Renal High Yield HO Flashcards
most accurate place to check for skin tenting
forehead
increase in acute phase reactants accompanies what processes in the body
inflammation and tissue injury both acute and chronic
what is the definition of acute phase proteins
proteins whose serum concentraitons increase or decrease by at least 25% during inflammatory states
positive: ESR, CRP, ferritin, WBC, haptoglobin, ceruloplasmin
negative: albumin, transferrin
thrombocytosis in the absence of a chronic myeloproliferative or myelodysplastic disorder
in patients who have a medical or surgical condition likely to be associate with increased plaetlet count
normalizes at the resolution of this surgery/infection/trauma
reactive thrombocytosis
causes of aki pre/intra/post
pre - dehydration/hypotension BUN/Cr 20:1
intra - anatomic abnormality (and resulting hypertrophy of normal kidny_, toxins - environmental/medications
post- obstruciton
KDIGO for cr and urine output criteria
increase in Cr >0.3 mg/dL w/in 48 hours or >50% within 7 days
OR
urine output of <0.5 mL/Kg/hr for >6 hours ** test question ** pay attention
clinical features of hyperkalemia
occur when k is >7 muscle weakness arrhythmias peaked t waves shrinking and loss of p waves widened QRS
occurs by increased k release from cells or reduced k excretion in urine
management of hyperkalemia
exclude pseudohyperkalemia
obtain ECG and perform continuous cardiac monitoring
give calcium gluconate over 2-3 minutes
give insulin and glucose
remove potassium by hemodialysis/diuretics/gi cation exchanger in patients with seve renal impairment
things included on a UA
luekocytes nitrite urobilinogen protein ph blood specific gravity ketone bilirubin glucose
appropriate use of urinary catheters
only for appropriate indications and only leave in palce as long as needed
minimize urinary cath use - avoid in patients in nursing home residents for management of incontinence
appropriate indictaions for indwelling urethral catheter use
acute urinary retention or bladder outlet obstruction
need for accurate measurements of urinary output in critically ill patients
periopoerative use for selected surgical procedures (urologic surgery - anticipated prologned duration of surgery - pt anticipated to recieve large volume infusions or duiretics during surgery - need for intraoperative monitoring of urinary output
to assist in healing of open sacral or peirineal wounds in incontinent patients
patient requires prolonged immobilization
to improve comfort for en d of life care
examples of innappropriate use of indwelling catheters
substitute for nursing care in patients or residents with incontinence
as a means of obtaining urine or culture when patient can voluntarily void
for prolonged postop duration without appropriate indications
ddx of a renal mass
RCC oncocytoma angiolypoma metanephric adenoma metastitic disease xanthogranulomatous pyelonephritis
in utero cuases of renal hypoplasia/atrophic kidney
vascular event urinary tract abnormalities posterio rurethral valve vesicouretrul reflux upj obstruction ACEI use genetic abnormality hyperglycemia/DM of mother maternal vit a deficiency intrauterine growth retardation
first year of life causes of atrophic kidney/ renal hypoplasia
persistent anorexia and vomiting
failure to thrive
after first year of life causes of atrophic kidney/renal hypoplasia
frequent pyelonephritis
other disorders that lead to renal scarring and ESRD
indications for dialysis therapy
fluid overload that is refractory to diuretics
hyperkalemia (serium k >6.5 meq/L) or rapidly rising k levels
metabolic acidosis in patients in whom the admin of bicarb is not indicated
signs of uremia such as pericarditis, neuropathy, or an otherwise unexplained decline in mental status
manifestatinos of SIRS
2 or more of the following temperature >38 or <36 hr over 90 respiration rate over 20 or paco <32 mm Hg WBC > 12000, < 4000 or >10% immature
definition of sepsis
systemic responses to an infection defined by 2 or more SIRS criteria as a result of an infection
what should you always get in septic patients before administering antibiotics
draw blood for blood cultures
most common cause of UTI and pyelonephritis
e coli
staph sprophyticius is primary cause of honeymoon cystitis
if previous urine culture are available look at those - pt will usually become infected with same organism
how to calculate anion gap
na - (cl + hco3)
viscerosomatic reflex of the kidneys
t10-11
what should be on your ddx of all women of childbearing age
pregnancy
number of times a woman has been pregnant
gravidity
number of pregnancies that led to brith at or beyond 20 weeks or an infant weighing more than 500g
parity
