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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
Dialysis options/transplant
hemodialysis, home hemodialysis, peritoneal dialysis, kidney transplant
26
Acute Kidney Injury (AKI) diagnostic guidelines (KDIGO) overview
stage is determined by serum creatinine or urine output, whichever is worse
27
Stage 1 AKI
serum: 1.5-1.9x baseline or >0.3mg/dl increase uo: <0.5 ml/kg/h for 6-12 hours
28
Stage 2 AKI
serum: 2.0-2.9x baseline uo: <0.5 ml/kg/h for more than 12 hours
29
Stage 3 AKI
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
Risk factors for AKI
major: old age, proteinuria, CKD, HTN, DM, CVD, exposure to nephrotoxins, cardiac surgery, fluid overload, sepsis
31
Etiology of Prerenal AKI
hypotension, hypovolemia, reduced cardio output (heart failure, tamponade, massive PE), systemic vasodilation (sepsis, SIRS, hepatorenal syndrome)
32
Etiology of Postrenal AKI
bladder output obstruction, ureteral obstruction, renal pelvis obstruction (stones, cancer, strictures, blood clots)
33
Etiology of Intrinsic AKI
50% ischemia - tubular necrosis 35% toxins - tubular necrosis 10% interstitial nephritis 5% glomerulonephritis
34
Drugs associated with Acute Interstitial Nephritis (AIN)
antibiotics, NSAIDs, and PPIs (protein pump inhibitors) | -can also be caused by infections or autoimmune disoders
35
Complications of AKI
development of CKD, progression of CKD, ESRD, CVD
36
Clinical Presentation of AKI
edema, hypertension, decreased urine output, foamy urine, asterixis, uremic frost
37
Diagnostic tests for AKI
UA with microscopy urine albumin/cr ratio or protein/cr ratio renal u/s
38
urine microscopy: | renal tubular epithelial cells, transitional epithelial cells, granular casts, or waxy casts
acute tubular necrosis (ATN)
39
urine microscopy: | WBC, WBC cast, or urine eosinophils
acute interstitial nephritis (AIN) or pyelonephritis
40
urine microscopy: | dysmorphic RBCs, RBC casts
vasculitis or glomerulnephritis
41
urine microscopy: | proteinuria <3.5g/day, hematuria, dysmorphic RBCs, RBC casts
nephritic syndrome
42
``` urine microscopy: heavy proteinuria (>3.5g/day), lipiduria, minimal hematuria ```
nephrotic syndrome
43
urine microscopy: | hyaline cast
non-specific, prerenal azotemia
44
urine microscopy: | WBCs, RBCs, bacteria
urinary tract infection
45
what is purpose of ordering a FeNa or FeUrea?
differentiate between prerenal azotemia from intrinsic renal injury (ATN usually)
46
FeNa or FeUrea is only valid in which type of patients?
``` Oliguric only (<400 to 500ml/day) -if pt is non-oliguric, then they cannot be prerenal ```
47
Is FeNa or FeUrea usually needed for differentiation of AKI?
no, physical exam should be enough
48
Treatment of AKI
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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