Approach to Renal Complaint

Question 1

Proteinuria

Answer 1

Protein in the urine

Question 2

Glucosuria

Answer 2

Glucose in the urine

Question 3

Hematuria

Answer 3

Blood in the urine

Question 4

Dysuria

Answer 4

Painful urination

Question 5

Polyuria

Answer 5

Frequent urination

Question 6

UTI

Answer 6

Urinary Tract Infection

Question 7

GFR

Answer 7

Glomerular Filtration Rate

Question 8

CrCl

Answer 8

Creatine Clearance

Question 9

AKI

Answer 9

Acute Kidney Injury

Question 10

CKD

Answer 10

Chronic Kidney Disease

Question 11

ESRD

Answer 11

End stage renal disease

Question 12

Uremia

Answer 12

Elevated BUN levels

Question 13

BUN

Answer 13

Blood Urea Nitrogen

Question 14

What is and How is urea nitrogen created?

Answer 14

A waste product created when liver breaks down proteins and sends to kidney for excretion

Question 15

Cr

Answer 15

Creatine

Question 16

How is creatine created?

Answer 16

Waste product of muscle breakdown that is constantly produced and excreted by kidneys

Question 17

4 Renal labs

Answer 17

BMP
CMP
Urinalysis
Urine Microscopy

Question 18

What should the levels of protein, blood, glucose and bilirubin be in the urine?

Answer 18

ZERO

Question 19

CMP test

Answer 19

A BMP + liver function tests

Question 20

What is an AKI?

Answer 20

Impairment of renal function that results in retention of waste products that are normally excreted by kidney

Question 21

If AKI does not resolve in _____ it may progress to ____

Answer 21

3 months

CKD

Question 22

Is AKI a structural injury to the kidney?

Answer 22

NO

Question 23

List some risk factors for AKI

Answer 23

Old age
CKD
Hypertension
Diabetes
Nephrotoxins (NSAIDS, Antibiotics)

Question 24

What are the 3 categories of causes for AKI?

Answer 24

1. Pre-renal AKI
2. Intrinsic AKI
3. Post-renal AKI

Question 25

Pre-Renal AKI

Answer 25

Injury occurring upstream of the kidneys | ex. Hypertension

Question 26

Intrinsic AKI

Answer 26

Injury occurring at the level of the kidneys | ex. Glomerulonephritis

Question 27

Post-Renal AKI

Answer 27

Injury occurring downstream of the kidneys | ex. Bladder outlet obstruction

Question 28

Main physical exam finding for pre-renal AKI?

Answer 28

HISTORY IS IMPORTANT Fluid loss, volume depletion - dry tongue, poor skin turgor, hypotension

Question 29

Renal ROS?

Answer 29

All things urine | - Urine frequency, appearance, painful

Question 30

Main thing to look at during a renal exam?

Answer 30

Volume status! | - jugular venous pressure (distended?), dry tongue, cap refill, edema

Question 31

What are the very important labs to obtain on all patients with AKI?

Answer 31

BMP and Urinalysis with urine microscopy

Question 32

What must be present to diagnose CKD?

Answer 32

FOR AT LEAST 3 MONTHS: - GFR < 60 - Proteinuria and Abnormal urinary sediment

Question 33

GFR is less than ___ for CKD

Answer 33

60

Question 34

If the GFR is less than 60 for less than 3 months what is the diagnosis?

Answer 34

AKI

Question 35

In absence of _______, stages 1 and 2 of CKD are not enough to diagnose CKD

Answer 35

Kidney damage

Question 36

As you progress further towards CKD stage 5, what number is dropping?

Answer 36

GFR

Question 37

List some risk factors for CKD

Answer 37

AKI Hypertension Diabetes Cardiovascular disease (CVD)

Question 38

Signs and symptoms for CKD are similar to AKI. What are a few extra things to look for?

Answer 38

Pericardial friction rub Asterixis - wrist thing Uremic frost

Question 39

What are the 3 labs to get for CKD patients?

Answer 39

1. GFR 2. Proteinuria 3. Urinalysis with Urine microscopy

Question 40

GFR is not reliable in patients with?

Answer 40

AKI

Question 41

Treatment for CKD?

Answer 41

Dialysis

Question 42

Indications for dialysis?

Answer 42

``` A - acidosis E - electrolyte disturbance I - ingestion O - volume overload U - uremia ```

Question 43

Cystitis

Answer 43

Bladder infection

Question 44

Pyelonephritis

Answer 44

Kidney infection

Question 45

How does a UTI occur?

Answer 45

Colonization of urethra or urine with uropathogen

Question 46

Most common uropathogen with a UTI?

Answer 46

E. Coli

Question 47

Common causes of UTI

Answer 47

Sexual activity Outflow obstruction Fecal contamination

Question 48

Symptoms of cystitis

Answer 48

Dysuria, urinary frequency

Question 49

Symptoms of pyelonephritis

Answer 49

Dysuria, urinary frequency, fever, flank pain, nausea

Question 50

Important lab to order for UTI?

Answer 50

Urine culture

Question 51

What number should you be looking for with a urine culture?

Answer 51

> 100,000 cfu/mL

Question 52

What is the gold standard test for pyelonephritis?

Answer 52

Ct scan

Question 53

Special test for Kidney (pyelonephritis)?

Answer 53

Lloyd's sign (punch)

Question 54

Lloyd's sign

Answer 54

(+) = pain with deep percussion of costovertebral angle

Question 55

Treatment for UTI/cystitis/pyelonephritis?

Answer 55

Antiobiotics

Question 56

Nephrolithiasis

Answer 56

Kidney stones

Question 57

Normally, kidney stones are made of?

Answer 57

Calcium oxalate

Question 58

Symptoms of nephrolithiasis?

Answer 58

Pain, urinary urgency, dysuria, polyuria

Question 59

Upper ureter sympathetic innervation

Answer 59

T10-T11

Question 60

Upper ureter parasympathetic innervation

Answer 60

Vagus

Question 61

Lower ureter sympathetic innervation

Answer 61

T12-L2

Question 62

Lower ureter and bladder parasympathetic innervation

Answer 62

S2-S4

Question 63

Palpable points that are reflections of visceral dysfunction

Answer 63

Chapman's reflex points

Question 64

Anterior kidney chapman point

Answer 64

1 inch superior and 1 inch lateral to umbilicus

Question 65

Anterior bladder chapman point

Answer 65

umbilicus

Question 66

Posterior kidney chapman point

Answer 66

Lateral to spinous process of L1

Question 67

Posterior bladder and ureter chapman point

Answer 67

Transverse processes of L2