Kidneys 101 (Exam 4) Flashcards

1
Q

3 basic functions of the kidneys?

A

Filtration of the blood
Regulating blood volume and blood pressure
Producing erythropoietin

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2
Q

The PCT reabsorbs what percentage of glucose and amino acids?

A

100%

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3
Q

The DCT is mainly involved in reabsorption of?

A

Sodium and calcium

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4
Q

What two lab values are needed to diagnose and acute kidney injury?

A

Cr and BUN

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5
Q

What are the 3 categories of renal disorders?

A

Prerenal
Intrarenal
Postrenal

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6
Q

AKI criteria?

A

Only need 1 of the following:
Increase in serum creatinine of >/= 0.3 above baseline within 48 hours
Serum creatinine increases >/= 50% in the past 7 days
Oliguria 6 hours

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7
Q

Normal Cr?

A

0.6-1.2 mg/dL

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8
Q

What is the single most valuable lab test in evaluating an AKI?

A

BMP

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9
Q

What other diagnostics are helpful for AKI?

A

Urinalysis, urine microscopy, measurement of urine output, renal ultrasound.

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10
Q

Life threatening complications of AKI?

A

Hyperkalemia
Fluid overload
Uremia
Metabolic acidosis

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11
Q

In what situations is dialysis indicated?

A
Serum creatinine >5-10
Unresponsive acidosis
Severe electrolyte disorders
Fluid overload
Uremic complications
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12
Q

AKI is most commonly due to?

A

Prerenal failure

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13
Q

Prerenal failure is defined as?

A

Reduced effective blood circulating to kidney

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14
Q

Causes of prerenal failure?

A

Reduction in fluid volume(hemorrhage, dehydration)
Effective volume depletion(CHF, cirrhosis)
Impaired renal blood flow (renal artery stenosis)

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15
Q

What lab findings are characteristic of prerenal failure?

A

Serum BUN:Cr ration >20:1
Urine sodium <20meq/L
Urine specific gravity >1.020

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16
Q

Why is urine sodium decreased in prerenal failure?

A

Kidney tries to increase BP by holding on to sodium and water

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17
Q

Treatment for prerenal failure due to CHF?

A

Diuresis

18
Q

Treatment for prerenal failure due to dehydration?

A

IVF

19
Q

Treatment for prerenal failure due to hemorrhage?

A

Blood + fluids

20
Q

What is the least common type of renal failure?

A

postrenal failure

21
Q

Blockage in what areas causes postrenal failure?

A

Ureters, bladder, urethra

22
Q

What diagnostic testing would you consider ordering for a patient suspicious for postrenal failure?

A

Post-void residual, ultrasound or IVP, +/- abdominal CT

23
Q

Treatment for postrenal failure?

A

Relieve obstruction

24
Q

What is intrinsic renal failure?

A

One or both kidneys have been damaged and do not work properly

25
Q

Most common cause of intrarenal failure?

A

Acute tubular necrosis

26
Q

Other causes of intrarenal failure?

A

Nephrotoxins
Interstitial diseases
Glomerulonephritis
Vascular diseases

27
Q

Labs findings suggestive of intrinsic renal failure?

A

Serum BUN:Cr ratio 10-15:1
Urine sodium > 40meq/L
FENa>2%
Urine specific gravity 1.010-1.020

28
Q

3 major causes of acute tubular necrosis?

A

Renal ischemia
Nephrotoxins
Sepsis

29
Q

Classic UA of ATN?

A

Muddy brown granular epithelial cell casts and free renal tubular epithelial cells

30
Q

Treatment for ATN?

A

Hold nephrotoxins, treat underlying cause, supportive management

31
Q

T/F? Most patients spontaneously recover renal function after ATN.

A

True

32
Q

What is acute interstitial nephritis?

A

An immune mediated process of tubulointerstitial injury

33
Q

Most common medications to cause acute interstitial nephritis?

A

Cephalosporins, penicillins, allopurinol, diuretics, NSAIDs, sulfonamides

34
Q

What are some non-iatrogenic causes of AIN?

A

illnesses - legionella, CMV, strep, ect

35
Q

UA findings in AIN?

A

WBCs, white cell casts, eosinophils, protein

36
Q

Treatment for AIN?

A

Stop offending med

Glucocorticoids

37
Q

What is glomerulonephritis?

A

Renal glomeruli are damaged by deposition of inflammatory proteins in the glomerular membrane

38
Q

What symptoms are classic for AIN?

A

Fever, maculopapular rash, eosinophilia

39
Q

Urine findings in glomerulonephritis?

A

Hematuria, urine may be tea or cola colored.
RBCs and RBC casts on UA.
Misshapen RBCs
Proteinuria

40
Q

Treatment for glomerulonephritis?

A

Nephrology consult!

Steroids and immunosuppressants.