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ADV DIAG > renal urology > Flashcards

renal urology Flashcards

1
Q

main role of kidney

A

regulate fluids and elytes

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2
Q

kidney fx

A
  1. regulate elytes and fluids
  2. excrete water soluble waste products of metabolism (cr, urea, uric acid)
  3. hormone production (erythropoietin, renin, bradykinin, prostaglandins, calcitriol, vit d3)
  4. process meds, ATBs
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3
Q

erythropoietin

A

RBC production

bone marrow stimulates erythropoietin when circulating blood volume is low to make more RBCs

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4
Q

renin and bradykinin

A

hormones rt bp

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5
Q

prostaglandins

A

hormones r/t renal perfusion

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6
Q

calcitriol/vitamin d3

A

hormones r/t bone production

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7
Q

ureters

A

smooth muscle tubes that carry urine that is created by kidney

propel urine from kidney to bladder

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8
Q

bladder

A

hollow muscular organ that collects and stores urine

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9
Q

serum cr lab values

A

male 0.7 - 1.3

female 0.6 - 1.1

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10
Q

what is creatinine

A

end product of protein metabolism, predominately looking at muscle

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11
Q

what affects creatinine

A

muscle mass, gender, race

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12
Q

how does aging affect creatinine

A

falsely decreased serum creatinine d/t decreased muscle mass

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13
Q

things that cause serum creatinine to rise

A
  1. renal fx decline
  2. renal damage
  3. nephrotoxic drugs
  4. dehydration
  5. CHF (likely prerenal failure)
  6. excessive blood loss, ie shock
  7. gout
  8. excessive exercise or muscle injury
  9. DKA- falsely elevated
  10. cephalosporin use
  11. high protein diet
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14
Q

creatinine clearance range

A

75-112

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15
Q

24 hr urine cr clearance

A

reflects renal fx in 24 hr period

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16
Q

creatinine clearance measures what

A

how much creatinine is being cleared from kidney

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17
Q

creatinine clearance 24 hr urine is used in presence of what

A

proteinuria, albuminuria, microalbuminuria

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18
Q

bence jones protein screens of what

A

multiple myelmoa

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19
Q

what can you measure protein in the urine with- first line

A

UA

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20
Q

what happens to creatinine clearance when renal fx decreases

A

decreases

bc amount of creatinine cleared from kidney will be less as when the kidneys aren’t functioning creatinine will be able to clear less

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21
Q

which is more sensitive, creatinine clearance or serum creatinine, and why

A

creatinine clearance

bc it is not affected by fluid status, diet, or exercise

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22
Q

what is a estimation of gfr

A

creatinine clearance

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23
Q

what is the best predictor for staging CKD

A

GFR

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24
Q

what does GFR represent

A

amount of fluid filtered by glomerulus within a certain unit of time

hence the name glomerular filtration rate

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25
Q

bun measures what

A

kidneys capacity to excrete urea

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26
Q

what is urea

A

waste product of protein metabolism

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27
Q

BUN can be used for what

A

to evaluate hydration status and assess renal function

also to assess blood in GI tract

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28
Q

what causes BUN to elevate

A
  1. AKI
  2. high protein diet
  3. hemolysis- breakdown of RBC
  4. CHF
  5. drugs- ie diuretics
  6. dehydration
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29
Q

sensitivity of BUN in comparison to GFR or serum creatinine

A

not as sensitive

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30
Q

what to check in regards to renal function if BUN elevated

A

check GFR, if normal, kidneys are most likely ok

31
Q

bun - cr ratio range

A

10:1 - 20:1

32
Q

what causes an increased bun to cr ratio

A

condition that causes a decrease in flow of blood to kidneys, such as CHF or dehydration or excessive blood loss

33
Q

urinalysis uses

A
  1. check for protein
  2. check for blood
  3. check for UTI
34
Q

what is happening to body in proteinuria

A

kidney damage

normally protein and albumin should not be allowed in glomuerular filtrate and what little does get through should be reabsorbed

35
Q

microalbuminuria

A

small amount of protein

36
Q

macroalbuminuric

A

large amount of protein in urine

37
Q

what amount of blood is normal in the urine

A

<5 RBC

38
Q

causes of hematuria

A

renal calculi, pyelonephritis, cystitis, bladder cancer

39
Q

pyelonephritis clinical presentation

A

bright red blood in urine, back pain, renal stones, FH of renal stones, fevers. chills, sweats, lower back pain

40
Q

leukocytes esterase lab range

A

normal is <10

41
Q

what is pyuria

A

presence of WBC in urine

42
Q

do uncomplicated UTIs need diagnostic testing for treatment

A

no can treat based on clinical symptoms

43
Q

leukocytes esterase indicate what

A

pyuria

44
Q

nitraites in UA indicate what

A

UTI with e coli

45
Q

what is normal in casts in UA

A

hyaline

46
Q

WBC cast indicates what

A

UTI or pyelonephritis

47
Q

RBC cast indicates what

A

glomerulonephritis

48
Q

why would you check WBC cast after treating UTI with ATB

A

to make sure casts have gone away

49
Q

urine specific gravity lab value

A

1.005 - 1.03

50
Q

urine specific gravity decreased with what

A
  1. renal disease
  2. too much fluid intake
  3. DI
51
Q

urine specific gravity elevated with what

A
  1. dehydration
  2. excessive fluid loss- v/d/f
  3. excessive radiographic contrast
  4. DM
  5. SIADH
52
Q

microalbuminuria lab value

A

30 - 150 mg/day

53
Q

mild albuminuria lab value

A

150 - 500 mg/day

54
Q

moderate albuminuria lab value

A

500 - 1000 mg/day

55
Q

heavy albuminuria lab value

A

1000 - 3000 mg/day

56
Q

nephrotic albuminuria lab value

A

> 3000 mg/day

57
Q

false positive for albuminuria

A
  1. hyperinfiltration (newly dx dm)
  2. exercise. ppl who exercise a lot spill a lot of protein and albumin into urine
  3. marked HTN
  4. CHF
  5. UTI
  6. acute febrile illness
58
Q

urine culture and sensitivity is used for what

A
  1. UTIs- recurrent, complicated, males
  2. pregnancy- risk for preterm birth
  3. pyelonephritis
59
Q

what happens if urine culture and sensitivity is positive

A

transfer to medium with discs applied to determine sensitivity to ATBs

may send automatic reflex culture depending on WBC and nitrates

60
Q

> 10,000 CFU/ml of organism indicates what

A

UTI

treat pt

61
Q

WBC casts with proteinuria indicate what

A

pyelonephritis

62
Q

large amounts of epithelial cells or multiple organisms indicate what

A

contaminated urine

63
Q

what labs are preferred for renal fx assessment

A

serum creatinine and GFR

not BUN

64
Q

Na, Cl, K are important for what

A

fx of nerves and muscles

65
Q

what happens to sodium with over hydration

A

decreases

66
Q

what happens to sodium with dehydration

A

increases

67
Q

what caues K to increase

A

renal failure

68
Q

what caues K to decrease

A

diuretics, excessive vomiting, g tubes

69
Q

cl generally follows what

A

Na

70
Q

what is KUB xray

A

plain firm of lower abdomen and pelvis

quick assessment of kidneys and ureters for calcium containing kidney stones and bowels for obstruction

71
Q

what to do if pt symptoms and PE suspicious of kidney stones

A

refer to urologist regardless of KUB findings

72
Q

best test to confirm or r/o possibility of calcium containing kidney stone

A

helical or spiral CT

calcium will light up on KUB bc its bone and will be white

73
Q

what kind of stones do not show up on KUB

A

uric acid stones

74
Q

what kind of testing is needed for uric acid stones

A

ultrasound

ADV DIAG (23 decks)

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