Flashcards in Global Approach to Renal Disease Deck (10):
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
What are the physical exam findings that indicate pre-renal disease?
decreased skin turgor
dry mucous membranes
What are the physical exam findings that indicate intra-renal disease?
Rales, S3, peripheral edema
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
anemia and hyperphosphatemia less useful
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
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
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)
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
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