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
