Approach to Renal Complaint

Question 1

What is blood urea nitrogen (BUN)?

Answer 1

urea nitrogen is a waste product, created when the liver breaks down proteins; normally travels from the liver to the kidneys and is excreted as waste product

Question 2

what is creatinine?

Answer 2

waste product of muscle breakdown; created constantly and properly functioning kidneys excrete this waste product

Question 3

what are nitrites in the urine associated with?

Answer 3

UTI (bacteria have the ability to convert nitrate into nitrite)

Question 4

AKI may progress to CKD if the renal dysfunction is not resolved in what time frame?

Answer 4

3 months

Question 5

what might the history of a pre-renal AKI look like?

Answer 5

history of fluid loss or poor fluid intake, hx of decreased effective circulatory volume, chronic use of NSAIDs or blood pressure medications

Question 6

what might a physical exam of a pre-renal AKI patient look like?

Answer 6

dry mucous membranes, tachycardia, hypotension, poor skin turgor

Question 7

what might the history of an intrinsic AKI patient look like?

Answer 7

history of CKD/diabetes/HTN, history of recent URI, auto-immune disease, hematuria, foamy urine

Question 8

what might the history of a post-renal AKI patient look like?

Answer 8

kidney stones, prostate issues, pelvic neoplasm, foley catheter

Question 9

what are three important signs to check when assessing volume status?

Answer 9

jugular venous pressure (JVD), oral mucosa (dry, tongue fissuring), and skin tenting (poor skin turgor)

Question 10

what abdominal exam is important to assess when you have a renal complaint?

Answer 10

abdominal bruits (renal artery stenosis)

Question 11

what labs must you obtain to diagnose AKI?

Answer 11

BMP and UA

Question 12

how do you treat AKI?

Answer 12

it depends on the etiology (either pre, intrinsic, or post-renal)

Question 13

what should you discontinue if you diagnose a patient with AKI?

Answer 13

nephrotoxins

Question 14

what are the main risk factors for CKD?

Answer 14

DM, HTN, cardiovascular disease, AKI

Question 15

what are symptoms of uremia?

Answer 15

n/v, confusion, metallic taste in mouth, fatigue, pericardial friction rub, asterixis, uremic frost

Question 16

what are three simply tests to identify most CKD patients?

Answer 16

glomerular filtration rate (GFR), proteinuria, and urinalysis with microscopy

Question 17

what are the limitations of GFR?

Answer 17

it is not reliable when GFR is >60, not reliable in AKI, not reliable in low muscle mass patients

Question 18

how do you measure proteinuria?

Answer 18

urine albumin to creatinine ratio or urine protein to creatinine ratio

Question 19

what is GFR based off of?

Answer 19

weight, creatinine, race, and sex

Question 20

what are two major complications of CKD?

Answer 20

cardiovascular disease (CVD) and osteoporosis

Question 21

what are the indications for dialysis?

Answer 21

AEIOU; severe acidosis, electrolyte disturbance, ingestion (ethylene glycols, methanol, etc.), volume overload, uremia

Question 22

what is the most common cause of a UTI?

Answer 22

E. coli

Question 23

what should you look for in a urine culture to diagnose cystitis?

Answer 23

> 100,000 cfu/mL on urine culture

Question 24

the duration of antibiotics will vary based off UTI type and severity. What are these variations?

Answer 24

for cystitis: 3-5 days of treatment; for pyelonephritis: 7-14 days

Question 25

what is the medical term for kidney stones?

Answer 25

nephrolithiasis

Question 26

what is nephrolithiasis caused by?

Answer 26

precipitation of minerals in the kidney and ureters that were soluble in the blood

Question 27

what is the most common type of kidney stone?

Answer 27

calcium oxalate

Question 28

what stone is caused by infection with organisms that produce ammonia?

Answer 28

struvite stones

Question 29

where would a stone be located if the patient has flank pain?

Answer 29

at the kidney or the renal pelvis

Question 30

where would a stone be located if the patient has groin/lower abdominal pain?

Answer 30

at the lower ureter