Kidney Flashcards
Stop metformin CRF GFR
GFR<30
Wilms
Wilms tumor (also called Wilms’ tumor or nephroblastoma) is a type of childhood cancer that starts in the kidneys. It is the most common type of kidney cancer in children. About 9 of 10 kidney cancers in children are Wilms tumors. Wilms’ tumor most often affects children ages 3 to 4 and becomes much less common after age 5.
changes in specific genes: A small number of Wilms tumors have changes in or loss of the WT1 or WT2 genes, which are tumor suppressor genes found on chromosome 11
This is often the first sign of a Wilms tumor. Parents may notice swelling or hardness in the belly while bathing or dressing the child. The lump is sometimes large enough to be felt on both sides of the belly. It’s usually not painful, but it might be in some children. Wilms tumour is curable in more than 9 out of 10 children (90%). The main treatments include: chemotherapy for almost all children. surgery for all children
RCC triad
Hematuria
Abdominal mass
Flank pain
Goodpasture syndrome
Goodpasture syndrome is a group of acute illnesses that affects the lungs and kidneys. It involves an autoimmune disorder. Normally, the immune system makes antibodies to fight off germs. But with Goodpasture syndrome, the immune system mistakenly makes antibodies that attack the lungs and kidneys
Environmental factors such as hydrocarbon chemical exposure, cigarette smoke, or infections such as influenza may play a role in the development of the disorder. It is not known why simple infections can progress to Goodpasture syndrome in some people
Anti-GBM antibodies are directed against the noncollagenous (NC-1) domain of the alpha3 chain of type IV collagen, which occurs in highest concentration in the basement membranes of renal and pulmonary capillaries.
What is leading cause of death in hemodialysis
Arrhythmia due to electrolyte imbalance
diabetes insipidus labs
In a patient whose clinical presentation suggests diabetes insipidus (DI), laboratory tests must be performed to confirm the diagnosis. A (1)24-hour urine collection for determination of urine volume is required. In addition, the clinician should measure the following: Serum electrolytes and glucose
(2)Plasma sodium concentration greater than 142 meq/L, due to water loss indicates diabetes insipidus
Diabetes insipidus is present when the (3)serum osmolality is raised (>295 milliOsmol/kg) with inappropriately (4)dilute urine (A urinary specific gravity of 1.005 or less and a urinary osmolality of less than 200 mOsm/kg are the hallmark of DI. Random plasma osmolality generally is greater than 287 mOsm/kg). The serum sodium is often elevated due to excess free water losses
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PSGN def? symph?
Poststreptococcal glomerulonephritis (GN) is a kidney disorder that occurs after infection with certain strains of streptococcus bacteria. Infection in a different part of the body, such as the skin or throat. The disorder may develop 1 to 2 weeks after an untreated throat infection, or 3 to 4 weeks after a skin infection
(1)Dark, reddish-brown urine.
(2)Swelling (edema), especially in the face, around the eyes, and in the hands and feet.
(3)Decreased need to pee or decreased amount of urine.
(4)Feeling tired due to low iron levels in the blood (fatigue due to mild anemia)
PKD diagnosis
Autosomal dominant PKD is usually diagnosed by ultrasound of the kidneys, CT scans and MRI tests. The number and size of the cysts increase with age. Thus, even only two cysts in each kidney of a 30-year-old patient who also has a family history of the disease is a strong indicator.
What do you monitor a CKD patient with?
The two key markers for CKD are (1)urine albumin and (2)eGFR.
To screen for CKD: assess urine albumin excretion to diagnose and monitor kidney damage. Screen using a spot urine albumin-to-creatinine ratio
How often should CKD be checked?
The frequency of monitoring recommended by NICE (National Institute for Health Care Excellence) varies between *once a year to two or more times a year depending on: (1)the stage of CKD and level of protein in the urine, (2)past patterns of the eGFR and creatinine levels, (3)the underlying cause of the CKD, (4)other illnesses.
Diabetic nephropathy?
Measurment?
is a common complication of type 1 and type 2 diabetes. Over time, poorly controlled diabetes can cause damage to blood vessel clusters in your kidneys that filter waste from your blood. This can lead to kidney damage and cause high blood pressure
The first step in the screening and diagnosis of diabetic nephropathy is to measure albumin in a spot urine sample, collected either as the first urine in the morning or at random, for example, at the medical visit. This method is accurate, easy to perform, and recommended by American Diabetes Association guidelines
Urinary albumin test. This test can detect the blood protein albumin in your urine. Typically, the kidneys don’t filter albumin out of the blood. Too much of the protein in your urine can indicate poor kidney function.
Albumin/creatinine ratio. Creatinine is a chemical waste product that healthy kidneys filter out of the blood. The albumin/creatinine ratio — a measure of how much albumin is in a urine sample relative to how much creatinine there is — provides another indication of kidney function.
Glomerular filtration rate (GFR). The measure of creatinine in a blood sample may be used to estimate how quickly the kidneys filter blood (glomerular filtration rate). A low filtration rate indicates poor kidney function.
A normal amount of albumin in your urine
A normal amount of albumin in your urine is less than 30 mg/g. Anything above 30 mg/g may mean you have kidney disease, even if your GFR number is above 60
Normal urine output
Normal urine osmolality
The normal range for 24-hour urine volume is 800 to 2,000 milliliters per day (with a normal fluid intake of about 2 liters per day)
serum osmolality: 282 - 295 mOsm/kg water; a serum osmolality of 285 mOsm usually correlates with a urine specific gravity of 1.010. Urine osmolality: can range from 50 - 1400 mOsm/kg water, but average is about 500 - 800 mOsm.
eGFR
GFR is Glomerular Filtration Rate and it is a key indicator of renal function. eGFR is estimated GFR and is a mathematically derived entity based on a patient’s serum creatinine level, age, sex and race.
Calculation of eGFR to assess renal function
CG equation: eGFR = [(140 − Age) × Weight/(72 × sCr)] × (0.85 if female)
Minimal change dis
Minimal change disease is a disorder where there is damage to your glomeruli. The disease gets its name because the damage cannot be seen under a regular microscope. It can only be seen under a very powerful microscope called an electron microscope
Minimal change disease is a kidney disorder that can lead to nephrotic syndrome. Nephrotic syndrome is a group of symptoms that include protein in the urine, low blood protein levels in the blood, high cholesterol levels, high triglyceride levels, and swelling
Children of all ages and even adults can get MCD, but it mostly affects young children under the age of 5. MCD is the most common cause of Nephrotic Syndrome in children, associated with 80 to 90% of cases. It makes up only 10 to 15% of Nephrotic Syndrome cases in adults. Lupus podocytopathy is the most common autoimmune etiology of minimal change disease.
The treatment plan for nephrotic syndrome in children with MCD is usually with a type of drug called a corticosteroid, often called steroids. It is very important to not stop treatment suddenly. By sticking to the full treatment plan, your child will be less likely to relapse
