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Flashcards in Renal Deck (17)
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1

A protein to creatinine ratio (PCR) of 1 is equivalent to?

1 g of protein on a 24 hour urine
Most accurate test to determine protein excretion

2

Eosinophils on UA think?

Allergic or acute interstitial nephritis (AIN)

3

UA with false positive for blood? What will you see on microscopic exam?

Due to hemoglobin or myoglobin, but no RBCs on microscopic exam of urine

4

Urinary sodium and FENa prerenal azotemia

Both LOW
UNa: less than 20
FENa less than 1%
Decreased BP or intravascular volume will increase Aldo, which increases sodium reabsorption so it is low in urine
However more water is reabsorbed due to ADH, so urine is actually concentrated

5

Urine osmolality and sodium excretion in ATN

UNa above 20 – Wastes sodium
UOsm below 300– Inappropriately low (should be above 500) cannot concentrate
Inability to reabsorb sodium and water

6

Manifestation of sickle cell trait

Isosthenuria: defect in renal concentrating ability, will produce inappropriately dilute, high volume of urine despite dehydration

7

Causes of ATN and timing

Aminoglycosides, ampohotericin, nsaids, cisplatin, cyclosporine, Acyclovir
contrast media, prolonged ischemia, hemoglobin and myoglobin – rhabdo
Tumor lysis syndrome, ethylene glycol poisoning, Ben's Jones proteins
Contrast has a very rapid onset, creatinine may rise the next day
Other toxins need 5 to 10 days

8

What else is use besides IV hydration to prevent contrast induced nephrotoxicity, with little evidence to support their use

N – acetylcysteine, bicarbonate

9

Causes of renal papillary necrosis

SAAD papa
Sickle cell disease
Analgesics- NSAIDs
Acute pyelo
Diabetes

10

Electrolyte changes in rhabdo

Hyperkalemia, hyperuricemia, Hyperphosphatemia due to release from cells
LOW calcium as more calcium binds to damaged muscles
In contrast, hemolysis does not cause hyperuricemia because RBCs do not have nuclei butt muscle cells do

11

How to treat rhabdo

IV hydration, mannitol – osmotic diuretic, bicarb – drives potassium back into cells and may prevent myoglobin precipitation in the kidney tubules

12

What specific findings with cholesterol emboli

Eosinophilia/uria, elevated ESR, Low complement, preferable pulses are normal as they're too small to accrued large arteries

13

Drugs implicated in AIN

Penicillin, cephalosporin, sulfas (Lasix, thiazides), phenytoin, rifampin, quinolones, allopurinol, PPIs
These meds also cause drug allergy, rash, SJS, TEN, hemolysis (skin, kidney, RBCs)
Also SLE, sarcoidosis, infections

14

Diagnosis of papillary necrosis

UA shows RBCs and wbc's, may show necrotic kidney tissue
Best test: CT scan, shows abnormal internal structure of kidney from loss of the papilla

15

Abdominal pain, stroke or MI in a young person, digital gangrene
Elevated ESR and CRP

Polyarteritis nodosa
Systemic vasculitis of small and medium arteries that most commonly affects the kidneys, may affect virtually every organ except the lung, associated with hepatitis B

16

Diagnosis and treatment of PAN

Angiography, most accurate is biopsy of symptomatic site
Treat with prednisone and cyclophosphamide, also treat the hepatitis B

17

What is amyloidosis associated with

Multiple myeloma, chronic inflammatory diseases, RA, IBD, chronic infections