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Block 9; Week 5-M > Patterson-Kidney > Flashcards

Patterson-Kidney Flashcards

(94 cards)

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1
Q

What are some symptoms of kidney dysfunction?

A

gross hematuria or flank pain OR extra-renal signs/symptoms- hypertension, edema or confusion
OR asymptomatic w/ abnormal creatinine, BUN, GFR, urinalysis
Can also use ultrasound, CT, biopsy

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2
Q

What is GFR a measure of? What is a normal value for men & women?

A

GFR is a measured or estimated value of # of total functioning nephrons

men: 130ml/min
women: 120ml/min

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3
Q

How much fluid is filtered in humans per day?

A

180L/day

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4
Q

In the elderly the GFR decreases by how much each year?

A

0.75 ml/min per year

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5
Q

What is a normal GFR in a >70 yo w/o HTN or diabetes?

A

60ml/min

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6
Q

What does a low GFR suggest?

A

a decreasing GFR suggests loss of nephron function OR a superimposed problem influencing filtration

  • does not always suggest physical loss of nephrons
  • possible to have progressive renal disease and a normal GFR
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7
Q

How can you measure the GFR?

A

clearance (x) = U(x) x V/ P(x)

inulin-best but tough
creatinine clearance good estimate; Scr inverse to GFR

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8
Q

When might you want to use inulin?

A

chemo drugs–need a more specific knowledge of GFR

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9
Q

What is creatinine a product of?

A

diet & muscle mass. Need these to stay the same to make GFR comparisons.

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10
Q

Someone has Scr of 3 & it changes to 3.5
Another pt has Scr of 0.7 & it changes to 0.9
Which patient are you more concerned about?

A

0.7-0.9 represents a bigger change in GFR.

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11
Q

What is a normal Scr for women &men? Ethnicity relationship?

A

Average SCr 1.13 mg/dl men and 0.93 mg/dl women
Higher in Blacks, young patients
and lower in Hispanics, elderly

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12
Q

What are some factors that can cause lower Scr?

A

amputees
vegetarians
elderly

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13
Q

What are some factors that can cause higher Scr?

A

H2 blockers, trimethoprim, tenofovir–decrease secretion of creatinine, increase serum conc’n
assays can mistake Cefotaxime, flucytosine
for creatinine.
lots of meat intake, supplements

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14
Q

Is creatinine reabsorbed, secreted, metabolized by kidney?

A

secreted only in PCT 10-40%

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15
Q

How can you measure creatinine clearance to estimate GFR?

A

Cockcroft-Gault equation
MDRD (modification of diet in renal disease) equation
CKD- EPI equation

OR
Measure the CrCl with a 24 hr. urine collection

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16
Q

What’s the deal with the Cockcroft-Gault equation?

A

Male GFR = (140 - age) x (weight) / (sCr x 72)
Female GFR = (140 - age) x (weight) x 0.85 / (sCr x 72).

Good for younger person of normal weight with renal disease (GFR b/w 15-60)

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17
Q

What’s the deal with MDRD equation?

A

Less accurate in extremes of age or weight, pregnancy, amputees and cirrhosis. Good for patients w/ CLK & GFR 15-60.

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18
Q

What is the deal with the CKD-EPI equation?

A

Good for GFR >60. Better for elderly.

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19
Q

What is the equation for 24 hour clearance? When is it useful?

A

CrCl = (uCr x uV) / (sCr x 1440)

Use in pregnancy, extremes of age or weight, amputees, malnutrition. Not used very often.

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20
Q

Which is more accurate in estimating GFR: SCr or BUN?

A

Scr is more accurate b/c it isn’t reabsorbed in the kidney. BUN is reabsorbed (40-50%) in the PCT

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21
Q

What are some things that will raise BUN?

A

high protein diet
trauma
hemorrhage (GI bleed)

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22
Q

What are some things that will lower BUN?

A

low protein diet

liver disease

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23
Q

What is a case when you want to compare BUN & Scr?

A

when a person is dehydrated, body wants to reabsorb as much as it can
reabsorbs most of the urea in PCT–>increases BUN
creatinine isn’t reabsorbed, so SCr doesn’t rise.
BUN/SCr goes up!!
dehydration could mean hypovolemia/hypotension–>pre-renal failure.
BUN/SCr>20 suggest pre-renal failure.

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24
Q

What is FENa? What’s the equation?

A

fractional excretion of sodium

FENa % = [Una x Scr / Ucr x Sna] x 100%

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25
If you're not excreting a lot of sodium...what could that mean?
could mean that you need it all + your water! Hypovolemia/Hypotension maybe it could even mean pre-renal AKI
26
What is the FENa value consistent with pre-renal AKI? What are possible ddx?
<1% | could mean acute interstitial nephritis, myoglobinuria, contrast induced nephropathy
27
What are 2 things that can make FENa less accurate?
person w/ normal GFR | person on diuretics
28
If a person is on diuretics & you want to evaluate them for pre-renal AKI...what measurement should you use?
FEurea instead of FENa | FEurea<35% consistent with pre-renal AKI
29
What are the 3 aspects of the UA?
Appearance: color, clarity Dipstick Evaluation Microscopic Analysis
30
What do you look for in the dipstick evaluation?
Blood, leucocyte esterase, nitrates, pH, S.G, urobilinogen, protein, ketones and glucose, pH
31
WHat do you look for in the microscopic analysis?
Cells, casts, crystals, bacteria
32
We are talking clarity/color on UA. WHat would a turbid appearance mean?
Turbid urine suggests infection, crystals or leucocytes
33
What would a hazy urine suggest?
mucus
34
What would a milky urine suggest?
chyluria from nephrotic syndrome (severe) with dyslipidemia and oval fat bodies, profofol
35
What would blue, black, pink urine suggest?
inborn errors of metabolism
36
How should you interpret red/brown urine?
spin it!
37
How do you differentiate infection from crystals if you see a turbid UA?
spin it. | crystals will precipitate. infection won't.
38
How would hematuria present w/ UA?
see brown/red urine. spin it. | clear supernatant on top. red sediment on bottom.
39
How would hemoglobinuria, myoglobinuria present w/ UA?
see brown/red urine. spin it. pink/red supernatant on top. red sediment on bottom. dipstick in supernant, reacts + for blood.
40
How would beets, rifampin, food dyes show up on UA?
see brown/red urine. spin it. pink/red supernatant on top. red sediment on bottom. dipstick in supernant, no reaction for blood.
41
What are 2 weird things that can cause your urine to turn green?
asparagus | propofol
42
What is a normal pH range for a kidney?
4.5-8.5
43
What are some things that can cause a low pH of urine?
metabolic acidosis
44
What can make the pH of the urine higher?
UTIs urease producing organisms such as proteus mirabilis urea-->NH3
45
What do you worry about if the pH of the urine is greater than 5 but the patient is in metabolic acidosis?
renal tubular acidosis
46
What is specific gravity? How is it different from Uosmolality?
conc'n of blood based off of # & size of particles. | Uosm is just based off of #.
47
Give an example of something that increases s.g. but not Uosm.
glucose contrast dye protein
48
What serum glucose is required to exceed Tmax of glucose reabsorption in PCT & get glucose in the urine?
serum glucose of 180
49
Which ketones are detected on UA? What can cause an elevation of them?
ONLY acetoacetic acids NOT beta-hydroxybutyric acid or acetone elevated w/ starvation, Atkin's
50
So....your patient appears to be in diabetic ketoacidosis. You check their UA & there are no ketones. T/F He's fine.
False. Ketones on UA only detect acetoacetic acids. | Check his serum ketones!
51
What's the story of urobilinogen? When is it elevated?
comes from bilirubin. converted in the gut. 2% of it is excreted in the urine. can be elevated with: hemolytic anemia, intestinal obstruction
52
Which protein is measured on the UA? What is it not useful in detecting?
albumin ONLY is detected | not immunoglobulin light chains-->can't tell you if you have multiple myeloma
53
Urine protein less than _____mg/day is not detected on UA.
300
54
IF you see protein on UA, you need to further investigate. What are your options--which of them is best?
24 hr urine | spot urine protein/creatinine ratio--BEST option.
55
How is blood detected on uA?
see if it reacts with peroxidase. | will be + with blood, free hemoglobin, myoglobin
56
What can cause a false positive on UA? False negative?
FP-->semen | FN-->Vit C
57
How do you get nitrites in the urine?
nitrate reductase, found in E coli | can't get with enterococcus.
58
WBCs in urine and + nitrites/LE= ?
UTI
59
WBCs in urine and – nitrites/LE = ?
sterile pyuria (urine contains pus, w/o infection)
60
What are some different crystals that can be seen on microscopic analysis of urine?
uric acid calcium phosphate magnesium phosphate (struvite)
61
When do you see uric acid crystals?
Seen in acidic urine | Due to uric acid crystals from too much uric acid- lymphoma, leukemia esp. after treatment (tumor lysis syndrome)
62
When do you see calcium phosphate crystals?
Seen in alkaline urine | Associated with nephrolithiasis
63
When do you see struvite crystals?
Seen in alkaline urine | Esp with urease producing organisms: Proteus and Klebsiella
64
When is it common to see RBCs in the urine?
after...menses, exercise, sex, UTI
65
What is a glomerular hematuria?
dysmorphic RBCs, come from upper GI tract, may include acanthocytes (look like bite out of them)
66
What is nonglomerular hematuria?
isomorphic RBCs from lower GI tract,
67
What does the presence of neutrophils mean in the urine?
UTI, nephrolithiasis, glomerulonephritis, interstitial nephritis
68
What does the presence of eosinophils mean in the urine?
Acute kidney injury! interstitial nephritis seen with prostatitis & renal atheroemboli
69
What is a cast seen in urine?
Formed in tubule lumen with organic material and mucoprotein as the ‘cement’
70
Give an example of a normal cast & when it is seen?
hyaline cast--hypovolemia
71
Give some examples of pathologic casts & what they suggest.
RBC casts- suggest glomerular hematuria / glomerulonephritis WBC casts – suggest kidney inflammation, pyelonephritis Granular casts- degraded tubular protein Muddy brown sediment ATN-acute tubular necrosis
72
What is acute kidney injury?
Rapid loss of kidney function resulting in retention of nitrogenous waste products Begins with: increase creatinine, decreased urine output, acidosis, hyperkalemia
73
Which patients get a LOT of AKI? What is the criteria associated w/ this?
``` 50% ICU patients RIFLE criteria (risk, injury, failure, loss, end stage) ```
74
When you are staging AKI....which creatinine measurements do you compare?
most recent to the oldest one you can find
75
What is Stage 1 AKI?
best prognosis SCr increased by 1.5-2X, 0.3 Urine output <0.5 (6 hr)
76
What is Stage 2 AKI?
SCr increased by 2-3X | Urine output <0.5 (12 hr)
77
What is Stage 3 AKI?
SCr increased by 3X or more, 0.5 | Urine output <0.3 (24 hr)
78
Rank the most common types of AKI. Which is the most reversible?
1. Pre-renal (60%) reversible with proper fluids 2. Renal 3. Post-renal
79
``` Heart attack Liver failure Severe burns NSAIDs allergic rxn Which type of AKI do these produce? ```
Pre-renal | NSAIDS decrease prostaglandins, which have a slight vasodilatory effect. Decrease renal blood flow.
80
Blood clots in veins/arteries to kidneys, cholesterol deposits chemo, antibiotics, alcohol Which type of AKI do these produce?
renal | things that affect the blood vessel
81
What diagnostics do you use in diagnosing acute kidney injury?
SCr, Urinalysis with microscopy, BUN, Fena, Urine Osmolality and Urine sodium, renal ultrasound
82
What Una is concerning for pre-renal AKI?
Una<20 is a problem. diuretics compromise this test, however.
83
What are the 3 forms of intrinsic AKI?
* disease of small-large vessels of the kidney * disease of glomeruli * disease of tubules & interstitium
84
Give the 2 categories of disease of the glomeruli.
nephritic | nephrotic
85
What do you see with nephritic AKI?
``` inflammatory cells active urine sediment casts cells dysmorphic RBCs ```
86
What do you see with nephrotic AKI?
>3.5 grams protein/24 hours. minimal cells & casts bland urine!
87
Give some diseases of the vessels of the kidney that can lead to intrinsic AKI?
``` Thrombocytic thrombocytopenic purpura hemolytic uremic syndrome malignant hypertension renal infarction thromboembolism renal vein thrombus ```
88
What are some nephrotic syndromes that could produce AKI?
``` diabetic nephropathy minimal change disease focal segmental glomerulosclerosis membranous glomerulosclerosis HIV malignancy ```
89
What are some nephritic syndromes that could cause AKI?
post-strep glomerulonephritis IgA nephropathy rapidly progressive glomerulonephritis membranoproliferative GN
90
What are some tubulointerstitial things that can cause AKI?
acute tubular necrosis acute interstitial nephritis tumor lysis syndrome
91
When we are talking intrinsic AKI...how do we know it is ATN?
FENa >2% | Microscopy muddy brown cast
92
When we are talking acute interstitial nephritis...what are the tip offs?
``` FENa >2% Microscopy leucocytes (eosinophils) , erythrocytes, leucocyte casts, fevers, arthralgias, rash ```
93
What do you see in acute glomerulonephritis?
Microscopy hematuria, proteinuria, erythrocyte casts, dysmorphic erythrocytes
94
If you suspect post-renal AKI...what is the next diagnostic step? What else do you occasionally see?
ultrasound of kidneys | occasionally see hyperkalemia

Block 9; Week 5-M (5 decks)

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