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CPR 2 Exam 3 > Renal Approach To Proteinuria And Polyuria - Dr. Grin > Flashcards

Renal Approach To Proteinuria And Polyuria - Dr. Grin Flashcards

1
Q

3 layers of glomerulous

A
  1. Fenestrated Capillary Endothelium : keep out cells (RBC, WBC)
  2. Glomerular BM : keep out plasma proteins (albumin)
  3. Podocytes : keep out plasma proteins
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2
Q

tubules reabsorb what proteins

A

low molecular weight ones that got through the glomerular BM and Podocytes

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2
Q

tubules reabsorb what proteins

A

low molecular weight ones that got through the glomerular BM and Podocytes

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3
Q

proteinuria is what

A
  1. low molecular weight proteins

2. Tamm- Horefall protein (made by renal tubules)

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4
Q

normal daily protein excretion

A
  1. Protein : < 150mg/day

2. Albumin : < 30 mg/day

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5
Q

Glomerular proteinuria

A

Damaged glomerular filtration barrier = albumin in urine

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6
Q

Overflow proteinuria

A

low molecular weight proteins filtered to overload the reabsorption in tubules
= LMW proteins in urine

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7
Q

Overflow proteinuria happens when

A

light chains in urine from multiple myeloma

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8
Q

Tubulointerstitial proteinuria

A

tubular damage –> X reabsorption of LMW proteins

= LMG in urine

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9
Q

Tubulointerstitial happens when

A

ATN (acute tubular necrosis)

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10
Q

urinalysis

A

cheap easy

= detect albumin (low sensitivity)

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11
Q

Spot urine albumin / Cr ratio

A

detect small amounts of albumin = important for early DM nephropathy
(detects albumin, higher sensitivity)

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12
Q

Spot urine protein / CR ratio

A

detects albumin, light chains, B2-macroglobulin)

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13
Q

24 hour Urine protein

A

GOLD STANDARD for proteinuria

= inconvenient

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14
Q

how to detect light chain nephropathy

A

from MM

= protein / CR ratio test

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15
Q

what causes Glomerular proteinuria

A
  1. nephrotic syndrome

2. nephritic syndrome

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16
Q

Nephrotic Syndrome

A

podocytes are damaged from inflammation
= albuminuria
= loss of Antithrombin 3

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17
Q

nephrotic syndrome

A
  1. edema in body (hypoalbumin)
  2. thrombotic complications
  3. liver increases lipoproteins = hypolipidemia
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18
Q

edema in nephrotic syndrome

A
  1. hypoalbuminemia = low oncotic P

2. low BV low renal BF = renin is increased = worse edema

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19
Q

SX of nephrotic syndrome

A
  1. proteinuria (foamy urine)
  2. edema
  3. hyperlipidemia (xanthelasemia, fatty casts)
  4. hypercoagulation
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20
Q

nephritic syndrome sx

A

= HTN
= RBC casts
= AKI / oligouria
= Proteinuria

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21
Q

conditions that can cause nephrotic syndrome

A
  1. DM
  2. FSGS = focal seg glomerulosclerosis (HIV or chronic reflux)
  3. Membranous (HEP b,c, syphilis, SLE, solid tumors)
  4. Amyloid
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22
Q

conditions that can cause nephritic syndrome

A
  1. immune complex (post strep, SLE, IgA)
  2. Anti-GBM (goodpasture)
  3. ANCA associated (wagners, microscopic polyangitis, eosinophilic granulomatosis with polyangiitis)
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23
Q

minimal change disorder

A

most common cause of nephrotic syndrome in children (idiopathic or post infection)

24
Q

focal segmental glomerulonephritis can be caused by

A

HIV, heroin use, chronic reflux 1

25
Q

DX nephrotic syndrome is done with what

A
  1. serum Cr = GFR
  2. urinalysis micoscopy (not dipstick, to see casts and cells)
  3. urine albumin/cr, protien / cr
  4. HIV, Hep B/C, SPEP - amyloid, lipids, A1C testing
26
Q

Membranous nephrotic syndrome is causes by `

A

(HEP b,c, syphilis, SLE, solid tumors)

27
Q

TX nephrotic syndrome

A
  1. immunosuppressants
  2. loop diuretic + Na restriction (edema)
  3. control BP + ACE/ ARBs (proteinuria)
  4. statin (hyperlipidemia)
28
Q

ACE/ ARBs should be used when

A

protective agains renal failure in nephrotic syndrome

= should not be used if renal failure has progressed to hyperkalemia

29
Q

nephritic syndrome is what

A

immune response damaging capillary endothelium = RBC and WBCs leak into Glomerulus
= RBC casts
= Pyuria (from WBC)

30
Q

nephritic syndrome sx

A
  1. inflammation –> oliguria* (low GFR) –> AKI*
  2. Azotemia
  3. pyuria (WBC)
    = increase renin = rapid HTN*
  4. Hematuria **
31
Q

when is AKI from nephritic syndrome usually seen

A

in ANCA conditions

and Goodpasture’s

32
Q

immune complex problems in nephritic syndrome

A
  1. low complement :
    - Post infection (strep) +
    - SLE nephritis
  2. normal complement :
    - IgA nephropathy
33
Q

SLE can cause what (kidneys)

A

rapidly progressive glomeruolnephritis = EM (nephritic syndrome)

can also cause membranous nephrotic syndrome

34
Q

IgA nephropathy does what to kidney

A

hematuria (nephritic syndrome) DURING URI infection

not after like in post strep nephritic syndrome

35
Q

pulmonary renal syndromes and what can they do

A

ANCA
Anti - GBM
= can progress to rapidly progressive GN

36
Q

3 things causing nephritic syndrome that are ANCA

A
  1. Wegners
  2. microscopic polyangiitis
  3. eosinophilic granulomatosis with polyangiitis
37
Q

nephritic syndrome DX how

A
  1. serum Cr : GFR
  2. urinalysis microscopy
  3. urine albumin/cr, protein/ cr
  4. ANCA, Anto-GBM, ANA, complement testing
38
Q

active vs bland urine

A

nephritic syndrome : ACTIVE (RBC, WBC, RBC casts) only some protein

nephrotic syndrome : BLAND : high proteins

39
Q

nephritic syndrome TX when rapidly progressing GN

A

renal consult
HIGH STEROIDS
Plasma exchange

40
Q

Polyuria is what

A

more then 3L urine in 24hrs

41
Q

serum osmolality is regulated by what

A

thirst and ADH

42
Q

ADH

A

released from hypothalamus and released from PP
= bind to vasopressin receptor 2
= increase aquaporins to open
= increase water back to blood (decrease osmolality)

43
Q

4 causes of polyuria

A
  1. osmotic diuresis
  2. central diabetes insipidus
  3. nephrogenic diabetes insipidus
  4. primary polydipsia
44
Q

central diabetes insipidus is what

A

low ADH = cant concentrate urine

45
Q

nephrogenic diabetes insipidus

A

kidneys dont respond to ADH that binds

46
Q

primary polydipsia

A

patient is drinking excessive water

47
Q

osmotic diuresis

A

high solutes in blood

= glucosuria (high glucose in tubules)—-> more water into tubules

48
Q

Osmotic diuresis from glucosuria DX

A

Dipstick : high glucose + high urine osmolality > 300mOsm/L

49
Q

Diabetes Insipidus sx

A

large diluted urine output
tasteless
= you drink more water a lot

50
Q

Central Diabetes Insipidus causes that can cause it

A

trauma
tumor
congenital

51
Q

Central Diabetes Insipidus what happens when they are thirsty overnight

A

no change in ADH levels

52
Q

Central Diabetes Insipidus TX

A
  1. drink more water

2. Desmopressin to administer ADH

53
Q

Nephrogenic Diabetes Insipidus can be caused by what

A
  1. Lithium (medication for bipolar disorder)**

2. congenital abnormal vasopressin Rs or aquaporins

54
Q

Diabetes Insipidus and NA level

A

hypernatremia usually however can be compensated with drinking water

55
Q

Primary Polydipsia SX

A

urine osmolality is low

and this increases over night

55
Q

Primary Polydipsia SX

A

urine osmolality is low

and this increases over night

56
Q

Nephrogenic Diabetes Insipidus TX

A
  1. drink more water

2. Thiazide diuretics

CPR 2 Exam 3 (5 decks)

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