Nephrology/Urology

Question 1

What does RIFLE help diagnose

Answer 1

Acute Renal Failure ARF and Acute kidney injury

Question 2

R of RIFLE

Answer 2

Risk of renal dysfunction:
GFR decreased more than 25% or sCR 1.5 fold increase
and UO is less than .5ml/kg/hr for 6 hours

Question 3

I of RIFLE

Answer 3

Injury to the kidney:
GFR decrease 50% or more, or sCR 2 fold increase
AND UO less than .5 ml/kg/hr for 12 hours

Question 4

F of RIFLE

Answer 4

Failure of kidney function:
GFR 75% or more decrease or sCR is 3x higher, or more than 4mg/dl in setting of acute increase of at least .5mg/dL
UO criteria: less than .3 ml/kg/hr for 24 hrs (oligouria) or anuria for 12 hrs

Question 5

L of RIFLE

Answer 5

loss of kidney function: persistant ARF - loss of function for more than 4 wks

Question 6

E of RIFLE

Answer 6

End stage kidney disease ESKD or ESRD: complete loss kidney function more than 3 mo

Question 7

What 2 disease cause most of the ARF cases?

Answer 7

reduced renal perfusion (lack blood flow to kidneys), and acute tubular necrosis

Question 8

3 categories of ARF causes

Answer 8

prerenal, intrinsic renal, and postrenal

Question 9

5 prerenal causes ARF

Answer 9

hypovolemia, hypotension, poor circulation volume (CHF, cirrhosis, early sepsis, nephrotic syndrome), aortic aneurysm, renal artery stenosis or embolic dz

Question 10

what category of ARF causes are most common?

Answer 10

prerenal

Question 11

5 intrinsic renal causes of ARF

Answer 11

acute tubular necrosis, nephrotoxins (NSAIDs, aminoglycosides, contrast), interstitial disease, glomerulonephritis, vascular disease (ie vasculitis, polyarteritis nodosa)

Question 12

Post renal causes

Answer 12

tubular obstructions, obstructive uropathy (urolithiasis, BPH, bladder outlet obstruction)

Question 13

What disease sx are.. N/V/D, pruritus, drowsiness, dizzy, hiccups, SOB, anorexia, hematochezia

Answer 13

ARF

Question 14

what sx indicate prerenal cause of ARF

Answer 14

tachycardia and hypotension

Question 15

signs of postrenal arf

Answer 15

distended bladder, CVA tenderness, enlarged prostate

Question 16

what do I order if suspect arf?

Answer 16

GFR, sCR, BUN, serum cystatin, urine biomarker options (IL 8, KIM1)

Question 17

what does a kidney less than 10 cm on ultrasound suggest?

Answer 17

chronic kidney problem

Question 18

when should dialysis be started for pts with ARF?

Answer 18

when sCR is above 5-10 mg/dL and/or if there is unresponsibe acidosis, electrolyte disorders, fluid overload, uremic complications

Question 19

CKD definition

Answer 19

GFR less than 60ml/min/1.73 m2 or presence of kidney damage from more than 3 mo

Question 20

CKD stage 1

Answer 20

kidney damage but normal GFR over 90 and persistent albuminuria

Question 21

CKD stage 2

Answer 21

damage plus mild GFR drop to 60-89

Question 22

CKD stage 3

Answer 22

GFR 30-59

Question 23

CKD stage 4

Answer 23

GFR 15-29

Question 24

CKD stage 5

Answer 24

kidney failure with GFR under 15

Question 25

how will stage 1 or 2 CKD pt present?

Answer 25

asymptomatic no BUN or sCR increase

Question 26

what will increase by stage 3 of CKD?

Answer 26

sCR and BUN, also other hormones will be weird (PTH, EPO, calcitriol)

Question 27

other signs of stage 4 CKD

Answer 27

anemia, acidosis, high K+, low Ca++, hyperphosphatemia

Question 28

4 most common cause of CKD

Answer 28

DM, HTN, glomerulonephritis, and polycysitic kidney dz

Question 29

what is gold standard of CKD diagnostics

Answer 29

GFR (MDRD equation is most accurate) for kids use a peds GFR calculator

Question 30

what will be elevated in CKD?

Answer 30

BUN and sCR, serum cystatin C may be elevated as well if below 88GFR

Question 31

CKD treatment

Answer 31

1. ACE or ARB to slow renal damage 2. Manage comorbid conditions 3. EPO, iron supplement, antiplatelet therapy considered to keep Hgb 11-12 4. Restrict PRO, Na, K, and phosphorus in diet 5. get pneumococcal vaccination and flu!! 6. hemodialysis, transplant etc.

Question 32

GN def

Answer 32

damage of renal glomeruli by deposition of inflammatory PRO in the glomerular membranes from an immunologic response

Question 33

focal GN

Answer 33

less than half of the GN affected

Question 34

diffuse GN

Answer 34

most glomeruli are affected

Question 35

common sx of glomerularnephritis

Answer 35

hematuria (tea or coke colored), edema of face in morning, edema feet or ankles evening, HTN common

Question 36

Diagnostics for GN

Answer 36

if recent streptococcal infection do a antistreptolysin 0 titer. UA finds hematuria, serum complement C3 will be low, renal biopsy helps with diagnosis/severity

Question 37

treatment GN

Answer 37

1. steroids immunosuppress 2. diet: restrict salt and fluids 3. dialysis if azotemia (high Cr and/or urea) with sx present 4. ACE and other comorbid meds

Question 38

Nephrotic syndrome

Answer 38

excretion of more than 3.5g of protein per 1.73m squared of body surface in 24 hours

Question 39

Nephrotic syndrome can lead to ____ due to loss of ____

Answer 39

thrombosis due to loss of Protein S, C and antithrombin III

Question 40

Sx of nephrotic syndrome

Answer 40

scrotal swelling, facial edema, oligouria, SOB, weight gain, abdominal distension, anorexia, ascites, HTN, retinal sheen, skin striae

Question 41

Oval fat body is what key finding

Answer 41

for nephrotic syndrome in the UA: a renal tubular cell that reabsorbed some excess lipids in the urine