Flashcards in Quiz 2 Deck (54)
Loading flashcards...
1
Sx of Diabetic Nephropathy
Albuminuria
Occult hematuria
Diabetic symptoms
2
2 key things to monitor w Diabetic Nephropathy
1. Microalbumin (random am sample or 24hr collection) N=0-30mg/d
-microalbuminuria: "high" 30-300mg/d
-macroalbuminuria: "very high" >300mg/d
2. HbA1c levels (>6.5% diagnostic for DM)
3
Risk factors for Diabetic Nephropathy
FMHx, advanced age, HTN, poor glycemic control, minorities, obesity, smoking, OCP
4
Tx for Diabetic Nephropathy
#1 treat diabetes; guidelines recommend drug therapy be initiated immediately
-Gingko (protect glomerulus)
-Flax and pumpkin seeds
-Curcumin (renal protective)
-Guggul
-Chromium
-ALA
5
Causes of Hypertensive Nephropathy
#1: Atherosclerosis (deposition of hyaline-like material on arteriole wall)
-Fibromuscular dysplasias
-Polyarteritis nodosa
-AV fistula
-Aortic aneurism
-Coarctation of aorta
-Embolism
6
Pathogenesis of Hypertensive Nephropathy
Decreased blood flow causes kidney to secrete renin, retain NaCl and H2O --> inc BP
Renin secretion also caused by Na depletion, hemorrhage, shock, CHF, renal artery stenosis
7
Sx of Hypertensive Nephropathy
Mb asx
HA, fatigue, confusion, vision changes, angina, HF, hematuria, epistaxis, irregular heartbeat, ear buzzing, pulmonary edema, uncontrollable HTN, L ventricular hypertrophy, HTN retinopathy, abdominal bruit
8
Labs (ish) for Hypertensive Nephropathy
Diastolic >120, HTN refractory to therapy. CBC, electrolytes, glucose, BUN, creatinine, UA, EKG, PLASMA RENIN, Captopril challenge test
9
Tx for Hypertensive Nephropathy
-Control BP
-Surgical reconstruction of damaged artery or bypass in case of hyperplasia
-Tx atherosclerosis (guggal, garlic, EFA, B vit)
-Vascular protectants (bioflavonoids, vaccinium)
10
Cx of Hypertensive Nephropathy
Early death
Hypertensive heart disease
MI
CHF
Kidney damage
KI failure
Stroke
Loss of vision
11
What population is Nephroptosis most common?
Females, young and thin, more common the right side. 64% of those w fibromuscular dysplasia of renal artery have this
12
What is happening with Nephroptosis?
Kidney drops >5cm upon moving from supine to standing. Theorized o be dt lack of perirenal fat and fascial support and/or longer renal vascular pedicle
13
Risk factors of Nephroptosis
Excessive weight loss
Frequent intense physical activity
14
Sx of Nephroptosis
Severe abdominal, CVA, flank pain and vomitting in upright position dt
1. acute hydronephorosis kinked proximal ureter
2. renal vessel lumen narrowing and ischemia
3. visceral nerve stimulation from traction
15
Nephroptosis Crisis sx
Severe pain, N/V, chills, tachycardia, oliguria, hematuria, proteinuria.
Pain relieved w upward movement of kidney/supine position
16
PE of Nephroptosis
kidney palpable in ipsilateral lower abdomen
17
DDX of Nephroptosis
Urolithiasis, cholecystitis, spastic bowel, PN, ovarian cyst, appendicitis, divertilucitis
18
Workup for Nephroptosis
renal US, IV urography
19
Tx for Nephroptosis
-Surgical nephropexy for symptomatic its w flank pain >1yr
-Laparoscopic nephropexy (newer tx)
20
3 Cystic diseases of the kidney
1. Simple or solitary cyst
2. Autosomal Dominant Polycystic Kidney Disease (ADPKD)
3. Acquired Renal Cystic Disease
21
Presentation of Simple cysts
Flank/back intermittent dull back pain, fever and malaise if infect. Abdominal mass, may be tender if infected
22
Diagnosis of Simple cysts
Labs: Normal UA
US: Sharply demarcated w smooth walls, enhanced back wall
CT: Smooth thin wall, sharply demarcated, should not enhance w contrast media
23
Tx of Simple cysts
Leave alone if simple
Const. hydrotherapy
Drainage or antimicrobial tx if infected
Surgery if obstruction
24
Dx of ADPKD
15-39yo w at least 3 cysts in BOTH kidneys, 40-59yo at least 2 cysts, AND positive FHx
25
Sx of ADPKD
Pain over both kidneys, gross hematuria, HTN, nocturne, palpable nodular kidney
Renal insufficiency: HA, N/V, weight loss
Infected: fever, chills, tender kidneys
26
Labs for ADPKD
-Incr. erythropoietin leads to inc HCB and HCT
-Anemia from blood loss
-Proteinuria, hematuria, pyuria, bacteriuria
-Uremia from renal insufficiency (inc BUN and creatinine)
27
Imaging for ADPKD
KUB: enlarged renal shadows up to 5x size
CT: 95% accurate, can detect from 0.5cm
US: Most cost effective, can detect 1-1.5cm
MRI: Differentiate Renal Cell Carcinoma
28
Cx of ADPKD
1. Gross Hematuria: rupture of cysts, mb CA
2. Nephrolithiasis: Ca oxalate
3. HTN
4. ESRF: 50% leads to renal failure
5. Pain: from enlarging cysts
6. Other: Cerebral aneurysm, MVP, aortic aneurysm, colonic diverticula
29
Tx of ADPKD
1. Low protein diet (0.5-0.75g/kg/d)
2. 3000ml or more fluids
3. Restrict caffeine
4. Flax oil
5. Avoid strenuous activity
6. Treat uremia, stones, infection
7. Tx HTN
8. Constitutional HP
9. Somatostatin, everolius
30
