Test 2: Renal Flashcards
When GFR decreases, serum creatinine ___
increases. only becomes elevated after more than 2/3 of renal function destroyed
oliguria
small amts of urine norm 800-2000 ml/day
Uremia
having abnormal waste product , urea, in blood
Acute Kidney Injury (AKI)
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
decreased renal perfusion can be caused by (going to dec GFR)
hypercalcemia
NSAIDs + ACE Inhibitors
A GFR less than ____ for 3months or more is indicative of
60, CKD
AKI- Pre Renal caused by
decrease blood flow to kidney, volume depletion, dehydration
AKI- Pre Renal Labs
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
AKI- Intrinsic Renal si/sx
HTN, flank pain, fever all are common
AKI- Intrinsic Renal Labs
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
AKI: Intrinsic Renal- Vasculature
Atheroembolic Renal Disease
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
AKI: Intrinsic Renal- Vasculature
Renal Vein Thrombosis
casue: Nephrotic syndrome, renal cell cancer
Si: proteinuria, hematuria,
Lab: CT w/contrast
Tx: anticoag, tx cause
AKI: Intrinsic Renal- Glomerulus
Glomerulonephritis Si/SX
mild edema, HTN, coke colored urine
Labs: RBC Casts
AKI: Intrinsic Renal- Glomerulus
Glomerulonephritis - Post strep
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
AKI: Intrinsic Renal- Glomerulus
Glomerulonephritis - IgA nephropathy (Berger’s dz)
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
AKI: Intrinsic Renal- Glomerulus
Glomerulonephritis - Henoch Schonlein Purpura
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
AKI: Intrinsic Renal- Glomerulus
Glomerulonephritis- HUS
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
AKI: Intrinsic Renal- Interstitium
Acute Interstitial Nephritis
Cause: Drugs, NSAIDs
Labs: WBC Casts, Biopsy (to differentiate between ATN, glomerulonephritis and interstitial nephritis)
Tx: remove agent
AKI: Postrenal
cause: obstruction
si: suprapubic pain, oliguria
Labs: High- B/C, K+, P, Mg, FENa: >2%
Low- pH (metabolic acidosis w/inc anion gap)
Acute Urinary Incontinence causes
DIAPPERS. delirium, infection, Atrophy, Pharmaceuticals, Psychoogical, Endocrine, Restricted mobility, Stool impaction
Stress Incontinence
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
Urge Incontinence
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
Overflow incontinence
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
Risk factors for Pyelonephritis
diabetic, immunosuppressive therapy, chronically ill, cathether, prostate cancer
Common bugs for complicated UTIs
PEEK: Pseudomonas (-), E coli (-), Enterococcus (+), Klebsiella (-)
Common bug for UTI in diabetics
Klebsiella
These Colors on a Urinalysis mean: Blue green Red Gold Orange CLoudy
Blue green- pseudomonas red- hematuria Gold- UTI or dehydration Orange- medications phenazopyridine cloudy- infection
UA Specific gravity normal 1.005-1.030
< 1.008 dilute, pyelonephritis, diabetes insipidus
> 1.020 concentrated, dehydration, SIADH, glycosuria
UA normal pH
4.5-8
UA content you might see in UTI patient
Blood Nitrates (phenazopyridine can give false positive) Leukocyte Esterates (pyuria) WBC in urine
WBC casts from Urine indicates.
pyelonephritis
Urine C&S is gold standard and necessary to dx
UTI Cystitis (bladder)
Sx
Labs
Tx
Sx: dysuria, frequency, urgency, hematuria suprapubic pain
Labs: UA. Can get a culture if reccurent or STI possible
Tx: TMP-SMX (bactrim) NItrofurantoin
UTI Pyelonephritis (kidneys)
SX
Labs
TX
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
In what cases would you treat Asymptomatic UTI
immunosuppresed
pregnant- Nitrofurantoin
about to undergo renal/urinary tract surgery
risk of endocarditis
UTI due to Candida
Risk Factors
TX
RF: antibiotic therapy and old age
Tx: Antifungal
When should you do a PVR? post void residual
Before prescribing for urinary incontinence
Tx for urinary incontinence
Anticholinergics
what kind of stones do these pH indicate? Norm 5.8-5.9
ph <5.5
ph 5.5-5.8
ph >7.2
ph <5.5 Uric Acid or Cystine Stone
ph 5.5-5.8 Calcium Stone
ph >7.2 Struvite stone
Calcium Oxalate or Calcium Phosphate Stones casues
Oxalate: excess purine, low calcium diet
Phosphate: Family Hx, lyperparathyroid
Uric Acid stones casues
high protein diet
gout
Struvite Stones
staghorn caliculi in renal pelvis
casue: cather, abnormal anatomy
Cystine Stones causes
genetic disorder, cystinuria
Stone in these location will have pain radiate to…
- upper ureter
- lower ureter
- UVJ
abdomen
ipsilateral groin, testicle/labia
cause urine frequency, urgency, lower pelvic pain
Procedues for kidney stones
Lithrotripsy: shockwave for <10mm
Utererorenoscopy: stones >1cm
Dietary Prevention of calcium stones, uric acid stones,
calcium stones- low sodium, low protien
uric acid- rich in alkali (fruits veggies), low in acid (meat)
Criteria for Dx AKI
absolute inc in serum creatinine of 0.3 mg/dl
50% inc in serum creatinine
Oliguria <400 mL in 24 hrs
