Global Approach to Renal Disease Flashcards Preview

Block 6 - Renal > Global Approach to Renal Disease > Flashcards

Flashcards in Global Approach to Renal Disease Deck (10):
1

What are findings in the history that indicate pre-renal vs. intra-renal disease?

pre - vomiting, diarrhea, blood loss, increased thirst
intra - increased urination, dyspnea, edema, nocturia, hematuria, renal stones

2

What are the physical exam findings that indicate pre-renal disease?

orthostatic hypotension
decreased skin turgor
dry mucous membranes
low JVP

3

What are the physical exam findings that indicate intra-renal disease?

HTN
retinopathy
elevated JVP
Rales, S3, peripheral edema

4

What are tools that can be used to assess duration of renal disease?

old medical records
kidney size - small means chronic
signs of renal osteodystrophy - supports chronic
kidney biopsy
anemia and hyperphosphatemia less useful

5

Why is it important to determine between acute and chronic renal disease?

acute - more likely to be self limited and better prognosis
treatment may vary

6

How is serum creatinine used to assess renal function?

varies inversely with GFR
but insensitive to mild to moderate reductions
also slow to reflect acute changes in function

7

What can be used as an alternative to creatinine to assess renal function?

24 hr urine collection with creatinine clearance
freely filtered and not reabsorbed - excreted by filtration
CCr can overestimate GFR in patients with CKD
can estimate with an equation or the MDRD (GFR)

8

How can you more directly measure GFR than using creatinine?

Inulin (or iothalamate) clearance - freely filtered and not reabsorbed or secreted
admin as continuous infusion, also expensive

9

What can the dipstick urine test detect or not detect?

detects negatively charged protiens (albumin)
cationic proteins (light chain Ig) will be negative - use SSA to detect all proteins

10

What does a negative dipstick with a positive SSA indicate?

multiple myeloma