Nephrolithiasis, Pyelonephritis, AKI

Question 1

What is the presenting chief complaint for nephrolithiasis?

Answer 1

flank pain/groin pain, N/V, inheritable/recurrent

Question 2

What is the presenting chief complaint for pyelonephritis?

Answer 2

flank pain/abd pain, fever/chills, N/V

Question 3

What is the presenting chief complaint for AKI?

Answer 3

asx, decreased urine output, fatigue, SOB/CP, N/V

Question 4

What are the sympathetics for the GU tract (includes bladder)?

Answer 4

T10-L2

Question 5

What are the sympathetics for the upper ureter?

Answer 5

T10-11

Question 6

What are the sympathetics for the lower ureter?

Answer 6

T12-L2

Question 7

What are the parasympathetics for the upper ureter?

Answer 7

OA, AA - vagus N

Question 8

What are the parasympathetics for the bladder and lower ureter?

Answer 8

S2-4

Question 9

What is the chapmans point for the kidney?

Answer 9

1 in lateral and superior to the umbilicus

Question 10

What is the chapman point for the ureters?

Answer 10

none

Question 11

what is the chapman point for the bladder?

Answer 11

umbilicus

Question 12

AIN is inflammation between the tubules and often a reaction to what?

Answer 12

Drugs such as NSAIDs, Abx, PPIs, diuretics

Question 13

What BUN Cr ratio suggests pre-renal azotemia?

Answer 13

20:1

Question 14

What is FeNa?

Answer 14

determines if the nephrons retain the ability to concentrate urine; can differentiate between ATN and pre-renal azotema

Question 15

FeNA of <1% suggests what?

Answer 15

tubules are intact; pre-renal azotemia

Question 16

FeNa >2% suggests what?

Answer 16

damaged tubules; ATN

Question 17

What is the gold standard for kidney imaging?

Answer 17

non constrast CT abd and pelvis

Question 18

What are the Ddx to rule out for nephrolithiasis?

Answer 18

pyelonephritis, abd organ pathology, ectopic pregnancy

Question 19

What initial labs/imaging should be performed for nephrolithiasis?

Answer 19

BMP or CMP, UA, beta-hCG (if female) –> non contrast CT if negative but if positive order US

Question 20

What are the expected lab/imaging results for nephrolithiasis?

Answer 20

Negative BMP +/- elevated BUN/Cr, UA + microscopic blood, - nitrites/leukocyte esterase, non contrast CT + for stone

Question 21

What DDx need to be ruled out for pyelonephritis?

Answer 21

nephrolithiasis, abd organ pathology, ectopic pregnancy, STIs

Question 22

What is the initial labs/imaging for pyelonephritis?

Answer 22

BMP or CMP, CBC, UA with culture, beta hCG if female, STI panel

Question 23

What are the expected lab results for pyelonephritis?

Answer 23

BMP negative +/- elevated BUN/Cr, CBC + leukocytosis, UA + nitrites and leukocyte esterase, culture + likely E coli, abx sensitivities, STI panel negative

Question 24

What Ddx need to be ruled out for pre-renal AKI?

Answer 24

intrinsic, post renal, CKD

Question 25

What initial labs/imaging should be performed for pre-renal AKI?

Answer 25

BMP or CMP, CBC, UA with microscopy w/ or w/o FeNa, +/- US

Question 26

What are the expected lab results for pre-renal AKI?

Answer 26

BMP + 20:1 BUN Cr, CBC -, UA specific gravity >1.030, FeNa <1%, microscopy hyaline casts, US no hydronephrosis or atrophy

Question 27

What are the Ddx to rule out for intrinsic tubular AKI (ATN)?

Answer 27

pre-renal, post renal, CKD

Question 28

What are the initial labs/imaging that should be done intrinsic tubular AKI (ATN)?

Answer 28

BMP or CMP, CBC, UA with microscopy with or wo FeNa, +/- US

Question 29

What are the expected lab results intrinsic tubular AKI (ATN)?

Answer 29

BMP + elevated BUN/Cr, UA microscopy shows tubular epithelial cells (granular casts), FeNa >2%

Question 30

What Ddx need to be ruled out for intrinsic interstitial AKI (AIN)?

Answer 30

pre-renal, post renal, CKD

Question 31

What labs/imaging should be done for intrinsic interstitial AKI (AIN)?

Answer 31

BMP or CMP, CBC, Ua with microscopy w or wo FeNa, +/- US

Question 32

What are the expected lab results for intrinsic interstitial AKI (AIN)?

Answer 32

BMP + elevated BUN/Cr, CBC showing eosinophilia, UA leukocytosis, microscopy WBC casts

Question 33

What Ddx need to be ruled out for glomerulonephritis?

Answer 33

pre-renal, intrinsic, post renal, CKD

Question 34

What labs/imaging should be done for glomerulonephritis?

Answer 34

BMP or CMP, CBC, UA with micropscy w or wo FeNA, +/- US

Question 35

What are the expected lab results for glomerulonephritis?

Answer 35

BMP + elevated BUN Cr, UA hematuria and proteinuria, microscopy RBC casts

Question 36

What Ddx need to be ruled for post-renal AKI?

Answer 36

pre-renal, intrinsic, CKD

Question 37

What labs/imaging should be performed for post-renal AKI?

Answer 37

BMP or CMP, CBC, Ua with microscopy w or wo FeNa, +/- US

Question 38

What are the expected results for post-renal AKI?

Answer 38

BMP + elevated BUN/Cr, US shows hydronephrosis