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nephrology & urology > renal diseases > Flashcards

renal diseases Flashcards

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1
Q

What is acute renal failure?

A

Syndrome of rapidly deteriorating GFR with accumulation of nitrogenous wastes(urea, creatinine).

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2
Q

What is azotemia?

A

accumulation of nitrogenous wastes(urea, creatinine)

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3
Q

What happens to serum creatinine with ARF?

A

acutely increases by more than 0.5 mg/dL or more than 50% over baseline levels

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4
Q

GFR and UO criteria for “risk of renal dysfunction”

A

GFR: increased serum Cr 1.5 fold or GFR decreases more than 25% UO: UO less than 0.5 mL/kg/hr for 6 hours

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5
Q

GFR and UO criteria for “injury to kidney”

A

GFR: increased serum Cr 2 fold or GFR decrease more than 50%

UO less then 0.5ml/kg/hr for 12 hours

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6
Q

2 diseases that account for the majority of cases of ARF

A

reduced renal perfusion and acute tubular necrosis

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7
Q

3 possible signs of post renal causes

A

distended bladder, CVA tenderness, enlarged prostate

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8
Q

key parameter to measure renal function

A

GFR

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9
Q

what is an estimate of renal function, but sensitive to dehydration, catabolism, diet, renal perfusion, and liver disease

A

BUN

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10
Q

UA shows a few hyaline casts, but essentially normal

A

prerenal or postrenal causes of ARF

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11
Q

metallic taste, hiccups, N/V, fatigue, malaise, anorexia, dyspnea, orthopnea, impaired mentation, insomnia, irritability, mm cramps, RLS, weakness, pruritis, easy bruising, altered consciousness, delirium, seizures, coma, “pericarditis”

A

think uremia symptoms

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12
Q

what is the marker for kidney damage

A

proteinuria

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13
Q

what med can slow down the progression of renal dysfunction

A

ACE And ARBS

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14
Q

what drugs are renoprotective

A

ACE, reduce urinary protein loss

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15
Q

Minimal change disease tx

A

Lipoid nephrosis, do steroids

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16
Q

wegeners granulonatosis dx

A

it is a vasculitide, dx is ANCA

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17
Q

goodpastures syndrome

A

affects basement membrane of kidneys and lungs; has hematuria and hemoptysis

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18
Q

main cause of prerenal ARF

A

inadequate perfusion!

decreased blood flow to kidney

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19
Q

main cause of postrenal ARF

A

obstruction

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20
Q

eosinophils in urine

A

malignant HBP

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21
Q

what is increased in ARF

A

BUN/Cr, K++, phosphate, Mg

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22
Q

what is decreased in ARF

A

pH, bicarb(metabolic acidosis)

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23
Q

BUN/Cr ratio >20/1, urine osmolalitiy high, FENa low

A

prerenal ARF

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24
Q

common causes of CRF

A

DM mainly, PKD, HTN, glomerulonephritis

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25
what is increased in CRF
BUN, Cr, K++, phosphate, Mg
26
what is decreased in CRF
pH, bicarb, Ca(vit D made by kidney), Hct(no erythropoietin)
27
PTH controlled by what
calcium level
28
what is azotemia
accumulation of nitrogenous wastes(urea, Cr both increased)
29
kidney smaller than 10cm on renal ultrasonography
chronic problem
30
Urine Na, FE Na, urine osmolality, Bun to plasma ratio in prerenal
Na low, FE Na \<1%, osmolality 500, Bun to Cr ratio is 20:1
31
Urine Na, FE Na, urine osmolality, Bun to plasma ratio in an intrinsic cause
Na high, FE Na \> 1-2%, osmolality 250-300, Bun to plasma ration \<15:1
32
criteria for dx ESRD or ESKD
complete loss of kidney function for more than 3 months
33
ARF account for what percentage of hosptalized patients and critical care patients what is the overall mortality rate
5% 30% 10-50% depending on pt comorbidities and clinical setting
34
name 5 contributing factors to ARF
HTN, HypoTN, volume loss, CHF, DM
35
ARF symptoms
general symptoms: N/V, diarrhea, pruritis, drowsiness, dizziness, hiccups, SOB, anorexia, hematochezia
36
Signs of prerenal causes of ARF
tachycardia and hypoTN
37
Serum Cystatin C sensitivity & specificity
new serum biomarker for detecting AKI. 87% to 97& sensitive 85% to 100% specific
38
HTN, HypoTN, volume loss, CHF, DM
name 5 contributing factors to ARF
39
general symptoms: N/V, diarrhea, pruritis, drowsiness, dizziness, hiccups, SOB, anorexia, hematochezia
ARF symptoms
40
tachycardia and hypoTN
Signs of prerenal causes of ARF
41
a distended bladder, CVA tenderness, or enlarged prostate
Signs of postrenal causes of ARF
42
What is helpful for monitoring renal insufficiency and provide clues to cause
BUN and Cr
43
Urea
reabsorbed in the nephron during stasis, which causes false elevations of BUN and therefore not a reliable indicator of renal function
44
Granular casts, WBC & casts, RBC & casts, proteinuria, tubular epithelial cells
ARF
45
reabsorbed in the nephron during stasis, which causes false elevations of BUN and therefore not a reliable indicator of renal function
Urea
46
ARF UA
Granular casts, WBC & casts, RBC & casts, proteinuria, tubular epithelial cells
47
2 urine biomarkers for detecting AKI
interleukin-18(IL-18) and kidney injury molecule(KIM-1)
48
Percentages of prerenal, intrinsic renal, and post renal causes
60-70% prerenal 25-40% intrinsic renal 5-10% post renal
49
5 causes of prerenal causes of ARF
hypovolemia hypoTN ineffective circulating volume aortic aneurysm renal artery stenosis or embolic disease
50
examples of ineffective circulating volume
CHF, cirrhosis, nephrotic syndrome, early sepsis
51
5 causes of intrinsic renal ARF
ATN nephrotoxins interstitial disease(SLE, infection, acute interstitial nephritis) glomerulonephritis vascular diseases(polyarteritis nodosa, vasculitis)
52
nephrotoxins
NSAIDs, aminoglycosides, radiologic contrast, metformin
53
2 postrenal causes of ARF
\*the kidney is having the problem tubular obstruction obstructive uropathy(urolithiasis, BPH, bladder outlet obstruction)
54
prerenal vs intrinsic renal 1) urine Na 2) Fractional excretion of Na 3) urine osmolality 4) BUN to plasma Cr ratio 5) urine specific gravity
* a)prerenal vs b)intrinsic renal * 1) urine Na * a) less than 20mEq/L * b) increased greater then 40 * 2) Fractional excretion of Na * a) less than 1% * b) greater than 1-2% * 3) urine osmolality * a) greater than 500mOsm/kg * b) 300-500 * 4) BUN to plasma Cr ratio * a) elevated 20:1 * b) decreased (\< 15:1) * 5) urine specific gravity * a) greater than 1.020 * b) 1.010 to 1.020
55
what if the presentation is unknown with respect to an acute episode vs a chronic problem
renal ultrasonography to measure renal size. a kidney smaller than 10cm indicates a chronic problem.
56
metabolic acidosis, hyperkalemia, azotemia, decreased Cr clearance, loss of renal function
other abnormal findings in ARF
57
treatment of prerenal states of ARF
achievement of normal hemodynamics: IV fluids, improving cardiac output
58
treatment of intrarenal states of ARF
adjustment and avoidance of medications and nephrotoxic agents
59
treatment of postrenal states of ARF
relief of urinary tract obstructions
60
when to do short term dialysis
AEIOU-Cr acidosis electrolyte abnormalities ingestions overload(fluid) uremic symptoms when serum Cr exceeds 5-10 mg/dL.
61
CKD criteria
GFR less than 60mL/min/1.73 m2 or presence of kidney damage(proteinuria, glomerulonephritis, or structural damage from PCOS) for \> or equal 3 months.
62
GFR in 5 stages of CKD
1) greater than 90 and persistant albuminuria 2) 60-89 3) 30-59 4) 15-29 5) less than 15
63
symptoms of stage 1 and 2 of CKD
generally asymptomatic without an increase in BUN or serum Cr
64
symptoms of stage 3 of CKD
remain asymptomatic however serum Cr and BUN increase. other hormones become abnormal(PTH, erythropoietin, calcitrol)
65
symptoms of stage 4 of CKD
symptomatic with anemia, acidosis, hyperkalemia, hypocalcemia, hyperphosphatemia
66
What stage is a pt a candidate for kidney replacement therapy
5
67
ACE and ARBS
slow the progression of renal disease, particularly in proteinuric pts
68
survival rate of CRF
35%
69
when does uremic symptoms develop in CRF
stage 3-5
70
cachexia(wasting away), wt loss, mm wasting, pallor, HTN, ecchymosis, sensory deficits, asterixis(tremor), kussmaul respirations
signs of CKD
71
CKD 1) gold standard 2) marker for kidney damage 3) what appears early in the disease
1) GFR 2) proteinuria 3) microalbuminuria
72
CKD treatment BP, HbA1c, LDL, HDL, Tg
BP under 130/80 HbA1c 6.5-7.5% LDL under 100 HDL over 50 Tg under 150 wt control and smoking cessation
73
what to give in CKD to maintain hemoglobin 11-12 what if it is over 12-13
erythropoietin, iron supplements, antiplatelet therapy. increased risk of stroke
74
dietary management of CKD
restriction of protein, adequate caloric intake, calcium and vitamin D supplements, limitation of water/Na/K++/phosphorus
75
what vaccine is recommended for CKD
pneumococcal
76
broad, waxy casts
microscopic urine examination for CKD
77
hypocalcemia, hyperphosphatemia, secondary hyperparathyroidism
think CKD
78
tx for abnormal bleeding in CKD
desmopressin (DDAVP)
79
oral phosphate binders
calcium acetate, calcium carbonate, sevelamer, lanthanum,
80
what to give for renal osteodystrophy
oral phosphate binders and calcitriol
81
hydronephrosis 1) causes 2) acute sx 3) gradual sx
1) abnormal anatomy or obstruction 2) severe pain 3) N/V, UTI
82
hydronephrosis 1) tests 2) tx
1) renal u/s during prenatal testing, urine culture, u/s, CT/MRI 2) remove obstruction or ureteric stents

nephrology & urology (7 decks)

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