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CPR-2 > Oliguria and/or Proteinuria DSA and CIS > Flashcards

Oliguria and/or Proteinuria DSA and CIS Flashcards

1
Q

What defines anuria, oliguria, and polyuria?

A

anuria: < 50-100 ml/day
oliguria: < 400-500 ml/day
polyuria: > 3000 ml/day

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2
Q

What is significant about the sx of uremia?

A

(must have elevated BUN)

sx are often non-specific w/ multiple etiologies causing them

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3
Q

What common drugs are nephrotoxic?

What do you always ask about them?

A

NSAIDs

antibiotics

proton pump inhibitors

always ask which ones, how many at a time, and for how long

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4
Q

What type of contrast dye can be nephrotoxic?

A

IV iodine contrast

(not the oral kind)

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5
Q

What defines acute kidney injury vs CKD?

A

< 3 mos w/ GFR < 60 ml/min and/or markers of kidney damage present = AKI

after 3 mos, pt can be labeled w/ CKD

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6
Q

What are the clinical markers of kidney damage?

How many are required to dx AKI or CKD

A

one or more required:

albuminuria

urine sediment abnormalities

electrolyte and other issuew due to tubular damage

histology or structural abnormalities

Hx of kidney transplant

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7
Q

What are the stages of CKD?

A
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8
Q

GFR greater than or equal to 90 is CKD stage ___

A

stage 1 = normal or high GFR

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9
Q

GFR btw 60-89 is CKD stage ___

A

2 = mild decrease

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10
Q

GFR btw 45-59 is CKD stage ___

btw 30-44 is stage ___

A

3a = mild to moderate decr

3b = moderate to severe decrease

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11
Q

GFR btw 15-29 is CKD stage ___

A

4 = severe decrease

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12
Q

GFR < 15 is CKD stage ___

A

5 = kidney failure/ESRD

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13
Q

Neither GFR category stage 1 or 2 apply (with the associated decreased GFR) if what?

A

if no sx

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14
Q

What are the top two causes of CKD?

A

diabetes = 38%

HTN = 26%

(total cause 64%)

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15
Q

What is asterixis?

A

type of negative monoclonus where body parts can just flop around according to google

(he has a picture of a flopping hand)

Sx of CKD and AKi

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16
Q

What is uremic frost?

A

deposition of urea crystals on skin

seen in CKD and AKI

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17
Q

What is the formula for estimating creatinine clearance?

A

the cockroft-gault formula

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18
Q

How can creatinine clearance skew estimated GFR?

A

tends to overestimate GFR because creatinine is freely filtered at glomerulus but is also secreted by tubules making urine creatinine concentration higher than expected

(use cockcroft-gault equation instead)

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19
Q

What tests can you do measure proteinuria?

A

urine albumin to creatinine ratio or urine protein to creatinine ration = random, spot urine

24 hr urine total protein collection = annoying, usually not done unless completely necessary

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20
Q

When is is eGFR not accurate?

What is the most accurate way to measure GFR?

A

in settings of rapidly changing creatinine (AKI)

measured GFR most accurate but only performed in limited institutions

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21
Q

How is serum creatinine used in diagnosis of CKD?

A

not often = poor marker of kidney function

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22
Q

What are the renal U/S findings for CKD?

A

atrophic or small kidneys

cortical thinning

increased echogenicity

elevated resistive indices

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23
Q

What is a doppler renal US used for?

A

to look for renal A stenosis or renal vein thrombosis or resistive index

high resistive indices (>0.7-0.8) indicate resistance to arterial flow w/in kidney

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24
Q

What is an abdominal CT scan better for evaluating in kidney dz?

A

better at detecting masses and kidney stones

can evaluate for same things as renal US

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25
Q

What is the most commonly used imaging of kidney?

A

renal US

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26
Q

What are the indications for dialysis?

A

AEIOU

A: severe acidosis

E: electrolyte disturbance (usually hyperkalemia)

I: Ingestion of toxins

O: volume overload

U: uremia

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27
Q

What are the 3 types of renal replacement therapy?

A

hemodialysis

peritoneal dialysis

renal transplant

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28
Q

What are BP goals in CKD?

A

no proteinuria: < 140/90

proteinuria: < 130/80

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29
Q

Tx for proteinuria

A

low salt diet

BP control

ACEi, ARB, aldosterone antagonist, renin inh, non-D CCB

30
Q

Tx for anemia in CKD?

A

oral or IV iron

EPO stimulating agents

31
Q

Tx for metabolic acidosis in CKD?

A

bicarbonate supplementation if HCO3 <22

32
Q

Tx for hyperkalemia in CKD?

A

renal failure diet = low salt, potassium, and phosphorus

diuretics

sodium plystyrene sulfonate or patiromer

33
Q

What is CKD-BMD and how do you tx?

A

secondary hyperparathyroidism to CKD (previously renal osteodystrophy)

tx w/ renal failure diet

posphorus binder

Vit D supplementation

calcimimetics to lower PTH

dialysis

34
Q

AKI definitions and stages

A
35
Q

What category of AKI do renal pelvis issues fall under (papillary necrosis, stones)?

A

postrenal AKI

36
Q

What are the 3 intrinsic causes of AKI?

A

tubular necrosis (ischemia = 50%, toxins = 35%)

interstitial nephritis = 10%

glomerulonephritis = 5%

37
Q

What sx is seen in AKI but not often in CKD?

A

shortness of breath

if pulmonary edema is present

38
Q

What labs do you obtain on all pts w/ AKI?

What imaging is commonly run?

A

urinalysis w/ urine microscopy

urine albumin/Cr ration or urine protien/Cr ratio

renal US

39
Q

Equation for fraction excreted Na

A
40
Q

What is the general tx of AKI?

A

mostly supportive

avoid hypotension

discontinue nephrotoxins

renal replacement if needed - usually hemodialysis

41
Q

What is the association w/ serum albumin and nephrotic syndrome?

A

if serum albumin is normal w/ nephrotic range proteinuria, then the pt DOES NOT have true nephrotic syn but instead nephrotic range proteinuria

42
Q

Why can thrombosis occur in nephrotic syndrome?

A

not well understood - can be venous or arterial

higher risk w/ albumin < 2.0 or 2.5 g/dL

urinary loss of antithrombotic factors (antithrombin III, plasminogen, protein S, etc)

increased levels of procoagulant factors

43
Q

Who is at high risk for thrombo-embolism in nephrotic pts?

A

serum albumin < 20 g/L

climical hypovolemia

bed rest/intercurrent illness

membranous nephropathy

44
Q

What are the two theories of pathogenesis of edema in nephrotic syn?

A

low intravascular oncotic pressure bc low albumin = underfill theory

renal sodium retention secondary to low renal perfusion from low RAAS or primary sodium retention by kidneys = overfill theory

45
Q

What is the classic presentation of nephrotic syndrome?

A

new onset hypertension

new onset edema

proteinuria

lipiduria

hyperlipidemia

minimal hematuria

46
Q

What are the monoclonal disease related etiologies of nephrotic syndrome?

A

multiple myeloma

amyloidosis

monoclonal Ig deposition disease (MIDD) = light chain, heavy chain, or both

47
Q

What are the 5 main etiologies of nephrotic syndrome to know?

A

diabetic nephropathy

minimal change dz

FSGS

membranous nephropathy

monoclonal disease related

48
Q

How do you tx thrombosis in nephrotic syn?

A

heparin or warfarin

consider prophylactic anticoagulation for serum albumin < 2.5 g/dL

49
Q

How to do tx predisposition to infection seen in nephrotic syndrome?

A

give IV Ig

50
Q

In what kidney dz do you usually have active urinary sediment?

A

nephritic syndrome

(nephrotic syn usually has “bland” urinary sediment)

51
Q

What kidney dz is due to thrombotic microangiopathy?

A

nephritic syndrome

52
Q

What heart dz can cause nephritic syndrome?

A

endocarditis

53
Q

When are complement levels helpful in kidney dz dx?

A

low complement levels are very helpful in ddx of nephrITIC syndrome

low C4 and C3 –> classical pathway

low C3 onl –> alternative pathway activated

54
Q

What do you see in urine in acute tubular necrosis?

A

renal tubular epithelial cells

transitional epithelial cells

granular casts

waxy casts

55
Q

What do you see in urine in acute interstitial nephritis or pyelonephritis?

A

WBC

WBC casts

urine eosinophils

56
Q

What do you see in urine in vasculitis or glomerulonephritis?

A

dysmorphic RBCs

RBC casts

57
Q

What do you see in urine in nephritic syndrome?

A

proteinuria < 3.5 g/day

hematuria

dysmorphic RBC and RBC casts

58
Q

What do you see in urine in non-specific, prerenal azotemia?

A

hyaline casts

59
Q

What do you see in urine in UTI?

A

WBCs

RBCs

bacteria

60
Q

How does hyperkalemia affect resting membrane potential?

A

makes membrane potential less negative –> easier to depolarize

61
Q

D-dimer and BNP lab findings should be interpreted with caution in what setting?

A

renal failure

62
Q

What does a CXR look like in pulmonary edema?

A

diffuse alveolar consolidation

63
Q

What is the initial management and tx of hyperkalemia?

A

calcium gluconate to antagonize cardiac AP

To lower potassium levels:

insulin and dextrose

furosemide (will also help w/ pulm edema and anasarca)

albuterol nebulizer

could give sodium polystyrene sulfonate

64
Q

What glomerular disorders have subEPIthelial deposits?

A

post-strep glomerulonephritis

membranous glomerulonephritis

65
Q

What glomerular dzs have subENDOthelial deposits?

A

MPGN type I

SLE (diffuse proliferative GN)

(probably more but these are the main ones I memorized for the last test)

66
Q

What is the general management for most cases of AKI?

A

avoid nephrotoxins (NSAIDs, IV contrast, etc)

renal dose all medications (discontinue metformin)

avoid hypotension

avoid dehydration

67
Q

What is meloxicam?

A

prescription NSAID

(consider nephrotoxicity)

68
Q

What is normal capillary refill time?

A

<2-3 seconds

anything greater –> sign of dehydration or anemia

69
Q

What are signs of hypovolemia or prerenal azotemia?

A

hemoconcentration

hypovolemic hyponatremia

contraction metabolic alkalosis

BUN/Cr ration > 20:1

hyaline casts in urine

70
Q

What are signs of acute tubular necrosis seen in urinalysis?

A

proteinuria

renal tubular epi cells

transitional epi cells

granular casts

FENA > 2%

71
Q

How are prerenal azotemia and acute tubular necrosis connected?

A

if prerenal azotemia is present long enough, the pt will start to develop ATN

72
Q

What is the prognosis of AKI?

A

once kidney fxn declines regardless of etiology, there is no guarantee that fxn will recover or improve

if it improves, still no guarantee it will go back to baseline

can take up to 3 mos for recovery –> after 3 mos, if not to baseline = CKD

CPR-2 (28 decks)

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