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Clin Assess Renal > Exam > Flashcards

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1
Q

What are the steps to approaching kidney and urologic diseases?

A
  1. Assess cause, severity, and duration
  2. Urinalysis
  3. Assessment of GFR
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2
Q

What is the most common renal and ureteral stone?

A

Calcium

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3
Q

What is “renal colic”?

A

Unilateral flank pain that waxes and wanes

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4
Q

What is the typical presentation of nephrolithiasis?

A

Renal colic, hematuria

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5
Q

What is the imaging test of choice to diagnose nephrolithiasis?

A

Non-contrast CT scan

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6
Q

Besides a CT, what other test could you do to diagnose nephrolithiasis?

A

US
IVP
KUB x-ray

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7
Q

KUB x-rays are good for when patients have ??

A

Radiopaque calculi

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8
Q

What can cause urinary incontinence?

A

Stress - leaking with increased intra-abd pressure
Urge
Mix of both
Incomplete emptying of the bladder

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9
Q

What do you do on a physical exam to assess urinary incontinence?

A

Pelvic/bimanual exam
DRE
Neuro exam if sudden onset (cauda equina)

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10
Q

How do you workup a patient with urinary incontinence?

A 
UA
Prostate specific antigen
Postvoid residual (via US or catheterization)
\+/- urodynamic testing
Referral to urology for cystoscopy
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11
Q

Risk factors for acute cystitis

A

Sexual intercourse
Spermicide use
History of UTI

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12
Q

What is the classic presentation of a UTI?

A

Dysuria, frequency, urgency, suprapubic pain +/- hematuria

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13
Q

What should you check on a physical exam when assessing a patient for a UTI?

A

CV tenderness and abdominal exam

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14
Q

What labs should you order to assess a UTI?

A

Clean Catch UA (microscopy or dipstick)

Urine culture

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15
Q

What is the most common organism to cause a UTI?

A

E. Coli

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16
Q

What is typically present in a UA when a patient has a UTI?

A

Leukocyte esterase
Nitrites
+/- Hematuria

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17
Q

Symptoms of acute pyelonephritis?

A 
Fever
Chills
Flank pain
CVA tenderness
N/V
Irritative voiding
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18
Q

How do you workup a patient who you suspect has nephrolithiasis?

A

UA and urine culture
+/- Pregnancy test
CBC and blood culture
+/- CT scan or renal US

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19
Q

Many patients with Renal Cell Carcinoma are asymptomatic until ??

A

Disease is advanced

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20
Q

Classic triad of renal cell carcinoma?

A

Flank pain
Hematuria
Palpable abdominal renal mass

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21
Q

An abdominal flank mass is typically ?

A

Firm, homogenous, non-tender

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22
Q

With renal cell carcinoma, the fever is ___ ?

A

Intermittent

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23
Q

What will you see on labs in a patient with RCC?

A

Hypercalcemia, anemia

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24
Q

What is another name for a Wilms tumor?

A

Nephroblastoma

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25
What are the symptoms of a Wilms tumor?
Abdominal mass and swelling with no other signs/symptoms
26
What is one possible presentation of symptoms of a Wilms tumor?
Fever, HTN, abdominal pain, hematuria
27
Describe a Wilms tumor mass
Firm, non-tender, smooth mass eccentrically located and rarely crosses the mdiline
28
What is the imaging test of choice to diagnose a Wilms tumor?
Ultrasound
29
What is the classic presentation of bladder cancer?
PAINLESS hematuria
30
What are the risk factors for bladder cancer?
Smoking, occupational toxins
31
The physical exam on most patients with bladder cancer is ___
Unremarkable
32
What is the gold standard for diagnosing and staging bladder cancer?
Cystoscopy
33
What is the best way to identify the location of bladder cancer?
CT abd/pelvis with and without contrast
34
**Rapid** decline in kidney function
Acute kidney injury
35
With AKI, serum creatinine will be ___ and GFR will be ____
Increased | Decreased
36
AKI results in the inability to ? (4 things)
- Maintain acid-base balance - Maintain fluid balance (decreased urine output) - Maintain electrolyte balance - Excrete nitrogenous wastes
37
1-1.5 fold increase in serum creatinine or decreased urinary output to 0.5ml/kg/h for 6-12 hours
Stage 1 AKI
38
2-2.9 fold increase in serum creatinine or decreased urinary output to 0.5ml/kg/h for more than 12 hours
Stage 2 AKI
39
Greater than 3 fold increase in serum creatinine or decreased urinary output to less than 0.3ml/kg/h for greater than 24 hours or anuria for greater than 12 hours
Stage 3 AKI
40
What are the three causes of AKI?
Pre-renal Intrinsic Postrenal
41
What is the most common cause of AKI?
Prerenal
42
Sudden and severe drop in blood pressure or interruption of blood flow to the kidneys from severe injury or illness, volume depletion (e.g. diarrhea)
Prerenal AKI
43
Obstruction of flow; tumor, enlarged prostate, kidney stones, injury
Postrenal AKI
44
Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply (ATN most common)
Intrinsic AKI
45
What do you order to workup AKI?
BMP UA Urine output +/- Kidney biopsy
46
Urine output less than 50mL in 24 hours
Anuria
47
Urine output less than 500mL in 24 hours
Oliguria
48
What are the indications for dialysis in AKI?
AEIOU ``` Acidosis Electrolyte disturbance Ingestions Overload (pulmonary edema) Uremia ```
49
End stage chronic kidney disease often causes ___ symptoms
Uremic
50
What is the most common cause of ESKD?
DM or HTN
51
Patients with CKD have an increased risk of ___ mortality
CV
52
What is the definition of CKD?
Presence of kidney damage (urinary albumin excretion of greater than 30mg/day) or decreased kidney function (GFR less than 60) for three or more months
53
Why is CKD often associated with anemia of chronic disease?
Decreased EPO production
54
What will you see on US in advanced stages of CKD?
Bilateral small, echogenic kidney
55
When do you refer a patient with CKD to a nephrologist?
Stage 3-5
56
What are the two options for treatment with ESKD?
Dialysis, kidney transplantation
57
Block of urinary flow anywhere along the urinary tract
Hydronephrosis
58
Hydronephrosis can be?
Acute or chronic Partial or complete Unilateral or bilateral
59
What does obstruction from hydronephrosis cause?
Kidney stones, cancer, external compression
60
Can hydronephrosis be reversed?
If found early
61
If hydronephrosis goes unrecognized, what can happen?
UTI, urosepsis, ESRD
62
Does hydronephrosis always indicate obstruction?
NO!
63
What are the symptoms of hydronephrosis?
Pain, changed urine output, HTN, hematuria, increased serum creatinine
64
What is the imaging test of choice to diagnose hydronephrosis?
Renal ultrasound
65
What is the hallmark finding of hydronephrosis?
Dilation of the collecting system in one or both kidneys
66
What is typically found in the urine sediment of glomerular disease?
Presence of RBCs and occasionally WBCs and casts
67
What two patterns are seen with glomerular disease?
Nephritic and nephrotic (focal or diffuse)
68
How do you workup glomerular disease?
``` UA GFR Serum creatinine Serum albumin Serologic testing ```
69
How do you diagnose glomerular disease?
Kidney biopsy
70
Characterized by active urinary sediment
Nephritic syndrome
71
Characterized by proteinuria (greater than 3.5g/d) and lipiduria with fatty casts
Neprhotic syndrome
72
Patients will have edema and hyperlipidemia
Nephrotic syndrome
73
Patients will have hypoalbuminemia and serum creatinine will be normal
Nephrotic syndrome
74
May have renal insufficiency (decreased GFR)
Nephritic syndrome
75
Caused by IgA nephropathy, post infectious GN, lupus, Membranoproliferative GN
Nephritic syndrome
76
Caused by minimal change disease, amyloidosis, focal glomerulosclerosis, diabetic neuropathy
Nephrotic sydrome
77
What will the face look like in a patient with nephrotic syndrome?
Puffy face with periorbital edema and swollen lips
78
Polycystic kidney disease is ?
Autosomal dominant
79
PKD is often clinically _____
Silent
80
With patients with PKD, they will sometimes present with?
HTN Hematuria Proteinuria Renal insufficiency
81
What clinical manifestations are common with patients with PKD?
Flank pain UTI Calculi
82
How do you diagnose PKD?
Renal ultrasound
83
What will you find on US of a patient with PKD?
Large kidneys | Extensive casts scattered throughout both kidneys
84
Causes a persistent and progressive decrease in GFR due to reduction of blood flow from atherosclerotic ischemia
Renal artery stenosis
85
What labs will increase with renal artery stenosis?
Serum creatinine and BUN
86
What is the gold standard imaging to diagnose renal artery stenosis?
Renal angiography
87
What is tested on a urine dipstick test?
``` Urine pH Specific gravity Protein Blood Glucose Leukocyte esterase Ketones Nitrites Bilirubin Urobilinogen ```
88
Reflects hydration status and concentrating ability of the kidneys
Specific gravity
89
What is the hallmark of kidney disease?
High protein in the urine
90
Leukocyte esterase is produced by?
Neutrophils
91
Ketones are a product of?
Fat metabolism
92
What can be seen on a microscopic examination of urine?
Crystals cells Casts Bacteria
93
Casts seen with pyelonephritis, CKD
Hyaline casts
94
Casts seen with GN
Red cell casts
95
Casts seen with pyelonephritis, interstitial nephritis
White cell casts
96
Casts seen with ATN, interstitial nephritis
Renal tubular cell casts
97
Casts seen with CKD
Broad, waxy casts
98
Casts seen with nephrotic syndrome, kidney disease, hypothyroidism
Fatty casts
99
What are the 3 types of catheters
External (condom or urinary pouch) Urethral (Indwelling foley or straight) Suprapubic (placed by surgeon)
100
Does every type of hematuria require evaluation?
Yes! Gross and microscopic need evaluation

Clin Assess Renal (1 decks)

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