Renal/ Urology Flashcards
Dietary recommendation for CKD
restriction of
- Salt
- Water
- Protein
- Potassium
- Phosphorus
- Magnesium
RIFLE classification of ARF
Risk to kidney- Serum CR up 1.5x or GFR down >25%
Injury to kidney - Serum CR up 2x or GFR down >50%
Failure of function- CR up 3x GFR down >75%
Loss of function - No function > 4 weeks
End stage renal failure - No function > 3 months
Which two conditions account for the majority of ARF
- Hypoperfusion of the kidneys (Pre renal)
- Acute Tubular Necrosis (Intrinsic)
Labs indicating Prerenal azotemia
- BUN:CR > 20:1
- Urine osmolality > 500
- Urine SG > 1.020
- Urine NA < 20 mEq/L
Labs indicating Intrinsic renal azotemia
- BUN:CR < 15:1
- Urine NA > 40 mEq/L
- Urine osmolality 300-500
- Urine SG 1.010- 1.020
A kidney less than how many CM on ultrasound indicates a chronic condition
< 10 CM
Short term dialysis should be initiated when
CR > 5-10 mg/dl
Stages of CKD
Stage 1 - GFR > 90 Stage 2 - GFR 60-89 Stage 3 - GFR 30-59 Stage 4 - GFR 15-29 Stage 5 - GFR <15
Conditions occurring due to stage 4 CKD
- Acidosis
- Anemia
- Hyperkalemia
- Hypocalcemia
- Hyperphosphatemia
Most common causes of CKD
- Hypertension
- DM
- Glomerulonephritis
- Polycystic Kidney Disease
5 year survival rate of Chronic Renal Failure
35%
Clinical manifestations of glomerulonephritis
- Hematuria (tea/ cola colored)
- Oliguria/ anuria
- Facial edema in the AM - Pedal edema in the PM
diagnosis of hematuria in urinalysis
- > 3 RBC/ HPF
- RBC’s will be misshapen (acanthocytes) due to passage through the glomerulus. RBC from urinary tract will maintain its normal shape
How does Polycystic Kidney disease cause kidney failure.
The cysts arise from the epithelial cells of the collecting duct and tubules. They replace the mass of the kidney leading to reduced function
Autosomal dominant polycystic kidney disease characteristics of the disease
- Most common form of PKD
- Always bilateral
- Sx develop during the 4th decade of life
Autosomal recessive polycystic kidney disease chracteristics
- Less common
- Typically leads to intrauterine death
- Surviving infants have shot life expectancy due to renal and hepatic failure
Acquired cystic kidney disease characteristics
- Occurs in individuals with long term renal disease
- More common in African American men
Clinical features of Autosomal Dominant Polycystic Kidney Disease
- Back pain from enlarging mass
- Headaches (greater risk of intracranial aneurysm)
- Nocturia due to inability to concentrate urine
- HTN
- Hematuria
- Recurrent UTI’s
Types of kidney stones
- Calcium (75- 85% of stones)
- Struvite (10-15% of stones) common with frequent UTI/ Foley. Combination of Calcium, ammonium, magnesium
- Uric Acid (5-8% of stones) Common in those with acidic urine. Urine may or maynot by hyperuricemic
- Cystine (< 1% of stones) caused by impaired cysteine transport.
Which kidney stones can be seen on X ray
- Calcium and Struvite
- Uric acid and cysteine are radiolucent
Gold standard imaging for nephrolithiasis
CT without contrast
- Xray will miss small radiopaque stones
- US indicated in pregnancy and peds
Imaging modality of choice for PKD
Renal US
What sized nephrolithiasis should be managed as they will likely not pass on their own
> 10 mm
Dialysis is indicated for hypernatremia at what level
> 200
Rapid correction of hypernatremia can lead to what
- Pulmonary or cerebral edema especially those with DM
Causes of hyponatremia with hypervolemia
- CHF
- Nephrotic syndrome
- Renal failure
- Hepatic cirrhosis
Causes of hyponatremia with euvolemia
- SIADH
- Hypothyroidism
- Steroid use excess
Granular (muddy brown) casts in urine
ATN
Red cells, dysmorphic red cells (acanthocytes) and red cell casts in urine
Acute Glomerulonephritis
White cells, white cell casts with or without eosinophils
Acute interstitial nephritis
Most common cause of Intrinsic kidney injury
ATN (85% of cases)
Nephrotoxic drugs which may cause ATN
- Aminoglycosides (mosti common)
- Ampho B
- Vancomycin
IV Acyclovir - Cephalosporins
- Contrast Dye
- Cyclosporine
Endogenous causes of ATN
- Heme containing products such as myoglobinuria and hematuria
- Uric acid
- Bence Jones Bodies (paraproteins)
Infectious causes of Interstitial nephritis
- Strep
- CMV
- Rocky Mtn Spotted Fever
- Histoplamosis
Autoimmune causes of Interstitial nephritis
- SLE
- Sjogren’s Syndrome
- Sarcoidosis
Drugs which cause interstitial nephritis
- Penicillins
- Cephalosporins
- Sulfa drugs
- NSAIDS
- Allopurinol
Anti GBM antibodies and pulmonary hemorrhage
Goodpasture Syndrome
Tx for ATN
- Furosemide or IV Thiazides
Tx for Interstitial Nephritis
- Corticosterois
- Dialysis
Tx for acute glomerulonephritis
High dose corticosteroids
Diagnostic for Nephritic syndrome
- AKI with 1-3 g/d of proteinuria
- hematuria
- RBC casts
- HTN
Diagnostic for Nephrotic syndrome
- Proteinuria >3 g/d
- Hypoalbuminemia
- Oval fat bodies in urine
Gold standard to dx nephritic syndrome
Renal BX
Diagnostic studies for post infectious glomerulonephritis
- rising ASO titers
- Low complememnt levels
What to suspect in gross hematuria with URI
IgA nephropathy and HSP
Why does nephrotic syndrome lead to hyper lipidemia
Loss of protein in the urine –> Hypoalbuminemia –> The liver producing more lipids = hyperlipidemia
Suspect which disease if AKI developlsafter starting ACEI
Renal Artery Stenosis
Gold Standard test for renal artery stenosis
MRA
2 extra renal conditions which can cause SIADH
- Small cell lung cancer
- Pituitary tumor
Flaccid paralysis is which electrolyte disorder
Hyperkalemia and severe hypokalemia
Chvostek and Trousseau signs are associated with
Hypocalcemia
Stones, bones, abdominal groan and psychiatric moans are associated with which electrolyte disorder
Hypercalcemia
- pH down
- PCO2 up
- HCO3 normal/up
Respiratory acidosis
- ph up
- PCO2 down
- HCO3 normal/down
Respiratory alkalosis
- pH down
- PCO2 down/normal
- HCO3 down
Metabolic acidosis
- pH up
- PCO2 normal/up
- HCO3 down
metabolic acidosis
- pH up
- PCO2 normal/up
- HCO3 up
Metabolic alkalosis
Anion gap acidosis
- Methanol
- Uremia (CKD)
- DKA
- Propylene glycol
- Infection
- Lactic acidosis
- Ethylene glycol
- Salicylates
Normal anion gap acidosis
- Hyperalimentation
- Acetazolamide (carbonic anhydrase inhibitors)
- Renal insufficiency
- Diarrhea/ diuretics
- Ureteroenterostomy
- Pancreatic fistula
Surgical indications for BPH
- Urinary retention
- Recurrent UTI
- Gross hematuria
- Bladder stones
- Renal insufficiency
Alpha blockers for the tx of BPH
- Terazosin
- Doxazosin
- Tamsulosin
- Alfuzosin
5a- Reductase inhibitors for the tx of BPH
- Finasteride
- Duasteride
First line therapy for pyelonephritis in women
TMP/SMX 10-14 days PO
Second line therapy for pyelonephritis in women
Floroquinolone 14-21 days
Signs of primary syphilis
Painless chancer
Signs of secondary syphilis
- Disseminated
- Condylomata lata
- Rash on palms and soles
Signs of tertiary syphilis
- Gummas
- Aortitis
- Neurosyphilis
- Argyle Robertson pupil
Tx for chlamydia
Azithromycin 1 gm one time
Tx for gonorrhea
Rocephin 250 mg IM once
Tx for disseminated gonorrhea
1 g IV/24hrs once
