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Clin Med II Unit III > 1 Renal Diagnostics > Flashcards

1 Renal Diagnostics Flashcards

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1
Q

What are the three main laboratory studies used to monitor kidney function?

A

Serum Creatinine

BUN

BUN/Cr ratio

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2
Q

Product of creatine catabolism in skeletal muscle and from dietary meat intake

A

Serum Creatinine (0.5-1.2)

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3
Q

Why is Serum Creatinine a good measure of kidney function?

A

It is released into the circulation at a RELATIVELY CONSTANT RATE —> STABLE PLASMA CONCENTRATION

It is freely filtered across the glomerulus and excreted by the kidney

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4
Q

An elevated Serum Creatinine typically indicates

A

There’s something wrong with the kidney

BUT - must keep the patient’s baseline Cr in mind (based on diet, muscle mass, etc)

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5
Q

A product of protein catabolism in the liver that is excreted by the kidneys

A

BUN (normal 10-20)

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6
Q

When would you see an increased BUN?

A

Dehydration

GI bleed

Use of certain meds (ie steroids or tetracyclines)

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7
Q

Ratio commonly used as a marker for volume status

A

BUN/Creatinine

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8
Q

Glomerular Filtration Rate is equal to…

A

The sum of the filtration rates in all of the functioning nephrons

Gives a rough measure of the number of functioning nephrons
—> used to track progression/regression of disease and to dose meds

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9
Q

GFR is dependent upon…

A

Age
Sex
Race
Body Size

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10
Q

What are normal values for GFR in men and women?

A

Men ~130mL/min/1.73m2

Women ~120mL/min/1.73m2

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11
Q

What is the Cockcroft-Gault formula?

A

Method to determine the Creatinine Clearance (and to approximate GFR)

CCr(men) = [(140-age) x LBW(kg)]/[PCr x 72]

CCr(women) = 0.85 x CCr(men)

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12
Q

Presence of kidney damage or decreased kidney function for 3 or more months, irrespective of the cause

A

Chronic Kidney Disease (CKD)

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13
Q

What lab should you run if you suspect:

Systemic Lupus Erythematosus (SLE)

A

Antinuclear antibodies (ANA)

Double-stranded DNA antibody levels

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14
Q

What lab should you run if you suspect:

Granulomatosis with Polyangitis

A

Cytoplasmic and perinuclear pattern antineutrophil cytoplasmic antibody (C-ANCA and P-ANCA) levels

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15
Q

What lab should you run if you suspect:

Goodpasture syndrom

A

Anti-glomerular basement membrane (anti-GBM) antibodies

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16
Q

What lab should you run if you suspect:

Forms of glomerulonephritis

A

Hep B and C
HIV
Venereal Disease Research Lab (VDRL) serology
Serum complement levels

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17
Q

What lab should you run if you suspect:

Post-streptococcal glomerulonephritis

A

Antistreptolysin O

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18
Q

What lab should you run if you suspect:

Multiple myeloma

A

Serum and urine protein electrophoresis (SPEP, UPEP)

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19
Q

What lab should you run if you want to improve estimates of GFR

A

Cystatin C

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20
Q

Glycoprotein found in high concentrations in the prostatic lumen that can be used as a screening method for early detection of prostate cancer and to monitor the disease after treatment

A

Prostate-Specific Antigen (PSA)

Normal = <4ng/mL

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21
Q

PSA levels are detectable in every male but are increased in …

A

Prostate cancer

BPH

Prostate tissue

Following prostate manipulation (ultrasound, biopsy)

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22
Q

What is one of the first signs of kidney disease in the U/A?

A

Proteinuria

NEVER ignore protein on a UA

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23
Q

What are the components of a urinalysis?

A 
pH
Specific gravity
Glucose
Ketones
Protein
Blood
Nitrite
Leukocyte esterase
WBCs
Bilirubin
Urobilinogen
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24
Q

Component of the U/A that reflects the ability of the kidney to concentrate and dilute urine

A

Specific gravity

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25
Ketones in the urine are suggestive of...
Dehydration Malnutrition DKA
26
Blood in a UA could indicate...
Calculi, glomerular damage, neoplasm, acute tubular necrosis, trauma, infection
27
What different things are you looking for when doing microscopic analysis of a urine sample?
``` RBC casts WBC casts Epithelial cell casts Hyaline casts Crystals ```
28
RBC casts in microscopic UA
Glomerulonephritis Vasculitis
29
WBC casts in microscopic U/A
Tubulointerstitial disease Acute pyelonephritis Glomerular disorders
30
Epithelial cell casts in microscopic UA
Acute tubular necrosis (kidney ischemia) Glomerulonephritis Contrast nephrotoxicity
31
Hyaline casts in microscopic UA
Dehydration
32
What are the different types of crystals you might see in a microscopic UA?
Uric acid Calcium phosphate or calcium oxalate Cystine Magnesium ammonium phosphate (struvite)
33
Why do a urine culture and sensitivity?
Identifies the causative organism of a urinary infection Shows sensitive and resistant abx
34
The earliest clinically detectable stage of diabetic nephropathy or other early kidney damage
Microalbumin
35
Urine eosinophils are most commonly seen in...
Acute interstitial nephritis May also be seen in transplant rejection, pyelonephritis, prostatitis, cystitis, atheroembolic disease, and rapidly progressive glomerulonephritis
36
What type of urine study provides a better quantitative measurement for proteinuria or GFR determination?
24-hour urine collection TEDIOUS - usually only collected inpatient
37
When might you perform a urine protein immunoelectrophoresis?
If you suspect Multiple Myeloma You would see Bence Jones proteins on UPEP
38
What is a KUB xray?
Kidneys, Ureters, and Bladder Not the most useful but often used as an initial diagnostic tool Can show calcium-containing, struvite, and cystine stones in the urinary tract, but will miss smaller stones, uric acid stone (radiolucent) or stones overlying bony structures
39
What kind of kidney stones are radiolucent?
Uric acid
40
Besides stones, what are some other findings you might see on KUB?
``` Prostatic calculi Bladder distension Pancreatic calculi Calcified arteries Calcification in biliary tract Bowel gas pattern Free air secondary to a ruptured viscus ```
41
Appropriate initial test in patients with renal failure of unknown etiology
Renal Ultrasonography
42
Test of choice to exclude urinary tract obstruction
Renal ultrasonography
43
What sorts of things can be identified on renal ultrasonography?
``` Nephrolithiasis Severity and length of urethral strictures Renal cysts (PCKD) and masses Hydronephrosis Renal or perinephric abscesses Strophic kidneys Urethral diverticuli ```
44
When might you want to do a renal DOPPLER ultrasonography?
``` Renal vein thrombosis Renal infarction RENAL ARTERY STENOSIS Intracranial vascular disease Arteriosclerosis ```
45
Good DDx for persistent HTN?
Renal artery stenosis
46
Why perform a CT scan for diagnosing renal conditions?
Provides more detailed info than ultrasound Helps distinguish between benign and malignant cysts Used to evaluate and stage renal cell carcinoma
47
When is NON-contract CT performed?
Diagnostic test of choice for nephrolithiasis Can detect radiolucent stones that my not appear on KUB
48
When would you perform a CT angiography?
To identify renal vascular problems Renal artery stenosis or renal vein thrombosis
49
What to remember about CT contrast
It is potentially nephrotoxic Hold metformin for 48 hours afterwards
50
Gold standard for diagnosis of renal vein thrombosis
MRI Can also use MRA
51
Contraindications to MRI/A
Gadolinium may increase risk for nephrogenic systemic fibrosis in patients with chronic renal failure (GFR < 30mL/min/1.73m2) or acute renal failure of any severity
52
How is intravenous pyelograpm (IVP) used?
To evaluate size/shape of kidneys, ureters, and bladder; look for kidney stones/obstruction NOT used frequently b/c it requires contrast dye and other Dx tests exist
53
How is an intravenous pyelogram performed?
Contrast dye is injected and x-rays taken Excretory function of the kidneys is measured by the length of time for passage of contrast through the kidneys
54
“Live action” x-rays of renal vasculature
Renal angiography Used less frequently due to the fact that other Dx tests are available Still used for pre-op mapping of renal vasculature if needed
55
“String of pearls” appearance on angiography
Fibromuscular Dysplasia Inflammation of medium sized arteries throughout the body but will show up on renal angiography
56
When might you want to do a renal biopsy?
``` Unexplained acute renal failure Nephrotic syndrome Acute nephrotic syndrome Renal mass Assessment for rejection following transplant ``` ***Can be US-guided or surgical
57
The bladder is filled with contrast and x-rays are taken while patient is voiding to visualize the contrast flow
Cystourethrogram
58
Primary bladder conditions are better seen with this study as compared to IVP
Cystourethrogram
59
Cystourethrogram is used to detect...
Vesicoureteral reflux Distortion of the bladder (due to tumor) Fistula Perforation
60
How is a cystoscopy performed?
Thin fiber optic tube in a hollow sheath is inserted into the urethra and advanced into the bladder Post-procedure hematuria is expected and should clear within three voids
61
Potential complications of cystoscopy
Sepsis Hemorrhage Perforation of the bladder Post-procedure dysuria
62
Indications for a cystoscopy
To assess bladder/urethral involvement due to malignancies To evaluate urogynecologic conditions (incontinence, sterile hematuria/pyuria, recurrent infection, urethral diverticula, fistula) To diagnose intrinsic bladder disease (interstitial cystitis, bladder tumors, stones, or scarring)
63
Noninvasive, quick diagnostic tool for the evaluation of testicular/scrotal masses, testicular size, testicular/scrotal pain
Testicular ultrasound Can also use to determine location of undescended testes
64
When evaluating testicular torsion, it’s important that the testicular ultrasound is...
DOPPLER - to evaluate blood flow
65
Prostate U/S and biopsy is performed...
Transrectally (TRUS) Helpful in detection of prostate cancer in patients with increased PSA

Clin Med II Unit III (6 decks)

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