Renal. AUR+crystAKI+protein+dial (07-29) (1)

Question 1

AUR.
urine volume?

Answer 1

oliguria =< 0,5 ml/kg/hr

Question 2

AUR. common complication of what? 2

Answer 2

surgery and anesthesia

Question 3

AUR. risk factors? nonsugical

Answer 3

advancing age
male sex
concomitant drugs (opioids, anticholinergics)
BPH
history of neurologic disease

Question 4

AUR. risk factors related to surgery?

Answer 4

abdominal, pelvic surgeries, abdominal arthroplasty
-> Bladder distention during general anesthesia
-> epidural anesthesia
-> high fluid intake during surgery

Question 5

AUR. clinical presentation? 4

Answer 5

suprapubic discomfort

bladder spasms

suprapubic fullness

HTN and tachy due to SNS stimulation

Question 6

AUR. diagnosis?
also what to rule out?

Answer 6

portable bladder scan
>300 ml urine
if inconclusve -> cath
(nelabai supratau kas cia parasyta)

urinalysis to rule out UTI

Question 7

AUR. treatment?

Answer 7

foley cath

Question 8

Crystal induced AKI. etiologies?6

Answer 8

acyclovir
sulfonamides
methotrexate
ethylene glycol
protease inhibitors
uric acic (tumor lysis syndrome)

Question 9

Crystal induced AKI. what viral medications? 2

Answer 9

acyclovir, proteoase inhibitors

Question 10

Crystal induced AKI. what syndrome may cause?

Answer 10

tumor lysis syndroem due to uric acid release

Question 11

Crystal induced AKI. clinical presentation?

Answer 11

usually asymptomatic
AKI => 7d of starting drug

Question 12

Crystal induced AKI. clinical presentation. what urinalysis?

Answer 12

hematuria, pyuria, crystals

Question 13

Crystal induced AKI. clinical presentation. what increases risk?

Answer 13

increased risk with volume depletion, CKD

Question 14

Crystal induced AKI. management? 3

Answer 14

discontinue of drug
volume repletion
loop diuretics

Question 15

Crystal induced AKI. what symptoms if they present?

Answer 15

hematuria, pyuria, crystaluria, flank pain

Question 16

UW. Dialysis. 5 groups of indications?

Answer 16

Acidosis
Electrolyte abnormalities (severe or symtomatic hyperK)
Ingestion
Overload
Uremia

Question 17

UW. Dialysis. Acidosis. what ,,criteria” in uw table?

Answer 17

Metabolic acidosis
pH < 7,1 refractory to medical therapy

Question 18

UW. Dialysis. electrolites. Symtomatic hyperkalemia?

Answer 18

ECG changes or ventricular arrhytmias

Question 19

UW. Dialysis. electrolites. Severe hyperkalemia?

Answer 19

> 6,5 refractory to medical therapy

Question 20

UW. Dialysis. Ingestion of what? 4

Answer 20

Toxic alcohols (methanol (M), ethylene glycol (E))
Salicylate (S)
Lithium (L)
Sodium valproate, carbamazepine
(I) isopropranolol
SLIME

Question 21

UW. Dialysis. overload?

Answer 21

Volume overload refractory to diuretics

Question 22

UW. Dialysis. uremia. what symtomatic?

Answer 22

Encephalopathy, pericarditis, bleeding

Question 23

UW. Dialysis. what lithium levels and symtoms?

Answer 23

Serum > 4
or
> 2,5 mEq/l with signs of lithium toxicity (seizures, depressed mental status) or inability to excrete lithium (renal disease, decompensated HF)

Question 24

UW. proteinuria. 4 types?

Answer 24

Selective glomerular
Non-selective glomerular
Tubular
Overflow

Question 25

UW. proteinuria. selective mechanism?

Answer 25

loss of negative charge of basement membrane, small to medium sized proteins (mostly albumin).

Question 26

UW. proteinuria. non-selective mechanism?

Answer 26

increased permeability to macromolecules. Macromolecules like transferrin and IgG present.

Question 27

UW. proteinuria. tubular mechanism?

Answer 27

small proteins on mass spectrometry like beta 2 microglobulin.

Question 28

UW. proteinuria. overflow mechanism?

Answer 28

Bence-Jones, hemoglobin, myoglobin.

Question 29

UW. proteinuria. the most common cause?

Answer 29

transient (intermitent)

Question 30

UW. proteinuria. what to do if suspect?

Answer 30

repeat urine dipstic twice.

Question 31

UW. proteinuria. what causes transient (intermitent)?

Answer 31

Can be caused by fever, exercise, seizures, stress, or volume depletion.

Question 32

UW. proteinuria. done dipstic twice. still persists?

Answer 32

If proteinuria persists or any of the initial studies are abnormal --> refer to nephrologist.

Question 33

UW. proteinuria. done dipstic twice. still persists. further investigation after nephrologist?

Answer 33

Further investigation: 24-hour urinary collection for protein, renal ultrasound, and renal biopsy.

Question 34

UW. proteinuria. what common in adolescent boys?

Answer 34

Increased protein excretion when patient is in upright position. Returns to normal in recumbent position.

Question 35

UW. proteinuria. also there may be persistent proteinuria (buvo ta lentele su range, bet vertes kitam BS kazkur yra)

Answer 35

.

Question 36

UW. proteinuria. algo. Asymptomatic, isolated proteinuria --> first moning urine --> elevated protein/Cr ratio -->?

Answer 36

Evaluate for glomerular/parenchymal disease

Question 37

UW. proteinuria. algo. Asymptomatic, isolated proteinuria --> first moning urine --> normal protein/Cr ratio -->?

Answer 37

do urinalysis and evaluate protein.

Question 38

normal protein/Cr ratio --> positive protein on urinalysis --> ?

Answer 38

orthostatic proteinuria

Question 39

normal protein/Cr ratio --> negative protein on urinalysis --> ?

Answer 39

transient proteinuria