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Fall CLIN MED 1 > Test 2: Renal > Flashcards

Test 2: Renal Flashcards

1
Q

When GFR decreases, serum creatinine ___

A

increases. only becomes elevated after more than 2/3 of renal function destroyed

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2
Q

oliguria

A

small amts of urine norm 800-2000 ml/day

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3
Q

Uremia

A

having abnormal waste product , urea, in blood

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4
Q

Acute Kidney Injury (AKI)

A

dec GFR, and urine output. happens very acutely within 48hrs. Elevated BUN, creatinine, and uric acid

Inc in serum creatinine of 0.3 mg/dl
oliguria <400 mL in 24hrs

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5
Q

decreased renal perfusion can be caused by (going to dec GFR)

A

hypercalcemia

NSAIDs + ACE Inhibitors

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6
Q

A GFR less than ____ for 3months or more is indicative of

A

60, CKD

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7
Q

AKI- Pre Renal caused by

A

decrease blood flow to kidney, volume depletion, dehydration

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8
Q

AKI- Pre Renal Labs

A

BUN: Creatinine >20:1
High: B/C, K+, P, Mg
Low: FENa <1%. pH (metabolic acidosis w/inc anion gap)

Urine Osmolality will be high bc retained Na so urine is concentrated

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9
Q

AKI- Intrinsic Renal si/sx

A

HTN, flank pain, fever all are common

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10
Q

AKI- Intrinsic Renal Labs

A

BUN: Creatinine <20:1
Urine Osmolality will be low bc dilute urine
High: B/C, K+, P, Mg, FENa: >2%
low: pH (metabolic acidosis w/inc anion gap)

Epithelial Casts

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11
Q

AKI: Intrinsic Renal- Vasculature

Atheroembolic Renal Disease

A

Cause: emboli, anti coag tx, aortic aneurysm
Si: common ones for AKI intrinsic
Lab: Eosinophilia common, microscopic hematuria, proteinuria
TX: sx management, dialysis temp, surgery, no more invasive vascular procedures

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12
Q

AKI: Intrinsic Renal- Vasculature

Renal Vein Thrombosis

A

casue: Nephrotic syndrome, renal cell cancer
Si: proteinuria, hematuria,
Lab: CT w/contrast
Tx: anticoag, tx cause

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13
Q

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis Si/SX

A

mild edema, HTN, coke colored urine

Labs: RBC Casts

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14
Q

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis - Post strep

A

MOSTLY KIDS
Cause: recent GAS infection of any kind

Labs: High- ASO titer / Low: C3 & C4 compliment
RBC casts, blood and protein

TX: supportive, dec diuretics

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15
Q

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis - IgA nephropathy (Berger’s dz)

A

cause: IgA deposits in mesangium of glomeruli
Si: commonly asx but can have norm intrinsic renal sx
Labs: High- IgA. complement levels norm
Tx: supportive care, resolve on own

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16
Q

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis - Henoch Schonlein Purpura

A

common Kids

cause: IgA deposition in affected tissues-vasculitis
affecting skin and mucous membranes
Si: rash on back of extremities THAT are PALPABLE

Labs: High- serum IgA level

Tx: ACE and diuretic. corticosteroids for renal disease

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17
Q

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis- HUS

A

cause: Shigga Toxin

Sx: first abd pn N/V/D, HTN, Oliguria, GI bleed

Labs: High- bilirubin. proteinuria, Anemia thrombocytopenia

Tx: Supportive fluids, control HTN, transfusion

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18
Q

AKI: Intrinsic Renal- Interstitium

Acute Interstitial Nephritis

A

Cause: Drugs, NSAIDs

Labs: WBC Casts, Biopsy (to differentiate between ATN, glomerulonephritis and interstitial nephritis)

Tx: remove agent

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19
Q

AKI: Postrenal

A

cause: obstruction
si: suprapubic pain, oliguria

Labs: High- B/C, K+, P, Mg, FENa: >2%
Low- pH (metabolic acidosis w/inc anion gap)

20
Q

Acute Urinary Incontinence causes

A

DIAPPERS. delirium, infection, Atrophy, Pharmaceuticals, Psychoogical, Endocrine, Restricted mobility, Stool impaction

21
Q

Stress Incontinence

A

caused by increased abd pressure, dec pelvic support,
loss of bladder control during activity (cough sneeze laugh), obesity, preg.
Post Voidal Residual low/normal <50-100
Tx: pelvic floor exercise, biofeedback

22
Q

Urge Incontinence

A

sudden urge bc of an overactive bladder leading to involuntary void. Detrusor muscle is overactive.
will have a strong urge then void, cant make it to toilet, unpredictable leakage and frequent

PE: DELAYED leak upon stress test
tx: bladder retraining, PME, anticholiergics (but do PVR first)
PVR low/normal <50-100

23
Q

Overflow incontinence

A

problem emptying bladder leading to overflow.
small leakage, dribble all day. weak stream hesitancy, nocturia.

tx: schedule toileting, alpha antagonist.
PVR high 100-400

Common in men due to enlarged prostate

24
Q

Risk factors for Pyelonephritis

A

diabetic, immunosuppressive therapy, chronically ill, cathether, prostate cancer

25
Q

Common bugs for complicated UTIs

A

PEEK: Pseudomonas (-), E coli (-), Enterococcus (+), Klebsiella (-)

26
Q

Common bug for UTI in diabetics

A

Klebsiella

27
Q 
These Colors on a Urinalysis mean:
Blue green
Red
Gold
Orange
CLoudy
A 
Blue green- pseudomonas
red- hematuria
Gold- UTI or dehydration 
Orange- medications phenazopyridine 
cloudy- infection
28
Q

UA Specific gravity normal 1.005-1.030

A

< 1.008 dilute, pyelonephritis, diabetes insipidus

> 1.020 concentrated, dehydration, SIADH, glycosuria

29
Q

UA normal pH

A

4.5-8

30
Q

UA content you might see in UTI patient

A 
Blood
Nitrates (phenazopyridine can give false positive)
Leukocyte Esterates (pyuria) WBC in urine
31
Q

WBC casts from Urine indicates.

A

pyelonephritis

Urine C&S is gold standard and necessary to dx

32
Q

UTI Cystitis (bladder)
Sx
Labs
Tx

A

Sx: dysuria, frequency, urgency, hematuria suprapubic pain
Labs: UA. Can get a culture if reccurent or STI possible
Tx: TMP-SMX (bactrim) NItrofurantoin

33
Q

UTI Pyelonephritis (kidneys)
SX
Labs
TX

A

SX: dysuria, frequency, urgency, hematuria, Flank pain, fever, N/V

Labs: UA, C&S w/WBC casts

TX: FQ and Aminoglycosides (avoid if renal disease)

Hospitalize if: >60,
immunocompromised, persistent vomiting

34
Q

In what cases would you treat Asymptomatic UTI

A

immunosuppresed
pregnant- Nitrofurantoin
about to undergo renal/urinary tract surgery
risk of endocarditis

35
Q

UTI due to Candida
Risk Factors
TX

A

RF: antibiotic therapy and old age
Tx: Antifungal

36
Q

When should you do a PVR? post void residual

A

Before prescribing for urinary incontinence

37
Q

Tx for urinary incontinence

A

Anticholinergics

38
Q

what kind of stones do these pH indicate? Norm 5.8-5.9
ph <5.5
ph 5.5-5.8
ph >7.2

A

ph <5.5 Uric Acid or Cystine Stone
ph 5.5-5.8 Calcium Stone
ph >7.2 Struvite stone

39
Q

Calcium Oxalate or Calcium Phosphate Stones casues

A

Oxalate: excess purine, low calcium diet
Phosphate: Family Hx, lyperparathyroid

40
Q

Uric Acid stones casues

A

high protein diet

gout

41
Q

Struvite Stones

A

staghorn caliculi in renal pelvis

casue: cather, abnormal anatomy

42
Q

Cystine Stones causes

A

genetic disorder, cystinuria

43
Q

Stone in these location will have pain radiate to…

  • upper ureter
  • lower ureter
  • UVJ
A

abdomen
ipsilateral groin, testicle/labia
cause urine frequency, urgency, lower pelvic pain

44
Q

Procedues for kidney stones

A

Lithrotripsy: shockwave for <10mm
Utererorenoscopy: stones >1cm

45
Q

Dietary Prevention of calcium stones, uric acid stones,

A

calcium stones- low sodium, low protien

uric acid- rich in alkali (fruits veggies), low in acid (meat)

46
Q

Criteria for Dx AKI

A

absolute inc in serum creatinine of 0.3 mg/dl
50% inc in serum creatinine
Oliguria <400 mL in 24 hrs

Fall CLIN MED 1 (3 decks)

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