1. Oliguria - Proteinuria Flashcards
(23 cards)
chronic kidney disease (CKD) is defined as one or more markers of kidney damage, and a decreased GFR (less than 60ml/min) for how many months?
after three months (less than 3 months is acute kidney injury)
The vast majority (64%) of CKD is caused by diabetes or?
HTN
Symptoms of CKD include edema, HTN, decreased urine output (UOP) foamy urine, uremia, pericardial friction rub, asterixis and uremic?
frosh (seen on feet/face white dust)
3 tests to identify most CKD patients include eGFR (estimated via mathematics- not accurate in rapid creatinine change- AKI), urine albumin to creatinine ratio or urin protein to creatinine ratio and?
urinalysis
Renal US (MC) may be performed and can see atrophic/small kidneys, cortical thinning, increased echogenecity and elevated?
resistive indices
NOTE: Abd CT best for masses, Abd MRI for stenosis
CKD treatment includes Renal Replacement Therapy (RRT) including hemodialysis, peritoneal dialysis, and renal transplantation. Indication for dialysis can be remembered by AEIOU... A: severe acidosis E: electrolyte disturbances I: Ingestion (ethylene glycol/methanol) O: Volume Overload U:
UREMIA
Acute kidney injury AKI is diagnosed/staged based on serum creatinine and or on urine output being less than?
0.5ml/kg/h
AKI presents with edema, HTN, decreased urine output, foamy urine (proteinuria), hematuria, SOB, uremia, pericardial friction rub, asterixis and?
Uremic frost
NOTE: mild AKI usually asymptomatic
Common diagnostic tests for AKI include UA with microscopy, urine albumin/cr ratio or protein/cr ratio, and a?
renal US
What is characterized by proteinuria (>3.5g/day), hypoalbuminemia, peripheral edema, hyperlipidemia, and lipiuria?
Nephrotic Syndrome
NOTE: if serum albumin is normal, pt does not have nephrotic syndrome, rather nephrotic range proteinuria
Along with the obvious outcomes of nephrotic syndrome, there is also increased chance for infection due to urinary loss of IgG and increased thrombosis due to?
loss of antithrombotic factors
also VIT D deficiency and Anemia
Multiple myeloma, amyloidosis, and monoclonal immunoglobulin deposition disease MIDD, are all possible DDX for?
nephrotic syndrome
Note: has bland urinary sediment compared to nephritic
Nephrotic syndrome is diagnosed by serum creatinine with eGFR, urinalysis, urine albumin to cr ratio, 24 hour protein collection, glomerulonephritis serologic evaluation and most importantly?
RENAL BIOPSY
What is characterized by proteinuria of less than 3.5gm per day, hematuria, HTN and commonly with renal failure?
Nephritic Syndrome
***Active urinary sediment (RBC/WBC/granular casts)
Low complement levels (C3/4) are helpful in DDx of nephritic syndrome- only a few cause them to drop. Low C3/4 indicated activation of classical while low C3 only indicates activation of?
alternative pathway
Kidney Disease:
Urinary Pattern: renal tubular epithelial cells, transitional epithelial cells, granular casts/waxy casts
Acute tubular necrosis ATN
Kidney Disease:
Urinary Pattern: WBC, WBC casts, Urine eosinophils
Acute interstitial nephritis/pyelonephritis
Kidney Disease:
Urinary Pattern: Dysmorphic RBCs, RBC casts
Vasculitis/GN
Kidney Disease:
Urinary Pattern: Hyaline casts
Non-specific, prerenal azotemia
Kidney Disease:
Urinary Pattern: WBCs, RBCs, bacteria
urinary tract infection
With hyperkalemia, you can see peaked T waves on EKG, the high concetration of K+ makes membrane potential?
less negative = more excitable initially then impairs excitation later
**treat hyperK first
All of the following are signs of what?
hemoconcentration, hypovolemic hyponatremia, contraction metabolic acidosis, BUN/Cr ratio >20:1 and hyaline casts
Hypovolemia or Prerenal azotemia
All of the following are signs of what?
proteinuria, renal tubular epi cells, transitional epi cells, granular casts and FENA >2%
Acute tubular necrosis
