Renal Urinary System part 2 Flashcards
Lupus Nephritis (SLE-systemimc lupus erythematosus with renal involvement)
x
syx
x
what are signs?
proteinuria, active urine sediment-(hematuria, RBC casts, RBC cells,) declining renal function
dx
x
what is required prior to guiding therapy?
kidney biopsy
signficant kidney involvement would show what?
proteinuria, active urine sediment-(hematuria, RBC casts, RBC cells,) declining renal function
what would complement levels show?
low serum complement (C3 and C4)
subtypes of lupus nephritis
x
what class is minimal mesangial involvemement, usually asyx, trx?
class I, no trx
what class is mesangial proliferative, with microscopic hematuria and proteinuria, trx?
class II, no trx
what class is focal with hematuria proteinuria, possible HTN, decreased GFR, variable prognosis, trx?
class III, immunosuppression with steroids (eg methylprednisolone, prednisone) and cyclophosphamide or mycophenolate mofetil
what class is diffuse histo pattern with poor prognosis , trx?
class IV, immunosuppression with steroids (eg methylprednisolone, prednisone) and cyclophosphamide or mycophenolate mofetil
what class is membranous and has nephrotic syndrome involved, trx?
class V, immunosuppression with steroids (eg methylprednisolone, prednisone) and cyclophosphamide or mycophenolate mofetil
what class is advanced sclerosing with progressive CKD with bland urinary sediment, trx?
class VI, no immunosupression
management
x
how do you track renal involvement and renal improvement with lupus nephritis?
anti-dsDNA (immune complexes that deposit on membrane) and complement levels (correlate well with disease activity)
Rhabdomyolysis
x
cause
x
what is the cause ?
muscular injury, PCP, trauma, toxin exposure
dx
x
what do the lab show?
elevated CK >10,000
what does the UA show?
blood with no RBCs (indicating myoglobinuria)
complications
x
what is a major complication of rhabdomyolysis?
AKI from myoglobinuria
trx
x
what is the major trx?
IV isotonic saline
Orthostatic Proteinuria
x
epid
x
most common cause of proetinuria in what age group?
adolescents
define
x
what is it?
abnoramlly high protein excretion during the day (when upright) but normal protein excertion at night (when supine)
dx
x
how do you ensure dx?
UA shows proteinuria and excludes hematuria, AKI
what makes you suspect orthostatic proteinuria?
24 h urine collection showing protien excretion, but not >3.5g/24 hr to make you think nephrotic syndrome
what is the test to dx orhtostatic proteinuria?
split (day and night) 24 hour urine collection , showing elevated daytime but normal nighttime protein excretion rates
management
x
what is the best management for orthostatic proteinuria?
benign condition, no further intervention, resolves with age
Hepatorenal Syndrome
x
pathophys
x
what is the pathophys?
cirrhosis develop decreased peripheral vascular resistance secondary to splanchnic vasodilation, which can cause the decreased renal perfusion of hepatorenal syndrome
cause
x
what is the cause ?
patients with cirrhosis
dx
x
what do you see on CMP?
elevated LFTs, acute elevated BUN and Cr
how do you dx?
by exclusion,
risk
x
what is a frequent percipitent of hepatorenal syndrome?
SBP (spontaneous bacterial peritonitis)
management
x
if patient has ascites and PMN>250, what do you do trx of hepatorenal?
paracentesis
Alcoholic Ketoacidosis
x
syx
x
what are symptoms?
AMS, confused, disoriented, generalized abd pain and thirst
dx
x
how do you diagnose it?
Anion gap acidosis, increased osmol gap, ketonemia, ketonuria , variable blood glucose
what is the plasma glucose level?
variable, <250 usually (as >250 indicates DKA)
risk
x
who are the risks of alcoholic ketoacidosis?
homeless, alcoholics
pathophys
x
what causes elevated glucose?
impaired insuline secretion and increased insulin resistance
management
x
what should be management?
IV dextrose containing normal saline and thiamine, insulin is generally not required
why do you need IV dextrose?
leads to increase in insulin secretion, which leads to the metabolism of ketone bodies to bicarb
Autosomal Dominant Polycystic Kidney Disease (ADPCKD)
x
syx
x
what are syx?
asyx but may develop HTN, hematuria, proteinuria, renal insufficiency, and/or flank pain.
PE
x
what are physical exam findings?
flank pain
what might be appreciated on exam?
palpable abd mass (usually bilateral)
dx
x
what do you see on U/S ? what is alternate imaging?
multiple bilateral renal cysts; CT or MRI
what do you see on UA?
hematuria, protenuria
association
x
what are other associated factors?
LVH and displaced PMI, associated with HTN
complications
x
what are the complications of ADPKD?
ESRD, HTN
what are some extra renal features?
Cerebral aneurysms Hepatic & pancreatic cysts Cardiac valve disorders (mitral valve prolapse, aortic regurgitation) Colonic diverticulosis Ventral & inguinal hernias
management
x
what is the best management?
- Follow blood pressure & renal function
- Aggressive control of cardiovascular risk factors, including hypertension
- ACE inhibitors preferred for high blood pressure
- End-stage renal disease: Dialysis, renal transplant
screening
x
what consequences can occur from a positive screening ADPKD and what must be done first prior to screening?
counseling is required prior to testing as a diagnosis of ADPKD often can result in psychological, insurability, and employment consequences.
patients with a fam hx of ADPCKD should get screened after >=18 y.o. with?
renal ultrasound
Acute kidney injury (AKI)
x
types
x
what are the types of AKI?
prerenal, ATN, postrenal
Prerenal
x
mechanism
x
what is the mechanism of action of prerenal ?
Decreased renal perfusion from volume depletion (eg, hypovolemia, hemorrhage) or decreased effective circulating volume (eg, heart failure)
association
x
what are associated conditions of prerenal AKI?
CHF
dx
x
what does BUN/Cr ratio show for prerenal AKI?
Typically >20
what does FeNa show for prerenal AKI?
<1%
what does urine osmolality for prerenal AKI show?
> 500 mOsm/kg
what does microscopy show for prerenal AKI?
Bland
management
x
what is the management of prerenal AKI?
Intravenous fluids (responds to fluid challenge)
ATN
x
mechanism
x
what is the mechanism of action of ATN ?
Tubular injury from renal ischemia, sepsis, or nephrotoxins (eg, aminoglycosides, tenofovir, radiocontrast media)
other etiopathology generally involves a perfusion deficit due to hypovolemia, hypotension, shock, sepsis, or low cardiac output states.
association
x
what are associated conditions of ATN?
aminoglycosides, tenofovir, radiocontrast media
dx
x
what does BUN/Cr ratio show for ATN AKI?
Typically normal (~10-15)
what does FeNa show for ATN AKI?
> 2%
what does urine osmolality for ATN AKI show?
~300 mOsm/kg
what does microscopy show for ATN AKI?
Muddy brown casts
management
x
what is the management of ATN AKI?
Supportive care, treatment of underlying cause &/or removal of offending agent
Postrenal
x
mechanism
x
what is the mechanism of action of Postrenal ?
Obstruction (eg, benign prostatic hypertrophy, renal stones, malignancy)
association
x
what are associated conditions of Postrenal AKI?
benign prostatic hypertrophy, renal stones, malignancy)
dx
x
what does BUN/Cr ratio show for Postrenal AKI?
Variable
what does FeNa show for Postrenal AKI?
Variable
what does urine osmolality for Postrenal AKI show?
Variable
what does microscopy show for Postrenal AKI?
bland
management
x
what is the management of Postrenal AKI?
Relief of obstruction
Prerenal Azotemia/Prerenal AKI
x
dx
x
what do labs show for prerenal azotemia?
decreased fractional excretion of sodium; however, once ATN sets in, the fractional excretion of sodium increases (usually >2).
what is the gold standard in distinguishing prerenal azotemia from ATN?
fluid challenge , as prerenal azotemia responds to a fluid challenge with improved urine output, where ATN does not
hyperchloremic non-anion gap metabolic acidosis
x
cause
x
what is the cause of hyperchloremic non-anion gap metabolic acidosis?
excess IV Normal Saline
Dialysis
x
indications
x
what are indications of dialysis?
intractable hyperkalemia, hypervolemia, severe metabolic acidosis (eg, pH <7.1), and marked uremic symptoms
