AKI, CKD Flashcards

Question

name uurine sediment that correlated w/ dz

Answer 1

Progressive loss of renal function that persists for more than 3 months Commonly irreversible Usually caused by long-term diseases such as DM, HTN

Answer 2

1. 1.Underlying etiology causes _Adaptive hyperfiltration_ and nephron damage 2. 2.In response to any damage the kidney - kidney ↑ filtration rate to normal undamaged nephrons (_Hyperfiltration_) 3. 3.Hyperfiltration over time = glomerular hypertrophy, distortion of the glomerular architecture, sclerosis and l_oss of remaining nephrons_ 4. 4.Manifested by _proteinuria_ and progressive renal failure

Answer 3

_RAAS and AII activated trying to maintain GFR_ w/ resultant hyperfiltration however… _↑ Pore size_ in GM by AII = _increasing protein leak_ across the glomerular basement membrane Consequence of repeated and continued activation of the RAAS = _Microalbuminuria/Proteinuria -_ toxic to the tubules

Answer 4

**Uremic Syndrom**e: clinical manifestations of uremia / advanced renal failure (stage 5) * Symptomatic manifestations associated with Azotemia **Azotemia** = the accumulation of urea and other nitrogenous compounds and toxins caused by the decline in renal function

Answer 5

Stage 1: GFR ≥ 90 Stage 2: GFR 60-89 Stage 3: GFR 30-59 Stage 4: GFR 15-29 Stage 5: GFR \<15 or dialysis

Answer 6

Renal US (consider other imaging) – imaging modality of choice

Answer 7

* GFR \< 30ml/min (CKD Stages 4 and 5) * Rapidly progressive CKD * Poorly controlled HTN despite 4 agents * Rare or genetic causes Suspected renal artery stenosis

Answer 8

**•Difficult to control HTN: large dose loop diuretics** * Difficult to control edema * Hyperkalemia * Uremia

Answer 9

↑ BUN , Creatinine Hyperkalemia, & phosphatemia Hypocalcemia Proteinuria – RBC/ & WBC cast in urine

Answer 10

DM - leading Cause\*\* Diabetic Nephropathy HTN HTN Nephropathy

Answer 11

1. Damages vessels in the kidney 2. Elevated blood glucose rises beyond kidneys capacity to reabsorb glucose 3. Glucose remains concentrated in the fluid, raising its osmotic pressure and causing more water to be carried out, increasing urine volume = prerenal hypovolemia and RAAS activation

Answer 12

_Primary prevention_ * Tight glucose control * Diet/exercise **•\*BP control \<130/80 - delays the onset of microalbuminuria**

Answer 13

First sign – microalbuminuria Most common co-morbidity –hypertension

Answer 14

**ACEI/ARB’s – ALL patients even if normotensive** * •renal protective qualities – inhibits angiotensin * •If need another BP lowering med Loop Diuretic – + a second agent to aide in BP control _fluid overload_ avoid sodium Smoking cessation & Protein restriction Treat c_hronic metabolic acidosi_s w/ bicarbonate

Answer 15

CKD is a risk factor for cardiovascular disease

Answer 16

**HTN** accelerates the progression of CKD Controlling BP slows down ↓GFR •Inhibiting RAAS is effective in lowering BP and ↓ microalbuminuria

Answer 17

proteinuria and hypertension

Answer 18

**CKD Stages 1-3 w/ proteinuria**: _ACEI/ARB_ * ↓ progression of CKD & ↓ mortality/morbidity in HF _ACEI_: _Monitor serum creatinine & potassium_ concentration * •prior to initiation * •within 2 weeks of starting the drug * •and within 2 weeks after an increases in dose **Stage 4 & 5** require nephron consult before initiating ACEI/ARB

Answer 19

Monitor **serum creatinine & potassium** concentration * •prior to initiation * •within 2 weeks of starting the drug * •and within 2 weeks after an increases in dose

Answer 20

**•Expect worsening creatinine or ↓ GFR** - * if values stabilized after initial rise - continue * (if they do not stabilize d/c & consult nephro) •Contribution to **hyperkalemia, \>6.0mmol/**L - stop any other harmful drugs, ↓ or hold potassium retaining diuretics, ↓ loop diuretic dosage

Answer 21

Wilms Tumor Arises from primitive metanephric blastema: Sporadic or hereditary •Genetics: loss of function mutations of tumor suppression & transcription genes à WT1 suppression gene, Chrom 11

Answer 22

GU: cryptorchidism, hypospadias Isolated hemihypertrophy Sporadic aniridia u 10% assoc w/ _congenital malformation syndromes:_ **WAGR:** * •Wilms tumor * •Aniridia * •GU abnormalities * •Retardation, Intellectual disability Beckwith-Wiedeman syndrome Denys-Drash syndrome

Answer 23

asymptomatic abdominal mass (gentle Wilms tumor are fragile) * Smooth & firm * Well demarcated * Rarely crosses midline

Answer 24

**Abdominal U/S w/ Doppler:** * Confirms mass arises from kidney * Evaluates contra- kidney * Doppler **Contrast CT for ALL renal tumors:** •Chest, Abdomen– pelvis CT: metastases evaluation

Answer 25

**Radical nephrectomy & LN sampling** _Depending on staging/risk stratification:_ **Very low risk pts w/ uni- tumor**= * Nephrectomy _w/out chemo-/radiation_ **Most pts:** Nephrectomy & _Chemo-_ **High risk pts:** Nephrectomy & _Chemo- & Radiation_

Answer 26

Stage I – tumor limited to Kidney and is completely excised Stage II – Tumor extends beyond the kidney but is completely excised Stage III – Residual tumor confined to the abdomen Stage IV – presence of metastases Stage V – Bilateral renal involvement at the time of diagnosis

Answer 27

**Atherosclerotic diseas**e - ostial & proximal renal arterial segments * More common, elderly, CV risk factors **Fibromuscular dysplasia** -middle & distal renal arterial segments * Younger pts \<50, more common in females _Pathophys:_ 1. Narrowing of renal arteries 2. Kidney hypoperfusion 3. Renovascular hypertension & ischemic nephropathy 4. Renal failure

Answer 28

**HTN** * •Onset of HTN 50 y \<30y or \>50 y * •Severe or Refractory HTN * •Resistance to antihypertensive therapy * •Moderate-Severe HTN in pts w/ recurrent episodes of flash Pulmonary edema * •Nο FHx of HTN

Answer 29

Renal angiography •Done after positive screening test

Answer 30

**Atherosclerotic Disease: Goals:** Control BP, Stabilize renal function, ↓ CV complications _Medical therapy : 1st line: ACEIor ARBs_ * •Monitor Cre, GRF for first wks à If ⬆ Cre: D/C * •Suggests bi- RAS, RAS in Uni- functional kidney, or RAS in allograft if kidney transplant recipient _Angioplasty +/- stenting_ _Surgical bypass_ **Fibromuscular Dysplasia**: Medical therapy alone usually not advised _Percutaneous transluminal angioplasty_: Often curative

Answer 31

**calcium stones** (Ca oxalate \> Ca phosphate) 15% **struvite** (magnesium ammonium phosphate) * •Uncommon UTI organisms 5% **uric acid** – radiolucent (cannot see on CT) * •Gout, hyperuricosuria 1-3% **cystine**: radiolucent (usu faintly radio-opaque)

Answer 32

Renal colic begins suddenly & waxes and wanes lasting 20-60 mins Severe unilateral flank pain-- radiating to groin/testicle/labia (T10-S4 dermatome) Pacing, Rocking, Writhing, Constant movement unable to find position of comfort (contrast to peritonitis)

Answer 33

**NCCT of abdomen + pelvis:** identifies all stone types in all location (uric acid, pure cystine and certain drug stones not seen) * Ureteral dilatation * Collecting system dilatation * Perinephric stranding * Periureteric stranding * Nephromegaly * “Rim sign”

Answer 34

**KUB:** NOT radiolucent stones **IVP:** info about the stone * •size, location, radiodensity * •and degree of obstruction. **US**: Detects indirect signs of obstruction: * •Procedure of choice for patients who should avoid radiation * • children, pregnant women and woman in childbearing age.

Answer 35

US •children, pregnant women and woman in childbearing age.

Answer 36

NSAID ketorolac FIRST LINE)

Answer 37

give _strainer_ and bring in stone for analysis _Cocktail of medications_ * Diclofenac 50mg po bid * Valium 2mg po QID prn * Tamsulosin 10mg qd * Oxycodone 5-10mg q4-6hr prn

Answer 38

Upper urinary tract stones involve the renal pelvis and extend into at least 2 calyces (struvite stone) * •Always assoc w/ infection - Urease-producing bacteria * •Pro_teus species (most common)_ * •Staphylococcus species, Klebsiella species, Providencia species, and Pseudomonas species

Answer 39

Rarely present as colic type stones, **no pain!!** _•Medical tx not enough_ - Suppressive antibiotic therapy or Urease inhibitors (acetohydroxamic acid) **•PNL surgical tx of choice** followed by PNL & ESWL combination

Answer 40

Tamsulosin – Med Expulsion Therapy •assoc 65% greater likelihood passage \>5mm distal stones

Answer 41

Extracorporeal shock wave lithotripsy Ureteroscopy Percutaneous nephrostolithotomy Percutaneous Nephrostomy Open nephrostomy

Answer 42

Uncomplicated stone \<10mm not passed in 4-6 wks * Symptomatic stones w/o other etiology for pain * \>10mm stones * Pregnancy and failed observation * Pediatric and failed MET _Contraindications:_ * Active UTI untreated * Coagulopathy * Pregnancy

Answer 43

Percutaneous Nephrostomy: Small tube through flank into renal pelvis for decompression (FASTEST) •Bridge to surgery

Answer 44

p**roximal stones**: Extracorporeal shock wave lithotripsy **mid and distal ureteral stones:** Ureteroscopy s**tones \>2cm and proximal collecting system:** Percutaneous nephrostolithotomy

Answer 45

Painless Hematuria (80-90%) \*\*

Answer 46

**Transitional cell carcinoma** : 90% of bladder Ca * Can arise anywhere in the urinary tract, including the renal pelvis, ureter, bladder, and urethra **Squamous cell carcinoma**: Up to 7% **Adenocarcinoma**: Rare _Risk Factors:_ **Cigarette smoking\*\*** Chronic urinary inflammation (SC injury & chronic catheter) **Occupational exposures\*\*** à organic chemicals, rubber, paint, paper production, and dye industries have increased risks of urothelial cancers.

Answer 47

Cystoscopy: Diagnostic standard w/ bx

Answer 48

**Non-muscle invasive** (Ta,T1,CIS): _Endoscopic TURBT_ w/ electrocautery or laser fulguration _Radical cystectomy_ _Immunotherapy and chemotherapy_: Intravesical instillation of BCG (Bacillus-Calmette Guerin) vaccine **Muscle-Invasive disease** (T2 and Greater) _Neoadjuvant chemotherapy before radical cystectomy_ (MVAC) * Methotrexate • Vincristine • Adriamycin • Cisplatin _Radical cystectomy w/ regional LN dissection_: Tx of choice\*\*\*\*\*\*\* _Radiation therapy (T2-3)_

Answer 49

**Hematuria (+/-painless)** Weight loss, Fever, Night sweats, Malaise L sided varicocele à obstruction of the testicular v. Supraclavicular LN **CLASSIC TRIAD** 1. flank pain 2. Hematuria 3. flank mass (10%)

Answer 50

Frequent occurrence w/ paraneoplastic syndromes

Answer 51

CT w/ contrast :

Answer 52

**Localized** dz: neohrectomy T1a \<4cm - partial nephrectomy T1b-T2 radical nephrectomy (recurrent 2-3%) **Locally advanced dz**: venous tumor thrombus à Dx w/ MRI Radical nephrectomy, LN dissection & IVC thrombectomy **disseminated** Palliative radical nephrectomy: to relieve sx Chemo & Radiation therapy: chemo & radioresistant tumor Biologic response modifiers: IL-2 & Interferon alpha Multikinase-inhibitor, VEGF inhibitor treatment

Answer 53

* lower extremity edema * isolated right-sided varicocele or one that does not collapse with recumbency * dilated superficial abdominal veins * pulmonary embolism * right atrial mass * nonfunction of the involved kidney

Answer 54

* TA Noninvasive papillary tumor * Tis Carcinoma in situ flat tumor **•T1** - in wedge _subepithelial conn. tissue_ **•T2** Tumor in _wedge muscle_ * •T2a tumor in superficial m, inner half * •T2b tumor in deep muscle, outer half **•T3:** through the _muscle layer of the bladder & into adipose_ **•T4**: _spread beyond the adipose to nearby organs_ or structures * •T4a: spread to the stroma of the prostate (in men), or uterus /vagina * •T4b: spread to the pelvic or abd wall

Answer 55

**•Stage I:—**Tumor is c_onfined within the kidney_ parenchyma * •**Ia:** \<4cm * •**Ib:** 4-7cm **•Stage II:**—_Tumor (\>7cm) involves the perinephric fat_ but is confined within Gerota's fascia **•Stage IIIA**:—Tumor i_nvolves the main renal vein or inferior vena cava_ **•Stage IIIB:**—Tumor i_nvolves regional LNs_ •**Stage IIIC:**—Tumor involves both _local vessels & regional LNs_ **•Stage IVA:**—Tumor _involves adjacent organs other than the adrenal_ (colon, pancreas, etc). **•Stage IVB:**—_Distant metastases_

AKI, CKD Flashcards

(82 cards)