renal questions (1) Flashcards
(108 cards)
presents with: symptoms: nausea, vomiting, diarrhea, pruritus, drowsiness, dizziness, hiccups, SOB, anorecia, hematochezia and o Signs: tachycardia and hypotension indicate prerenal. Distended bladder, CVA tenderness, enlarged prostate indicate postrenal. Other signs: anuria, change in volume status, change in mental status, edema, weakness, dehydration, rashes, JVD, uriniferous odor, ecchymosis
acute renal failure
lab that is key parameter to measure renal function
GFR
tx of acute renal failure
correcting underlying problem
**IV fluids for prerenal states.
Avoidance of medications and nephrogenic agents in intrarenal states.
Relief of urinary tract obstruction in postrenal states.
Short term dialysis if serum creatinine exceeds 5-10 mg/dL
presents with: symptoms: fatigue, malaise, anorexia, nausea, vomiting, metallic taste, hiccups, dyspnea, orthopnea, impaired mentation, insomnia, irritability, muscle cramps, restless legs, weakness, pruritus, easy bruising, altered consciousness and cachexia, weight loss, muscle wasting, pallor, hypertension, ecchymosis, sensory deficits, asterixis, Kussmal respirations
Chronic kidney disease
labs for CKD
Measure GFR gold standard.
Proteinuria is marker of kidney damage. BUN and creatinine are elevated. Hemoglobin and hematocrit, serum electrolytes, urinalysis are abnormal
tx for CKD
ACEI and ARBs
tight glycemic control in diabetic pts,
cholesterol-lowering therapy,
tobacco cessation,
weight control.
Erythropoieten, iron supplements, antiplatelet therapy
presents with: hematuria, urine is tea or cola colored, oliguria, edema of the face and eyes is present in the morning, and edema of the feet and ankles occurs in the afternoon and evening, hypertension
glomerulonephritis
glomerulonephritis labs
antistreptolysin O titer increased. Urinalysis reveal hematuria, RBC cases and proteinuria. Serum complement (C3) is decreased
glomerulonephritis tx
steroids and immunosuppressive drugs, salt and fluid intake should be decreased, dialysis, ACEI
presents with: symptoms: malaise, abd distention, anorexia, facial edema/puffy eyelids, oliguria, scrotal swelling, SOB, weight gain and o Signs: ascites, edema, hypertension, orthostatic hypotension, retinal sheen, skin striae
nephrotic syndrome
nephrotic syndrome labs
Urinalysis shows proteinuria, lipiduria, glycosuria, hematuria, foamy urine. Microscopic exam shows RBC casts, granular casts, hyaline casts, fatty casts, key finding is oval fat body . blood chemistry shows hypoalbuminemia, azotemia, hyperlipidemia. C3 levels low or normal
nephrotic syndrome tx
ACEI, diuretics, sodium and fluid restriction. Dietary protein and potassium normal
presents with: back and flank pain, headaches, hematuria, hypertension, recurrent UTI, weight loss, renal colic, N/V, one or both kidneys palpable and feel nodular or tender
polycystic kidney disease
PKD labs
anemia on CBC, Urinalysis shows proteinuria, hematuria, pyuria and bacteriuria. o Imaging: US shows fluid filled cysts- imaging of choice
PKD tx
no cure, supportive. ACEI or ARB for HTN, high fluids, low protein. ABX(Bactrim, fluoroquinolones, chloramphenicol, vanco), Dialysis
presents with: asymptomatic until inflame or ureteral obstruction, unilateral back pain and renal colic that waxes and wanes.
Symptoms: hematuria, dysuria, urine frequency, fever, chills, N/V
Stone in upper ureter: pain radiate to anterior abdomen
Stone in lower ureter: pain radiate to ipsilateral groin, testicle or labia
Stone in UVJ: pain in pelvis and urinary frequency and urgency
Signs: diaphoresis, tachycardia, tachypnea, restlessness, CVA tenderness, abd distention because of ileus
nephrolithiasis
main stone type
calcium
nephrolithiasis labs
microscopic or gross hematuria on urinalysis. o Imaging of choice helical CT, plain film radiograph
nephrolithiasis tx
stone less than 5 mm: pass spontaneously, drink plenty of fluids, strain urine to capture stone, alpha blocker or CCB to facilitate passage. Most stones pass 2-4 weeks. o Stone 5-10mm: pass spontaneously, increased fluid and analgesics, elective lithotripsy or ureteroscopy.o Stone >10 mm: not likely to pass spontaneously, vigorous hydration, ureteral stent or percutaneous nephrostomy(gold standard), extracorporeal shock wave lithotripsy, analgesics
presents with: alterations in brain water content, thirst, restlessness, irritability, disorientation, lethargy, delirium, convulsions, coma, dry mouth, dry mucous membranes, lack of tears, flushed skin, tachycardia, hypotension, fever, oliguria, anuria, hyperventilation, lethargy, hyperreflexia
hypernatremia
hypernatremia tx
IV D5W, dialysis if Na > 200. Rapid correction of hypernatremia can cause pulmonary or cerebral edema
presents with: symptoms: lethargy, disorientation, muscle cramps, anorexia, hiccups, N/V, sz and o Signs: weakness, agitation, hyporeflexia, orthostatic hypotension, Cheyne-Stokes respirations, delirium, coma, stupor
hyponatremia
hyponatremia tx
consultation with nephrology, fluid restriction, monitor volume status, hypertonic saline used if Na <120. Overly rapid correction can cause central pontine myelinolysis, resulting in neurologic damage
presents with: polyuria, nocturia, polydipsia.
diabetes insipidus
