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PCM > Renal/GU Complaint > Flashcards

Renal/GU Complaint Flashcards

1
Q

Chronic Kidney Disease (CKD)

A 
present for 3 months:
1. GFR <60ml/min/1.73m^2 
OR
2. Markers of Kidney Damage
-proteinuria
-abnormal urinary sediment (RBC or WBC cast)
-abnormal kidney biopsy
-abnormal renal imaging
-electrolyte abnormalities from tubular disorders
-hx of kidney transplantation
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2
Q

what if kidney disease symptoms have lasted less than 3 months?

A

considered acute kidney injury (AKI)

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3
Q

CKD Stage 1

A

> 90 GFR; normal or high

-if no evidence of kidney damage, stage 1 doesn’t fulfill criteria for CKD

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4
Q

CKD Stage 2

A

60-89 GFR; mild decrease

-if no evidence of kidney damage, stage 2 coesn’t fulfill criteria for CKD

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5
Q

CKD Stage 3a

A

45-59 GFR; mild to moderate decrease

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6
Q

CKD Stage 3b

A

30-44 GFR; moderate to severe decrease

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7
Q

CKD Stage 4

A

15-29 GFR; severe decrease

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8
Q

CKD Stage 5

A

<15 GFR; kidney failure/ESRD

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9
Q

Prognosis of CKD by GFR and albuminuria pattern

A

very high risk with severely increased albuminuria and kidney failure (extremely low GFR); low risk if normal albuminuria and normal or high GFR

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10
Q

Prevalence of CKD in US

A

15% of adults have CKD; 1 in 7 adults

~37 million adults in US

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11
Q

CKD Awareness Amongst Patients

A

most patients do not know they have CKD until they reach stage 4

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12
Q

CDK risk factors

A

diabetes mellitus, hypertension, cvd, acute kidney injury

family history, hypercholesterolemia, African Americans, Hispanics, Asian or Pacific Islanders

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13
Q

Etiology of CKD

A

vast majority of CKD cases caused by diabetes or hypertension (64%)

  • Diabetes 38%
  • Hypertension 26%
  • glomerulonephritis 16%
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14
Q

Clinical Presentation of CKD

A

many have no symptoms

  • edema
  • hypertension
  • decreased urine output
  • foamy urine (proteinuria)
  • hematuria
  • uremia (nausea/vomiting, confusion, metallic taste in mouth)
  • pericardial friction rub
  • asterixis (tremor of hand with wrist extension)
  • uremic frost
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15
Q

CKD Diagnostic Tests

A

eGFR
urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio
urinalysis

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16
Q

Renal U/S findings for CKD

A

atrophic or small kidneys
cortical thinning
increased echogenicity
elevated resistive indices

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17
Q

Can serum creatinine be used to estimate renal function?

A

no; GFR could be very different with same serum creatinine, also depends on age/race/gender

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18
Q

Kidney function changes in aging

A

GFR declines by 1ml/min/year after age 30-40

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19
Q

complications of CKD

A

CVD, chronic kidney disease-mineral and bone disease (CKD-MBD), secondary hyperparathyroidism, anemia of CKD, electrolyte abnormalities, metabolic acidosis, volume overload, uremia, hypertension

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20
Q

Causes of Death from CVD

A

vast majority are from CVD (54%)

21
Q

CKD Treatment

A

low salt diet, BP control, statins for hyperlipidemia, oral or IV iron for anemia, low potassium and phosphorus diet, dialysis

22
Q

Indications for Dialysis

A

A: severe acidosis
E: electrolyte disturbance (usually hyperkalemia)
I: ingestion (ethylene glycols, methanol)
O: volume overload
U: uremia

23
Q

define azotemia

A

elevated BUN without symptoms

24
Q

define uremia

A

elevated BUN with symptoms (N/V, confusion, pruritis, metallic taste in mouth, fatigue, anorexia)

25
Q

Dialysis options/transplant

A

hemodialysis, home hemodialysis, peritoneal dialysis, kidney transplant

26
Q

Acute Kidney Injury (AKI) diagnostic guidelines (KDIGO) overview

A

stage is determined by serum creatinine or urine output, whichever is worse

27
Q

Stage 1 AKI

A

serum: 1.5-1.9x baseline or >0.3mg/dl increase
uo: <0.5 ml/kg/h for 6-12 hours

28
Q

Stage 2 AKI

A

serum: 2.0-2.9x baseline
uo: <0.5 ml/kg/h for more than 12 hours

29
Q

Stage 3 AKI

A

serum: 3.0x OR increase in serume to >4mg/dl OR initiation of renal replacement therapy OR in pts <18 y/0, decrease in eGFR <35ml/min
uo: <0.3 ml/kg/h for >24 hours OR anuria for >12 hours

30
Q

Risk factors for AKI

A

major: old age, proteinuria, CKD, HTN, DM, CVD, exposure to nephrotoxins, cardiac surgery, fluid overload, sepsis

31
Q

Etiology of Prerenal AKI

A

hypotension, hypovolemia, reduced cardio output (heart failure, tamponade, massive PE), systemic vasodilation (sepsis, SIRS, hepatorenal syndrome)

32
Q

Etiology of Postrenal AKI

A

bladder output obstruction, ureteral obstruction, renal pelvis obstruction (stones, cancer, strictures, blood clots)

33
Q

Etiology of Intrinsic AKI

A

50% ischemia - tubular necrosis
35% toxins - tubular necrosis
10% interstitial nephritis
5% glomerulonephritis

34
Q

Drugs associated with Acute Interstitial Nephritis (AIN)

A

antibiotics, NSAIDs, and PPIs (protein pump inhibitors)

-can also be caused by infections or autoimmune disoders

35
Q

Complications of AKI

A

development of CKD, progression of CKD, ESRD, CVD

36
Q

Clinical Presentation of AKI

A

edema, hypertension, decreased urine output, foamy urine, asterixis, uremic frost

37
Q

Diagnostic tests for AKI

A

UA with microscopy
urine albumin/cr ratio or protein/cr ratio
renal u/s

38
Q

urine microscopy:

renal tubular epithelial cells, transitional epithelial cells, granular casts, or waxy casts

A

acute tubular necrosis (ATN)

39
Q

urine microscopy:

WBC, WBC cast, or urine eosinophils

A

acute interstitial nephritis (AIN) or pyelonephritis

40
Q

urine microscopy:

dysmorphic RBCs, RBC casts

A

vasculitis or glomerulnephritis

41
Q

urine microscopy:

proteinuria <3.5g/day, hematuria, dysmorphic RBCs, RBC casts

A

nephritic syndrome

42
Q 
urine microscopy:
heavy proteinuria (>3.5g/day), lipiduria, minimal hematuria
A

nephrotic syndrome

43
Q

urine microscopy:

hyaline cast

A

non-specific, prerenal azotemia

44
Q

urine microscopy:

WBCs, RBCs, bacteria

A

urinary tract infection

45
Q

what is purpose of ordering a FeNa or FeUrea?

A

differentiate between prerenal azotemia from intrinsic renal injury (ATN usually)

46
Q

FeNa or FeUrea is only valid in which type of patients?

A 
Oliguric only (<400 to 500ml/day)
-if pt is non-oliguric, then they cannot be prerenal
47
Q

Is FeNa or FeUrea usually needed for differentiation of AKI?

A

no, physical exam should be enough

48
Q

Treatment of AKI

A

depends on etiology

  • prerenal needs IV fluid
  • ATN need supportive care
  • avoid hypotension
  • discontinue nephrotoxins (antibiotics, NSAIDs, ACEi)

PCM (7 decks)

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