Urinalysis, Renal Failure, Dialysis

Question 1

defn of proteinuria?

Answer 1

> 150 mg/day

Question 2

inc albumin in urine, think

Answer 2

the earliest sign of diabetic nephropathy

Question 3

how many RBCs/hpf to be considered hematuria

Answer 3

> 3RBC/hpf

Question 4

inc ketones in urine, think

Answer 4

DKA or starvation

Question 5

inc nitrates in urine indicates

Answer 5

bacteria in urine

Question 6

inc LE in urine indicates

Answer 6

WBCs in urine

Question 7

see eosinophils in urine, think

Answer 7

acute interstitial nephritis

Question 8

RBCs casts in urine, think

Answer 8

glomerulonephritis
ischemia
malignant HTN

Question 9

WBC casts in urine, think

Answer 9

pyelonephritis
tubulointerstitial disease
transplant rejection

Question 10

granular casts, think

Answer 10

ATN

Question 11

broad waxy casts, think

Answer 11

CRF w/ dilated ducts

Question 12

fatty casts, think

Answer 12

nephrotic syndrome

Question 13

hyaline casts

Answer 13

non-specific

Question 14

How to the kidneys handle BUN?

Answer 14

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

Question 15

when will you see elevate BUN

Answer 15

azotemia and uremia (> 60)

Question 16

how do the kideys handle creatine

Answer 16

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

Question 17

how is BUN and Cr affected in acute renal failure

Answer 17

both will increase

Question 18

what are the 3 phases of acute renal failure?

Answer 18

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

Recovery phase: recovery of tubular function

Question 19

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

Answer 19

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

Question 20

pathophys of ischemic vs toxin mediate ARF

Answer 20

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)

Question 21

defn of chronic renal failure

Answer 21

irreversible, progressive reduction in GFR

Question 22

etiologies of chronic renal failure

Answer 22

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

Question 23

Stahes of chronic renal failure w/ GFR range

Answer 23

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)

Question 24

ARF/CRF complications

Answer 24

↓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

Question 25

what is dialysate

Answer 25

artificial solution that resembles human plasma

Question 26

What are the indications for dialysis

Answer 26

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

Question 27

2 limitations of dialysis

Answer 27

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

Question 28

difference in how hemodialysis is performed vs peritoneal dialysis

Answer 28

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

Question 29

how often can hemodiaysis and peritoneal dialysis be performed?

Answer 29

hemo: MWF or TuTrSa peritoneal q 4-8 hrs

Question 30

advantages to hemo vs peritoneal dialysis

Answer 30

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

Question 31

disadvantages to hemo vs peritoneal dialysis

Answer 31

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