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PCM II Final > Approach to Renal or Genitourinary Complaint > Flashcards

Approach to Renal or Genitourinary Complaint Flashcards

(56 cards)

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1
Q

What is important to ask about for kidney specific complaint?

A

precipitating event for pain

diabetic or hypertensive

drinking enough fluids

NSAID use

IV contrast exposure

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2
Q

Why is medication information important in kidney complaint?

A

medications are often the cause of kidney problems

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3
Q

Specific PE exams for kidney complaint

A

**volume status
cardiac exam
lung exam
abdominal exam

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4
Q

Definition of Chronic Kidney Disease

A

present for 3 months:

low GFR (<60ml/min)
markers of kidney disease
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5
Q

What are some markers of kidney disease?

A 
protein in urine
abnormal urinary sediment
abnormal biopsy
abnormal imaging
electrolyte abnormalities
hx of kidney transplant
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6
Q

What is acute kidney injury?

A

low GFR or marker of kidney damage that is less than 3 months

because kidneys usually recover w/ in 3 months of damage

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7
Q

What is urinary sediment?

A

RBC cast, WBC cast

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8
Q

Do stages 1 or 2 fulfill criteria for CKD?

A

No b/c no evidence of kidney damage (only lowered GFR)

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9
Q

What is the prevalence of CKD in US?

A

15% of US adults have CKD (about 1 in 7 adults)

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10
Q

What are the major CKD risk factors?

A 
diabetes mellitus
hypertension
CVD
acute kidney injury
family history of kidney disease 
nephrotoxic agents
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11
Q

What are the majority of CKD cases caused by?

A

diabetes or hypertension (64%)

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12
Q

When will patients have symptoms of CKD?

A

significant kidney dysfunction before start presenting w/ symptoms

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13
Q

Signs & symptoms of CKD

A 
edema
hypertension
decreased urine output
foamy urine
hematuria
uremia
pericardial friction rub
asterixis
uremic frost
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14
Q

What are the signs of uremia?

A

high urea in blood

nausea/vomiting
confusion
metallic taste in mouth
fatigue
anorexia
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15
Q

How do you diagnose CKD?

A 
serum creatinine 
GFR
creatinine clearance
proteinuria
UA w/ microscopy
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16
Q

Does elevated serum creatinine always indicate CKD?

A

NO because creatinine comes from muscle

so if more muscle mass, will have more creatinine

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17
Q

What are the 3 tests used to identify most CKD patients?

A

eGFR (an estimation!)

urine albumin to creatinine ratio (or urine protein to creatinine ratio)

UA

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18
Q

What should you look at on renal ultrasound?

A

renal size (should be proportional to height & not always symmetric)

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19
Q

What is suggestive of CKD on renal ultrasound?

A

small kidneys

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20
Q

What is hydronephrosis?

A

dilation of renal calyx (urine obstructed from leaving thru ureter)

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21
Q

What are key renal ultrasound findings for CKD?

A

atrophic/small kidneys

cortical thinning

increased echogenicity

elevated resistive indices (how much blood is flowing in kidney)

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22
Q

What is important in relationship of serum creatinine & GFR?

A

once get to 5-7 serum Cr, not a huge change in GFR so not huge change in kidney function

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23
Q

What happens to GFR with age?

Study These Flashcards
A

GFR declines by 1ml/min/year after age of 30-40

24
Q

What are complications assoc w/ CKD?

Study These Flashcards
A 
CVD
CKD-MBD
anemia of CKD
electrolyte abnormalities
metabolic acidosis
volume overload
uremia
hypertension
25
How is CKD related to secondary hyperparathyroidism?
CKD leads to hypocalcemia, hyper phosphate & vitamin D deficiency leads to increase secretion of PTH by parathyroid gland so increase reabsorption of bone
26
What is the major cause of death in end-stage renal disease?
cardiovascular disease (54%)
27
What are indications for dialysis?
``` A (severe acidosis) E (electrolyte disturbance) I (ingestion) O (volume overlaod) U (uremia) ```
28
What is azotemia?
elevated BUN w/o symptoms
29
What is uremia?
elevated BUN w/ symptoms (confusion, pruritus, metallic tase in mouth, fatigue)
30
What does renal replacement therapy include?
Hemodialysis Peritoneal dialysis Renal Transplant
31
What is important for hemodialysis?
good access to blood
32
How do you define acute kidney injury (AKI)?
based on change in creatinine level from baseline or urine output
33
What are major risk factors for AKI?
``` old age proteinuria CKD HTN DM CVD exposure to nephrotoxins cardiac surgery fluid overload sepsis ```
34
What are the 3 main etiologies of AKI?
pre-renal intrinsic post-renal
35
What is pre-renal AKI?
not enough blood to kidneys due to hypotension, hypovolemia, reduced CO, systemic vasodilation
36
What is post-renal AKI?
obstruction to kidney bladder outlet or ureter obstruction or renal pevlic stones
37
What is intrinsic AKI?
acute tubular necrosis interstitial nephritis glomerulonephritis
38
Which drugs tend to cause acute interstitial nephritis?
antibiotics, NSAIDs, and PPIs
39
Complications of AKI
development of CKD progression of CKD end stage renal disease CVD
40
What do you always need to do to diagnose AKI?
UA w/ urine microscopy random sample to determine albumin/creatinine ratio
41
What are main causes of AIN?
drugs, infections or autoimmune disorders
42
What are common diagnostic tests for AKI?
UA w/ microscopy urine albumin/cr or protein/cr renal ultrasound
43
Acute tubular necrosis (urinary pattern)
renal tubular epithelial cells, transitional epithelial cells, granular or waxy casts
44
Acute interstitial nephritis or pyelonephritis (urinary pattern)
WBC, WBC cast, urine eosinophils
45
Vasculitis or glomerulonephritis (urinary pattern)
dysmorphic RBCs, RBC casts
46
Nephritic syndrome (urinary pattern)
proteinuria, hematuria, dysmorphic RBC & RBC casts
47
Nephrotic syndrome (urinary pattern)
heavy proteinuria, lipiduria, minimal hematuria
48
Non-specific pre-renal azotemia (urinary pattern)
hyaline cast
49
Urinary tract infection (urinary pattern)
WBCs, RBCs, bacteria
50
What is the purpose of ordering FeNA or FeUrea?
to differentiate pre-renal azotemia from intrinsic renal injury
51
When is FeNa or FeUrea valid?
in oliguric patients (<400 to 500ml/day) intended for low urine output pts (due to intrinsic problem in kidney or due to low circulating volume?)
52
Anuria
<50 to 100 ml/day
53
Polyuria
>3000 ml/day
54
Why are urine eosinophils limited for AIN diagnosis?
not very sensitive or specific many causes for urine eosinophils
55
What are common causes of urine eosinophils?
AIN pyelonephritis or UTI Atheroembolic renal disease
56
What influences AKI treatment?
etiology of disease

PCM II Final (6 decks)

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