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CPRII- Renal Exam > Path-1 > Flashcards

Path-1 Flashcards

(44 cards)

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1
Q

MCC of CRF (chronic renal failure)/ ESRD (end stage renal dz). Other causes?

A

DM

Other causes include autoimmune dz (IgA nephropathy; lupus)

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2
Q

Average kidney size?

A

Weight: 120-150 g
Length: 10-12 cm
Width: 6 cm
Thickness: 3 cm

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3
Q

Where does renal colic pain begin and where does it g?

A

Begins at renal angle )between lower 12th rib border and lateral border of Erector Spinae), travels down and forwards to groin.

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4
Q

Why is R kidney lower?

A

Because of the liver

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5
Q

What structures are anterior to the L kidney?

A 
Suprarenal gland
Spleen
Stomach
Pancreas
Left colic flexure
Jejunum
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6
Q

What structures are posterior to the L kidney?

A

Diaphragm
11th and 12th ribs
Psoas major, quadratus lumborum and transversus abdominis
Subcostal, iliohypogastric and ilioinguinal nerves

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7
Q

What structures are anterior to the R kidney?

A

Suprarenal gland
Liver
Duodenum
Right colic flexure

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8
Q

What structures are posterior to the R kidney?

A

Diaphragm
12th rib
Psoas major, quadratus lumborum and transversus abdominis
Subcostal, iliohypogastric and ilioinguinal nerves

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9
Q

How do surgeons divide the retroperitoneum to treat a retroperitoneal hemorrhage/neoplasm?

A

Into three zones!

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10
Q

Zone I

A

Called the central midline retroperitoneum.

Contains:

  • abdominal aorta
  • IVC
  • root of the mesentery
  • portions of the pancreas and duodenum
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11
Q

Zone II

A

Zone II is the lateral retroperitoneum

Contains:

  • kidneys
  • adrenal glands
  • renal vasculature
  • ascending and descending colon
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12
Q

Zone III

A

Called the pelvic retroperitoneum

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13
Q

Are the kidneys always paired?

A

NO

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14
Q

How do most kidney issues present?

A
  • Hematuria, proteinuria, oliguria, anuria
  • HTN
  • Edema
  • Labs: Increased serum/urine Cr, decreased Cr clearance, increased serum BUN
  • Can be asx
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15
Q

Most important Q to ask a pt suspected of having renal dz?

A

Have you ever had this before? B/c there is a big difference between acute and chronic kidney injury.

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16
Q

What is the “gatekeeper” of the cell?

A

Cell membrane becuase it provides cellular structure, protects cytosolic contents, and allows cells to be specialized. Phospholipid bilayer is responsible for keeping homeostasis.

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17
Q

Compartments of the kidney?

A

Glomeruli, tubules, interstitium, vessels

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18
Q

What compartment does DM primarily affect?

Study These Flashcards
A

Glomeular (microvasculature)

But still could have tubulointerstitial features

19
Q

What compartment does systemic HTN primarily affect?

Study These Flashcards
A

Vascular (arteriolar)…so this is a tubulointerstitial dz

20
Q

What is the general category of glomerular disorders due to?

Study These Flashcards
A

Immunologic disorders…could be primary or secondary

21
Q

What causes the long term complications of DM?

Study These Flashcards
A

Persistent hyperglycemia aka glucotoxicity

22
Q

What are the prototypes of the compartmental renal dz processes?

Study These Flashcards
A
  • Glomeruli = glomerulonephritis
  • Tubules = Bence-Jones proteinuria
  • Interstitium = fibrosis, inflammation, or edema
  • Vessels = vasculitis, nephrosclerosis
23
Q

Azotemia

  • def
  • lab values
  • result of?
Study These Flashcards
A
  • Biochemical abnormality
  • BUN and Cr elevation due to a decreased GFR
  • Result of renal disorders but could also come from extra-renal insults (pre-renal or post-renal)
24
Q

Prerenal azotemia

Study These Flashcards
A
  • Happens after hypoperfusion of kidneys (hemorrhage, shock, volume depletion, CHF) –> leads to impaired renal fx
  • Impaired renal fx in absence of primary renal parenchymal damage
25
Postrenal azotemia
-Obstruction! Distal to calyces and renal pelvis. Remove obstruction corrects the azotemia.
26
Uremia definition
Azotemia + clinical sx resulting from renal damage
27
What kind of sx does a uremia pt have?
Usually nonspecific. Get worse over time.
28
Metabolic abnorms in uremia?
Anemia Acidemia Electrolyte abnormlaities
29
How could a diabetic pt present if they have uremia?
- May have better glycemic control as renal fx declines but they'll have more hypoglycemic episodes. - This is paradoxical due to increased insulin secretion and prolongation of its t1/2
30
What systems are affected (and their sx) in uremia?
Cardio: HTN, atherosclerosis, valvular stenosis, CHF, angina GI: occult GI bleed; NV; uremic fetor breath Neuro: fatigue, weakness, HA, amyloid deposits --> medial nerve neuropathy, carpal tunnel, or other nerve entrapments Cutaneous: fluid retention, edema; calcium phosphate deposition and nail atrphy
31
What do most uremic pt's also present w/?
Peripheral neuropathy
32
What are the general clinical signs of a pt w/ uremia?
- NV, WL, faigue, anorexia - Pruritus - Polydipsia - Electrolyte issues --> muscle cramps - Encephalopathy - Bleeding --> due to platelet dysfx and anemia - Pericarditis - Pleuritis/ pleural diffusion
33
Normal GFR?
90-120 mL/min/1.73 m^2
34
Clinical sx of AKI
- Rapid decline of GRF - Oliguria or anuria - Due to glomerular, interstitial, vascular, or acute tibular injury such as acute tubular necrosis - Reversible but can progress to CKD
35
Clinical sx of CKD
- Mild or silent - If severe --> uremia - Persistently decreased GFR (<60 mL/min for at least 3 months due to any cause) - Persistent albuminuria - Irreversible
36
Clinical sx of ESRD
GFR <5% normal | End stage of uremia
37
What are more characteristic of glomerular dz?
- Nephritic and Nephrotic - Asx hematuira or proteinuria - Chronic Renal Failure - Acute Renal Failure
38
What are more characteristic of tubulointerstitial dz?
- UTI - Obstruction - Renal tumor - Nephrolithiasis
39
Nephrotic Syndrome
- Severe PROTEINURUA - Hypoalbuminemia - Severe edma - Hyperlipidemia - Lipiduria
40
Nephritic Syndrome
- Acute onset HEMATURIA - Mild--> mod. proteinuria - HTN - May also have edema but is less common
41
Rapidly progressive glomerulonephritis
Nephritic syndrome signs + rapid decline in GFR
42
What do you see w/ isolated urinary abnormalities?
Glomerular hematuria and/or subnephrotic proteinuria
43
What could cause a glomerulus to be hypercellular?
Increased nuclei due to: 1. Endothelial cells 2. Mesangial cells 3. VIsceral epithelia 4. Inflammatory cell infiltrate 5. Crescents (if you see this --> rapidly progressing glomerulonephritis)
44
Histomorphologic features of glomerulopathies?
- Hypercellularity - Basement membrane thickening and deposits - Hyalinosis (glassy) - Sclerosis (obliterative) - Issue w/ visceral epithelial cells could lead to an issue w/ the barrier

CPRII- Renal Exam (6 decks)

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