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Medicine Clerkship > Urinalysis, Renal Failure, Dialysis > Flashcards

Urinalysis, Renal Failure, Dialysis Flashcards

1
Q

defn of proteinuria?

A

> 150 mg/day

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2
Q

inc albumin in urine, think

A

the earliest sign of diabetic nephropathy

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3
Q

how many RBCs/hpf to be considered hematuria

A

> 3RBC/hpf

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4
Q

inc ketones in urine, think

A

DKA or starvation

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5
Q

inc nitrates in urine indicates

A

bacteria in urine

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6
Q

inc LE in urine indicates

A

WBCs in urine

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7
Q

see eosinophils in urine, think

A

acute interstitial nephritis

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8
Q

RBCs casts in urine, think

A

glomerulonephritis
ischemia
malignant HTN

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9
Q

WBC casts in urine, think

A

pyelonephritis
tubulointerstitial disease
transplant rejection

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10
Q

granular casts, think

A

ATN

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11
Q

broad waxy casts, think

A

CRF w/ dilated ducts

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12
Q

fatty casts, think

A

nephrotic syndrome

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13
Q

hyaline casts

A

non-specific

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14
Q

How to the kidneys handle BUN?

A

normally reabs, so if the kidney is damaged it will be excreted

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15
Q

when will you see elevate BUN

A

azotemia and uremia (> 60)

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16
Q

how do the kideys handle creatine

A

freely filtered and not reabs (therefore used to measure GFR)

17
Q

how is BUN and Cr affected in acute renal failure

A

both will increase

18
Q

what are the 3 phases of acute renal failure?

A

Oliguric phase: UOP 500 mL/day, due to diuresis of retained fluids/electrolytes

Recovery phase: recovery of tubular function

19
Q

what are the 3 categories of ARF and how are they distinguished?

A
  1. pre-renal: due to dec RBF –> dec GFR (hypotension, CHF)
    - BUN/Cr > 20:1
    - low urine Na/FENa
    - high urine osm (>500)
  2. intrinsic: damage to renal parenchema (ATN, toxins, GNits)
    - BUN/Cr 20
    - low urine osm (15:1
    - urine Na > 40/high FENa
    - urine osm <350
20
Q

pathophys of ischemic vs toxin mediate ARF

A

Ischemic ATN: ↓renal blood flow → proximal/distal tubules don’t enough O2 for Na/K pump → cell death → ARF

Nephrotoxic ATN: toxin-mediated damage to proximal tubules → cell death → ARF (e.g. IV dye, gentamycin, Hb/Mb)

21
Q

defn of chronic renal failure

A

irreversible, progressive reduction in GFR

22
Q

etiologies of chronic renal failure

A

DM (#1), HTN (#2), chronic glomerulonephritis (#3)

23
Q

Stahes of chronic renal failure w/ GFR range

A 
stage 1 GFR 90-100
stage 2 GFR 60-89
stage 3 GFR 30-59
stage 4 GFR 15-29
stage 5 GFR <15 or dialysis (aka ESRD)
24
Q

ARF/CRF complications

A

↓GFR → electrolyte retention → ↑Na, ↑K, ↑H → HTN, CHF

uremia → n/v, pericarditis, asterixis, encephalopathy, platelet dysfxn

↓EPO → normocytic anemia

↓vit D → renal osteodystrophy, 2° HPTH, calciphylaxis

25
Q

what is dialysate

A

artificial solution that resembles human plasma

26
Q

What are the indications for dialysis

A

AEIOU

  • Acidosis (severe metabolic acidosis)
  • Electrolytes (severe hyperkalemia)
  • Intoxication (methanol, ethylene glycol, lithium, aspirin)
  • Overload (severe hypervolemia)
  • Uremia (severe uremia, pericarditis, BUN >150)
27
Q

2 limitations of dialysis

A

doesn’t help w/ kidney synthetic functions (e.g. EPO, vitamin D)

28
Q

difference in how hemodialysis is performed vs peritoneal dialysis

A

hemodialysis: blood from AV fistula pumped through dialyzer, filtrated, then sent back into pt body
peritoneal: high-glucose dialysate infused intoperitoneal cavity, then drained from abdomen

29
Q

how often can hemodiaysis and peritoneal dialysis be performed?

A

hemo: MWF or TuTrSa

peritoneal q 4-8 hrs

30
Q

advantages to hemo vs peritoneal dialysis

A

hemo: faster/more efficient, can be initiated quickly
periotneal: mimics normal kidney function, self dialysis

31
Q

disadvantages to hemo vs peritoneal dialysis

A

hemo:
 risk of removing too much fluid or electrolytes
 requires vascular access
 “first-use syndrome” – chest and back pain, rare anaphylaxis w/ new machine

peritoneal:
 risk of hyperglycemia
 risk of peritonitis
 increased abdominal girth

Medicine Clerkship (20 decks)

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