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Flashcards in Renal CIS Deck (35)
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1

Most accurate place to check for skin tenting

Forehead

2

Markers whose serum concentrations increase or decrease by at least 25% during inflammatory states and tissue injury

Acute phase reactants

3

Positive acute phase reactants (go up during infection/inflamm)

ESR
CRP
Ferritin
WBC
Haptoglobin
Ceruloplasmin

4

Negative acute phase reactants (go donw during infection/inflamm)

Albumin
Transferrin

5

Increased platelet count in the absence of a chronic myeloproliferative or myelodysplastic disorder, in pts who have a medical or surgical condition likely to be associated with an increased platelet count, and in whom platelet count normalizes or is expecte dto normalize after resolution of this condition

Reactive thrombocytosis

[examples are recent surgery, bacterial infxn, and trauma]

6

Ddx for prerenal AKI

Dehydration, hypotension (BUN/CR of 20:1 think more dehydration)

7

Intrarenal ddx for AKI

Anatomic abnormalities (atrophic kidney), toxins (environmental, medications like NSAIDs)

8

Postrenal ddx for AKI

Obstruction, stone, BPH

9

KDIGO diagnostic criteria for AKI

Increase in serum Cr of >0.3mg/dL within 48 hrs or >50% within 7 days

OR

Urine output of <0.5 mL/kg/hr for >6 hrs

10

First step to management of hyperkalemia

Need to get baseline EKG with elevated K

11

Clinical features of hyperkalemia

S/s uncommon, occur only when serum K is >7 — can include weakness and ventricular arrhythmias

12

What type of hyperkalemia does not produce ECG changes?

Pseudohyperkalemia

13

2 major mechanisms of hyperkalemia

Increased K release from cells — severe hyperglycemia, rhabdomyolysis

Reduced K excretion in urine — hypoaldosteronism, renal failure

14

ECG findings with hyperkalemia

Tall peaked T waves

Shrinking then loss of P waves

Widening of QRS interval and then sine wave, ventricular arrhythmia, and asystole

15

What do you give pts with a hyperkalemic emergency?

Calcium gluconate over 2-3 mins

Insulin and glucose

Give therapy to remove K from body if needed — hemodialysis, diuretics, GI cation exchanger like patiromer

Note: sodium polystyrene sulfonate should NOT be given unless there areno other options to effectively remove K from body in timely fashion

16

What is included on UA?

Leukocytes
Nitrite
Urobilinogen
Protein
pH
Blood
Specific gravity
Ketones
Bilirubin
Glucose

17

Catheters should be used only for appropriate indications and left in place only as long as needed. Who is especially high risk for catheter use?

Women, elderly, pts with impaired immune systems

Also avoid use in pts and nursing home residents for management of incontinence

18

Examples of appropriate indications for indwelling urethral catheter use

Pt has acute urinary retention or bladder outlet obstruction

Need for accurate measurements of urinary output in critically ill pts

Perioperative use for selected surgical procedures — urologic, prolonged duration, large volume infusions or diuretics anticipated, intraoperative urine output monitoring

Assist in healing open sacral or perineal wounds in incontinent pts

Pts who require prolonged immobilization (unstable spine fracture, multiple trauma such as pelvis fracture)

Improve comfort for end of life care as needed

19

Ddx of renal mass

RCC

Benign renal tumor — oncocytoma, angiomyolipoma, metanephric adenoma

Metastatic disease

Xanthogranulomatous pyelonephritis

20

Ddx of atrophic kidney in terms of in utero vs. first year of life vs. later

In utero — vascular events, urinary tract abnormalities like posterior urethral valves, VUR, UPJO, ACEI use, genetic abnormality, hyperglycemia/DM in mother, maternal vit A def, intrauterine growth retardation

First year of life — persistent anorexia and vomiting, FTT

After first year of life — frequent pyelo, other d/o that lead to renal scarring and ESRD

21

Indications for dialysis in patients with AKI

Fluid overload that is refractory to diuretics

Hyperkalemia > 6.5mEq/L or rapidly rising K levels refractory to other medical therapy

Metabolic acidosis pH < 7.1, for pts in whom admin of bicarb is not indicated (such as volume overload) or those with lactic acidosis or ketoacidosis in whom bicarb has not been shown to be effective

Signs of uremia such as pericarditis, neuropathy, or otherwise unexplained decline in mental status

22

Differentiate SIRS criteria from sepsis

Sepsis = systemic response to an infection defined by 2 or more SIRS criteria as a result of an infection

SIRS response is manifested by 2+ of the following:
Temp > 38 or < 36
HR > 90 bpm
RR > 20/min or PaCO2 <32 mmHg
WBC > 12,000/uL, <4000/uL, or >10% immature (band) forms

23

What should you ALWAYS get in sepsis pts before starting abx?

Blood cultures

24

MCC of UTI and pyelo

E.coli

Staph saprophyticus — honeymoon cystitis

Note that previous urine cultures can clue you in, pt likely has same organism

25

Anion gap calculation

Na - (Cl + HCO3)

26

Viscerosomatic reflex of the kidneys

T10-T11

27

Important considerations for female pts

Always ask LMP

Have pregnancy on DDx of all women of childbearing age

Ask about contraception including IUDs, OCPs

Begin to think of Gs and Ps of woman’s obstetric hx

28

Anterior chapmans reflex 2 inches above and 1 inch lateral to umbilicus

Adrenals

29

Anterior chapmans point 1 inch above and 1 inch lateral to umbilicus

Kidney/ureter

30

Anterior chapmans point in periumbilical region

Bladder