteinuria should employ a spot morning albumin/creatinine ration or 24 hour urine collection
protein>150mg/24hr or >30mg/dL (dipstick)

functional: protein<2g/24hr
overflow: associated with mm, hemoglobinuria, myoglobinuria

Question 18

glomerular: nephritic syndrome

Answer 18

protein>150mg/24hr but <3.5g/24hr
example PSGN

Question 19

glomerular: nephrotic syn

Answer 19

protein >3.5g/24hr
loss of neg charge on GBM
example MCD

Question 20

proteinuria type : tubular

Answer 20

protein <2g/24hr
defect in Proximal tubule reabsorption
assoc with: heavy metal poisoning, falconi syndrome, hartnup disease (niacin def)

Question 21

hyaline casts

Answer 21

composed of THMP (Tamm-Horsfall mucoprotein/uromodulin)

Question 22

RBC casts

Answer 22

glomerulonephritis or vasculitis,
interparenchymal bleeding
dysmorphic rbc: glomerular bleeding
normal rbc: extraglomerular

Question 23

granular casts

Answer 23

nonspecific but pathologic- form in any proteinuric condition

Question 24

muddy brown granular casts

Answer 24

acute tubular injury
greater likelihood of dialysis requiring acute kidney injury

Question 25

wbc casts

Answer 25

acute pyelonephritis (infection of renal parenchyma) or tubulointerstitial disease such as acute tubulointerstitial nephritis

Question 26

waxy casts

Answer 26

severe chronic renal failure
malignant htn
renal amyloidosis
diabetic nephropathy
acute renal disease
tubular inflammation and degeneration
renal allograft rejection

Question 27

fatty casts

Answer 27

fatty degeneration of tubular epithelium as in degenerative tubular disease
nephrotic syndrome
diabetic glomerulosclerosis
chronic glomerulosclerosis
lupus nephritis

Question 28

hematuria

Answer 28

2-5 rbc per high power field
isolated: bleeding from urinary tract, stones, neoplasms, tuberculosis, trauma, and prostatis
hemoglobinuria/myoglobinuria (intravascular hemolysis or rhabdomyolysis): pink after centrifuge

Question 29

glomerular and extraglomerular bleeding

Answer 29

rbc casts: glomerular bleeding
rbc round and uniform: extraglomerular bleeding
origin in pelvis, ureter, bladder, prostate, urethra
blood clots in hematuria: extrarenal in origin

Question 30

calcium oxalate crystals

Answer 30

envelop/dumbbell shaped
precipitate in acidic urine
radiopaque

Question 31

magnesium ammonium phosphate crystals

Answer 31

coffin lid
precipitate in alkaline urine

Question 32

uric acid crystals

Answer 32

diamond/rhombic/rosette
precipitate in acidic urine
radiolucent

Question 33

cystine crystals

Answer 33

hexagonal
precipitate in acidic urine

Question 34

polyuria

Answer 34

more than 3 L a day
urine osmolarity measured
water deprivation test
response to desmopressin

Question 35

polyuria: osmotic diuresis

Answer 35

those that decrease sodium reabsorption in proximal nephron
for ex: uncontroled dm

Question 36

polyruria: water diuresis

Answer 36

decreased ADH in central dm
reduced renal response to ADH in nephrogenic dm
decreased adh due to increase in water intake: primary polydipsia

Question 37

acute or rapidly progressive renal failure

Answer 37

diagnostic clues: anuria, oliguria, recent decline in GFR
common findings: htn, hematuria, proteinuria, pyuria, casts, edema

Question 38

acute nephritis

Answer 38

diagnostic clues: hematuria, rbc casts, azotemia, reduced gfr, oliguria, edema, htn
common findings: proteinuria, pyuria, circ congestion

Question 39

chronic renal failure

Answer 39

diagnostic clues: azotemia >3 mos, uremia, casts, renal osteodystrophy, kidneys reduced in size bilaterally, broad casts in urinary sediment
common findings: proteinuria, casts, hypocalc, hyper phosphat, hyper PTH, polyuria, nocturia, edema, hypertension, hyperkalemia, metabolic acidosis

Question 40

nephrotic syndrome

Answer 40

proteinuria >3.5g/24hr
hypoalbuminemia
edema
hyperlipidemia
casts
lipiduria
hypercoagulable state

Question 41

asymptomatic urinary abnormalities

Answer 41

hematuria
proteinuria
sterile pyuria, casts

Question 42

urinary tract infection/pyelonephritis

Answer 42

bacteriuria
pyuria, leukocyte cast
frequency, urgency
bladder tenderness
flank tenderness
hematuria
mild azotemia and reduced GFR
mild proteinuria
fever

Question 43

renal tubular defects

Answer 43

electrolyte disorders
polyuria, nocturia
renal calcification
large kidneys
renal transport defects
hematuria
tubular proteinuria
enuresis
electrolyte issues

Question 44

hypertension

Answer 44

systolic/diastolic hypertension
proteinuria
casts
azotemia

Question 45

nephrolithiasis

Answer 45

previous history of stone passage or removal
previous stone seen by xray
renal colic
hematuria
Pyuria
frequency, urgency

Question 46

urinary tract obstruction

Answer 46

azotemia, oliguria, anuria
hematuria
polyuria, nocturia, urinary retention
pyria
slowing of urinary stream, enuresis, dysuria, large prostrate, large kidneys
flank tenderness, full bladder after voiding