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Clin Med II Unit III > 1 Renal Diagnostics > Flashcards

1 Renal Diagnostics Flashcards

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
Q

Ketones in the urine are suggestive of…

A

Dehydration
Malnutrition
DKA

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26
Q

Blood in a UA could indicate…

A

Calculi, glomerular damage, neoplasm, acute tubular necrosis, trauma, infection

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27
Q

What different things are you looking for when doing microscopic analysis of a urine sample?

A 
RBC casts
WBC casts
Epithelial cell casts
Hyaline casts
Crystals
28
Q

RBC casts in microscopic UA

A

Glomerulonephritis

Vasculitis

29
Q

WBC casts in microscopic U/A

A

Tubulointerstitial disease
Acute pyelonephritis
Glomerular disorders

30
Q

Epithelial cell casts in microscopic UA

A

Acute tubular necrosis (kidney ischemia)

Glomerulonephritis

Contrast nephrotoxicity

31
Q

Hyaline casts in microscopic UA

A

Dehydration

32
Q

What are the different types of crystals you might see in a microscopic UA?

A

Uric acid

Calcium phosphate or calcium oxalate

Cystine

Magnesium ammonium phosphate (struvite)

33
Q

Why do a urine culture and sensitivity?

A

Identifies the causative organism of a urinary infection

Shows sensitive and resistant abx

34
Q

The earliest clinically detectable stage of diabetic nephropathy or other early kidney damage

A

Microalbumin

35
Q

Urine eosinophils are most commonly seen in…

A

Acute interstitial nephritis

May also be seen in transplant rejection, pyelonephritis, prostatitis, cystitis, atheroembolic disease, and rapidly progressive glomerulonephritis

36
Q

What type of urine study provides a better quantitative measurement for proteinuria or GFR determination?

A

24-hour urine collection

TEDIOUS - usually only collected inpatient

37
Q

When might you perform a urine protein immunoelectrophoresis?

A

If you suspect Multiple Myeloma

You would see Bence Jones proteins on UPEP

38
Q

What is a KUB xray?

A

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
Q

What kind of kidney stones are radiolucent?

A

Uric acid

40
Q

Besides stones, what are some other findings you might see on KUB?

A 
Prostatic calculi
Bladder distension
Pancreatic calculi
Calcified arteries
Calcification in biliary tract
Bowel gas pattern
Free air secondary to a ruptured viscus
41
Q

Appropriate initial test in patients with renal failure of unknown etiology

A

Renal Ultrasonography

42
Q

Test of choice to exclude urinary tract obstruction

A

Renal ultrasonography

43
Q

What sorts of things can be identified on renal ultrasonography?

A 
Nephrolithiasis
Severity and length of urethral strictures
Renal cysts (PCKD) and masses
Hydronephrosis
Renal or perinephric abscesses
Strophic kidneys
Urethral diverticuli
44
Q

When might you want to do a renal DOPPLER ultrasonography?

A 
Renal vein thrombosis
Renal infarction
RENAL ARTERY STENOSIS
Intracranial vascular disease
Arteriosclerosis
45
Q

Good DDx for persistent HTN?

A

Renal artery stenosis

46
Q

Why perform a CT scan for diagnosing renal conditions?

A

Provides more detailed info than ultrasound

Helps distinguish between benign and malignant cysts

Used to evaluate and stage renal cell carcinoma

47
Q

When is NON-contract CT performed?

A

Diagnostic test of choice for nephrolithiasis

Can detect radiolucent stones that my not appear on KUB

48
Q

When would you perform a CT angiography?

A

To identify renal vascular problems

Renal artery stenosis or renal vein thrombosis

49
Q

What to remember about CT contrast

A

It is potentially nephrotoxic

Hold metformin for 48 hours afterwards

50
Q

Gold standard for diagnosis of renal vein thrombosis

A

MRI

Can also use MRA

51
Q

Contraindications to MRI/A

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
Q

How is intravenous pyelograpm (IVP) used?

A

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
Q

How is an intravenous pyelogram performed?

A

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
Q

“Live action” x-rays of renal vasculature

A

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
Q

“String of pearls” appearance on angiography

A

Fibromuscular Dysplasia

Inflammation of medium sized arteries throughout the body but will show up on renal angiography

56
Q

When might you want to do a renal biopsy?

A 
Unexplained acute renal failure
Nephrotic syndrome
Acute nephrotic syndrome
Renal mass
Assessment for rejection following transplant

***Can be US-guided or surgical

57
Q

The bladder is filled with contrast and x-rays are taken while patient is voiding to visualize the contrast flow

A

Cystourethrogram

58
Q

Primary bladder conditions are better seen with this study as compared to IVP

A

Cystourethrogram

59
Q

Cystourethrogram is used to detect…

A

Vesicoureteral reflux
Distortion of the bladder (due to tumor)
Fistula
Perforation

60
Q

How is a cystoscopy performed?

A

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
Q

Potential complications of cystoscopy

A

Sepsis
Hemorrhage
Perforation of the bladder
Post-procedure dysuria

62
Q

Indications for a cystoscopy

A

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
Q

Noninvasive, quick diagnostic tool for the evaluation of testicular/scrotal masses, testicular size, testicular/scrotal pain

A

Testicular ultrasound

Can also use to determine location of undescended testes

64
Q

When evaluating testicular torsion, it’s important that the testicular ultrasound is…

A

DOPPLER - to evaluate blood flow

65
Q

Prostate U/S and biopsy is performed…

A

Transrectally (TRUS)

Helpful in detection of prostate cancer in patients with increased PSA

Clin Med II Unit III (6 decks)

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