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(OMS1) PCM II Final > Approach to Renal or Genitourinary Complaint > Flashcards

Approach to Renal or Genitourinary Complaint Flashcards

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?

A

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

24
Q

What are complications assoc w/ CKD?

A 
CVD
CKD-MBD
anemia of CKD
electrolyte abnormalities
metabolic acidosis
volume overload
uremia
hypertension
25
Q

How is CKD related to secondary hyperparathyroidism?

A

CKD leads to hypocalcemia, hyper phosphate & vitamin D deficiency

leads to increase secretion of PTH by parathyroid gland so increase reabsorption of bone

26
Q

What is the major cause of death in end-stage renal disease?

A

cardiovascular disease (54%)

27
Q

What are indications for dialysis?

A 
A (severe acidosis)
E (electrolyte disturbance)
I (ingestion)
O (volume overlaod)
U (uremia)
28
Q

What is azotemia?

A

elevated BUN w/o symptoms

29
Q

What is uremia?

A

elevated BUN w/ symptoms (confusion, pruritus, metallic tase in mouth, fatigue)

30
Q

What does renal replacement therapy include?

A

Hemodialysis
Peritoneal dialysis
Renal Transplant

31
Q

What is important for hemodialysis?

A

good access to blood

32
Q

How do you define acute kidney injury (AKI)?

A

based on change in creatinine level from baseline or urine output

33
Q

What are major risk factors for AKI?

A 
old age
proteinuria
CKD
HTN
DM
CVD
exposure to nephrotoxins
cardiac surgery
fluid overload 
sepsis
34
Q

What are the 3 main etiologies of AKI?

A

pre-renal
intrinsic
post-renal

35
Q

What is pre-renal AKI?

A

not enough blood to kidneys due to hypotension, hypovolemia, reduced CO, systemic vasodilation

36
Q

What is post-renal AKI?

A

obstruction to kidney

bladder outlet or ureter obstruction or renal pevlic stones

37
Q

What is intrinsic AKI?

A

acute tubular necrosis
interstitial nephritis
glomerulonephritis

38
Q

Which drugs tend to cause acute interstitial nephritis?

A

antibiotics, NSAIDs, and PPIs

39
Q

Complications of AKI

A

development of CKD
progression of CKD
end stage renal disease
CVD

40
Q

What do you always need to do to diagnose AKI?

A

UA w/ urine microscopy

random sample to determine albumin/creatinine ratio

41
Q

What are main causes of AIN?

A

drugs, infections or autoimmune disorders

42
Q

What are common diagnostic tests for AKI?

A

UA w/ microscopy

urine albumin/cr or protein/cr

renal ultrasound

43
Q

Acute tubular necrosis (urinary pattern)

A

renal tubular epithelial cells, transitional epithelial cells, granular or waxy casts

44
Q

Acute interstitial nephritis or pyelonephritis (urinary pattern)

A

WBC, WBC cast, urine eosinophils

45
Q

Vasculitis or glomerulonephritis (urinary pattern)

A

dysmorphic RBCs, RBC casts

46
Q

Nephritic syndrome (urinary pattern)

A

proteinuria, hematuria, dysmorphic RBC & RBC casts

47
Q

Nephrotic syndrome (urinary pattern)

A

heavy proteinuria, lipiduria, minimal hematuria

48
Q

Non-specific pre-renal azotemia (urinary pattern)

A

hyaline cast

49
Q

Urinary tract infection (urinary pattern)

A

WBCs, RBCs, bacteria

50
Q

What is the purpose of ordering FeNA or FeUrea?

A

to differentiate pre-renal azotemia from intrinsic renal injury

51
Q

When is FeNa or FeUrea valid?

A

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
Q

Anuria

A

<50 to 100 ml/day

53
Q

Polyuria

A

> 3000 ml/day

54
Q

Why are urine eosinophils limited for AIN diagnosis?

A

not very sensitive or specific

many causes for urine eosinophils

55
Q

What are common causes of urine eosinophils?

A

AIN
pyelonephritis or UTI
Atheroembolic renal disease

56
Q

What influences AKI treatment?

A

etiology of disease

(OMS1) PCM II Final (9 decks)

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