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CPR II Week 7/8/9 > Renal Clinical Medicine Part 3: Approach to Proteinuria, Oliguria, and Polyuria (Selby) > Flashcards

Renal Clinical Medicine Part 3: Approach to Proteinuria, Oliguria, and Polyuria (Selby) Flashcards

1
Q

A urine output of less than 50-100 ml/day is defined as?

UOP less than 400-500 ml/day?

UOP more than 3,000 ml/day?

A

1) Anuria
2) Oliguria
3) Polyuria

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2
Q

Elevated blood urea nitrogen (BUN) without symptoms is known as?

Elevated BUN with symptoms?

A

1) Azotemia

2) Uremia

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3
Q

What is the criteria for chronic kidney disease (CKD)?

A

1) Markers of kidney damage

2) Decreased GFR (less than 60 ml/min)

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4
Q

When can a diagnosis of acute kidney injury be changed to chronic?

A

After 3 months of symptoms

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5
Q

In absence of evidence of kidney damage, what GFR categories do NOT fulfill the criteria for CKD?

A

Stage 1 or Stage 2

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6
Q

What are the main risk factors for CKD?

A

1) Diabetes mellitus
2) Hypertension
3) Cardiovascular disease
4) Acute Kidney Injury

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7
Q

What are some signs and symptoms of CKD? (8)

A

1) Edema
2) Hypertension
3) Decreased urine output
4) Foamy urine (proteinuria)
5) Uremia
6) Pericardial friction rub
7) Asterixis
8) Uremic frost

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8
Q

What are the 3 simple tests to identify most CKD patients?

A

1) eGFR
2) Urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio
3) Urinalysis

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9
Q

What are the renal ultrasound findings for CKD?

A

1) Atrophic or small kidneys
2) Cortical thinning
3) Increased echogenicity
4) Elevated resistive indices

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10
Q

What is used if you are worried about renal artery stenosis or renal vein thrombosis?

A

Doppler ultrasound

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11
Q

What complications of CKD are treated with renal failure diet that consists of low salt, potassium and phosphorus?

A

1) Hyperkalemia

2) CKD-BMD (Bone mineral disease)

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12
Q

What are the indications for dialysis when treating CKD?

A

AEIOU:

A: Severe Acidosis
E: Electrolyte disturbance (usually hyperkalemia)
I: Ingestion (ex: ethylene glycols, methanol, etc…)
O: Volume overload
U: Uremia

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13
Q

Acute kidney injury (AKI) can be defined by changes in either?

A

1) Serum creatinine

2) Urine output

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14
Q

What are the different categories when determining the etiology of AKI?

A

1) Prerenal
2) Intrinsic
3) Postrenal

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15
Q

What are causes of prerenal AKI?

A

1) Hypotension
2) Hypovolemia
3) Reduced cardiac output
4) Systemic vasodilation

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16
Q

What is the most common intrinsic AKI?

What are other causes?

A

1) Acute Tubular Necrosis

2) Interstitial Nephritis and Glomerulonephritis

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17
Q

What are causes of postrenal AKI?

A

1) Bladder outlet obstruction
2) Ureteral obstruction
3) Renal pelvis (Papillary necrosis from NSAIDS)

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18
Q

What are labs to obtain on all patients with AKI?

A

1) Urinalysis with urine microscopy

2) Urine Albumin/creatinine ratio or urine protein/creatinine ratio

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19
Q

What other diagnostic test may be done in patients with AKI in order to rule out hydronephrosis?

A

Renal ultrasound

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20
Q

Urinary pattern consisting of renal tubular epithelial cells, transitional epithelial cells, granular casts, or waxy casts are characteristic of what kidney disease?

A

Acute tubular necrosis

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21
Q

Urinary pattern consisting of WBC, WBC cast, or urine eosinophils are characteristic of what kidney disease?

A

Acute interstitial nephritis or pyelonephritis

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22
Q

Urinary pattern consisting of dysmorphic RBCs, RBC casts are characteristic of what kidney disease?

A

Vasculitis or glomerulonephritis

23
Q

Urinary pattern consisting of proteinuria (<3.5 g/day), hematuria, dysmorphic RBC and RBC casts are characteristic of what kidney disease?

A

Nephritic syndrome

24
Q

Urinary pattern consisting of heavy proteinuria (>3.5g/day), lipiduria, minimal hematuria are characteristic of what kidney disease?

A

Nephrotic syndrome

25
Q

Urinary pattern consisting of hyaline casts are characteristic of what kidney disease?

A

Non-specific, prerenal azotemia

26
Q

Urinary pattern consisting of WBCs, RBCs, and bacteria are characteristic of what kidney disease?

A

Urinary tract infection

27
Q

What is Nephrotic Syndrome defined as?

A

1) Proteinuria (> 3-3.5 grams/day)
2) Hypoalbuminemia
3) Peripheral edema
4) Hyperlipidemia
5) Lipiduria

28
Q

Why is infection a common complication of Nephrotic Syndrome?

Why is Vitamin D deficiency a common complication of Nephrotic Syndrome?

Why is Anemia a common complication of Nephrotic Syndrome?

A

1) Urinary loss of IgG
2) Urinary loss of Vitamin D Binding Protein
3) Urinary loss of Transferrin and Erythropoietin

29
Q

What is the most common cause of Nephrotic Syndrome?

What is the most common cause in children?

A

1) Diabetic Nephropathy

2) Minimal Change Disease

30
Q

What should be done to diagnosis Nephrotic Syndrome and Nephritic Syndrome?

A

Renal biopsy

31
Q

Between Nephritic and Nephrotic syndrome, which usually has active urinary sediment?

A

Nephritic

32
Q

What is Nephritic Syndrome defined as?

A

1) Hematuria
2) HTN
3) Proteinuria (< 3.5 grams/day)
4) AKI

33
Q

What can be very helpful in determining the DDx of Nephritic Syndrome?

A

Low complement levels (C3 or C4)

34
Q

What is Diabetes Insipidus characterized by?

A

Polyuria (Urine output more than 3 L/day)

35
Q

The differential diagnosis of polyuria includes?

A

1) Solute diuresis

2) Water diuresis

36
Q

What falls under the solute diuresis category?

A

1) Glucosuria
2) Urea
3) Sodium
4) Mannitol

37
Q

What are the basic requirements for forming concentrated urine?

A

1) Hypertonic Medullary Interstitium

2) High levels of ADH

38
Q

Serum osmolality is normally around?

It is regulated by?

A

1) 282 mOsm/kg

2) Osmoreceptor-ADH system and Thirst mechanism

39
Q

ADH has a short half-life of about?

It is metabolized by?

A

1) 15-20 minutes

2) Liver and kidney

40
Q

The glomerulus filters how much fluid per day from the plasma?

Where is 90% of it reabsorbed in?

The remaining 18 L is reabsorbed under the regulation of?

A

1) 180 L
2) Proximal tubule and descending limb of the loop of Henle
3) ADH

41
Q

ADH (aka Arginine Vasopressin) is a preprohormone synthesized by specialized nuclei in the?

A

Hypothalamus (Magnocellular nuclei)

42
Q

Once the ADH is produced in the magnocellular nuclei, it is transported down the axons of these nuclei to?

Once it reaches this area, it is released in response to?

A

1) Posterior pituitary

2) Osmotic or non-osmotic stimuli

43
Q

Osmotic stimuli is characterized by increases in serum osmolality which is detected by?

A

Osmoreceptors

44
Q

Non-osmotic stimuli is characterized by decrease in BP or increase in blood volume which are detected by?

A

1) Arterial baroreceptors

2) Atrial stretch receptors

45
Q

When ADH binds to V2 receptors it increases what levels?

This leads to insertion of what transporters in the apical and basolateral membrane?

A

1) cAMP

2) AQP-2 and Urea transporters

46
Q

What are the 2 main types of Diabetes Insipidus?

A

1) Central Diabetes insipidus

2) Nephrogenic diabetes insipidus

47
Q

Central Diabetes insipidus is caused by?

Nephrogenic diabetes insipidus?

A

1) Decreased release of ADH

2) Decreased response to ADH

48
Q

What can lead to Nephrogenic diabetes insipidus?

A

1) Lithium toxicity

2) Hypercalcemia

49
Q

When activated by elevated calcium levels, what induces degradation of AQP-2 channels by autophagosomes?

What does this lead to?

A

1) Apical membrane calcium sensor

2) Nephrogenic diabetes insipidus

50
Q

How is Diabetes insipidus diagnosed?

A

1) 24 hour urine volume collection
2) Urine osmolality < 300 mOsm/kg
3) Water deprivation test

51
Q

When performing the water deprivation test, if there is increase in urinary osmolality with exogenous vasopressin or desmopressin then what is the diagnosis?

If there is little or no increase?

A

1) Central diabetes insipidus

2) Nephrogenic diabetes insipidus

52
Q

What is the treatment of central diabetes insipidus?

A

Vasopressin

53
Q

What is the treatment of nephrogenic diabetes insipidus?

A

1) Decrease solute intake
2) Thiazide diuretics
3) NSAIDs

CPR II Week 7/8/9 (14 decks)

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