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PCM II Final > Approach to Renal GU Complaint > Flashcards

Approach to Renal GU Complaint Flashcards

1
Q

Define Chronic Kidney Disease (CKD):

  • Present for _____ mos, w/ GFR < ______ ml/min AND/OR ______ present
A

Present for 3+ mos w/ GFR <60 ml/min AND/OR markers of kidney damage present

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2
Q

Define Acute Kidney Injury (AKI):

  • Present for _____ mos, w/ GFR < ______ ml/min AND/OR ______ present
A

Present for <3 mos, w/ GFR <60 ml/min AND/OR markers of kidney damage present

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3
Q

What are markers of kidney damage? List 6.

A
  • Proteinuria
  • Abnml urinary sediment
  • Abnml kidney biopsy
  • Abnml renal imaging
  • Electrolyte abnormalities from tubular disorders
  • Hx of kidney transplant
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4
Q

Under what circumstances would patients w/ a GFR category 1 (90+ ml/min) or category 2 (60-89 ml/min) be diagnosed w/ CKD?

A

If they had markers of kidney damage present for 3+ mos

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5
Q

Name 4 risk factors for CKD.

What are the top 2 that account for >60% of CKD?

A

4 risk factors:

  • DM
  • HTN
  • CVD
  • AKI

Top 2 risk factors: DM, HTN

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6
Q

Clinical Presentation of CKD and AKI (note: same types of sx just to different severities)

  • E_____
  • ____tension
  • ____ urine output
  • ____ urine
  • ____uria
  • ____emia
  • ____ ____ rub
  • A____ (hand tremors when wrist is extended)
  • Uremic ____ (crystallized urea)
A
  • Edema
  • Hypertension
  • Decreased urine output
  • Foamy urine
  • Hematuria
  • Uremia
  • Pericardial friction rub
  • Asterexis
  • Uremic frost

Also nausea, vomiting, metallic taste

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7
Q

What are 3 tests to diagnose most CKD patients?

A
  • eGFR (estimated) - utilizes equations
  • urine albumin-to-creatinine ratio OR urine protein-to-creatinine ratio
  • urinalysis
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8
Q

What abnormality does urine albumin-to-creatinine ratio OR urine protein-to-creatinine ratio tell us about?

A

proteinuria

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9
Q

What are 4 situations in which eGFR is not a reliable measure for diagnosing patients?

A
  1. AKI b/c of rapidly fluctuating creatinine levels
  2. GFR >60 ml/min
  3. Low muscle mass
  4. Patients <18 yo
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10
Q

Name 4 major abnormal renal ultrasound (U/S) findings to look for during imaging that would indicate CKD.

A
  • atrophic/small kidneys
  • cortical thinning
  • increased echogenecity
  • elevated resistive indices
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11
Q

Relationship between kidney fx and aging:

  • _____ declines by _____ ml/min/year after ages ___ to ____
A

GFR declines by 1 ml/min/year after ages 30 to 40

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12
Q

Majority (50+%) of deaths among CKD patients are due to what complication?

A

CVD

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13
Q

Indications for dialysis tx:

  • A:
  • E:
  • I:
  • O:
  • U:
A
  • A: severe acidosis
  • E: electrolyte disturbance (usually hyperkalemia, hypocalcemia, hyperphosphatemia)
  • I: ingestion of ethylene glycol, methanol
  • O: volume overload
  • U: uremia
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14
Q

Elevated BUN w/o sx is?

A

Azotemia

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15
Q

Elevated BUN w/ sx is?

A

Uremia

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16
Q

Current definition of AKI is based on what criteria established in 2012?

A

KDIGO guidelines

17
Q
  • According to KDIGO, AKI is defined as a change in _____ or _____.
  • The stage of AKI is then determined based on _______.
A
  • Change in serum creatinine (SC) or urine output (UO)
  • Stage based on whichever (SC or UO) is worse
18
Q

Major risk factors for AKI:

  • ____ age
  • ____uria
  • CKD, D___, H___, C___
  • ____toxins
  • ____ surgery
  • fluid _____
  • s____
A
  • old age
  • proteinuria
  • CKD, DM, HTN, CVD
  • nephrotoxins
  • cardiac surgery
  • fluid overload
  • sepsis
19
Q

Common etiology of AKI is divided into what 3 categories?

A
  • prerenal (i.e. “the hypos” - hypotension, hypovolemia)
  • intrinsic (i.e. tubular necrosis is a biggie)
  • postrenal (i.e. obstructions)
20
Q
  • 3 causes of acute interstitial nephritis (AIN)?
  • Of the above, the most common cause and 3 examples of it?
A
  • drugs, infections, autoimmune disorders
  • drugs: antibiotics, NSAIDs, PPIs
21
Q

Top 4 complications of AKI?

A
  • Development CKD
  • Progression CKD
  • ESRD
  • CVD
22
Q

What 2 labs need to be obtained on all patients w/ AKI?

A
  • urinalysis w/ urine microscopy
  • urine albumin-to-creatinine ratio or protein-to-creatinine ration
23
Q

Describe the general workup for an AKI patient

A
  • urinalysis w/ urine microscopy
  • urine albumin-to-creatinine ratio or protein-to-creatinine ratio
  • renal U/S
24
Q

Kidney disease suggested by the following urinary pattern:

  • Renal tubular epithelial cells, transitional epithelial cells, granular casts, or waxy casts
A

acute tubular necrosis (ATN)

25
Q

Kidney disease suggested by the following urinary pattern:

  • WBC, WBC cast, or urine eosinophils
A

acute interstitial nephritis (AIN) or polynephritis

26
Q

Kidney disease suggested by the following urinary pattern:

  • Dysmorphic RBCs, RBC casts
A

vasculitis or glomerulonephritis

27
Q

Kidney disease suggested by the following urinary pattern:

  • Proteinuria (<3.5 g/day), hematuria, dysmorphic RBC and RBC casts
A

nephritic syndrome

28
Q

Kidney disease suggested by the following urinary pattern:

  • Heavy Proteinuria (> 3.5g/day), lipiduria, minimal hematuria
A

nephrotic syndrome

29
Q

Kidney disease suggested by the following urinary pattern:

  • Hyaline cast
A

non-specific, prerenal azotemia

30
Q

Kidney disease suggested by the following urinary pattern:

  • WBCs, RBCs, bacteria
A

urinary tract infection (UTI)

31
Q

Anuria is how many ml/day?

A

<50-100 ml/day

32
Q

Oliguria is how many ml/day?

A

<400-500 ml/day

33
Q

Polyuria is how many ml/day?

A

>3000 ml/day

34
Q

What is the purpose of ordering an FeNa or FeUrea?

A

To distinguish between prerenal azotemia from intrinsic renal injury (i.e. ATN)

35
Q

FeNa or FeUrea is only valid in which type of patients, oliguric or non-oliguric patients?

A

Oliguric

36
Q

What 4 conditions are usually tested for using urine eosinophils?

A
  • acute interstitial nephritis (AIN)
  • pyelonephritis
  • UTI
  • atheroembolic renal disease

PCM II Final (10 decks)

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