Test 2: Renal

Question 1

When GFR decreases, serum creatinine ___

Answer 1

increases. only becomes elevated after more than 2/3 of renal function destroyed

Question 2

oliguria

Answer 2

small amts of urine norm 800-2000 ml/day

Question 3

Uremia

Answer 3

having abnormal waste product , urea, in blood

Question 4

Acute Kidney Injury (AKI)

Answer 4

dec GFR, and urine output. happens very acutely within 48hrs. Elevated BUN, creatinine, and uric acid

Inc in serum creatinine of 0.3 mg/dl
oliguria <400 mL in 24hrs

Question 5

decreased renal perfusion can be caused by (going to dec GFR)

Answer 5

hypercalcemia

NSAIDs + ACE Inhibitors

Question 6

A GFR less than ____ for 3months or more is indicative of

Answer 6

60, CKD

Question 7

AKI- Pre Renal caused by

Answer 7

decrease blood flow to kidney, volume depletion, dehydration

Question 8

AKI- Pre Renal Labs

Answer 8

BUN: Creatinine >20:1
High: B/C, K+, P, Mg
Low: FENa <1%. pH (metabolic acidosis w/inc anion gap)

Urine Osmolality will be high bc retained Na so urine is concentrated

Question 9

AKI- Intrinsic Renal si/sx

Answer 9

HTN, flank pain, fever all are common

Question 10

AKI- Intrinsic Renal Labs

Answer 10

BUN: Creatinine <20:1
Urine Osmolality will be low bc dilute urine
High: B/C, K+, P, Mg, FENa: >2%
low: pH (metabolic acidosis w/inc anion gap)

Epithelial Casts

Question 11

AKI: Intrinsic Renal- Vasculature

Atheroembolic Renal Disease

Answer 11

Cause: emboli, anti coag tx, aortic aneurysm
Si: common ones for AKI intrinsic
Lab: Eosinophilia common, microscopic hematuria, proteinuria
TX: sx management, dialysis temp, surgery, no more invasive vascular procedures

Question 12

AKI: Intrinsic Renal- Vasculature

Renal Vein Thrombosis

Answer 12

casue: Nephrotic syndrome, renal cell cancer
Si: proteinuria, hematuria,
Lab: CT w/contrast
Tx: anticoag, tx cause

Question 13

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis Si/SX

Answer 13

mild edema, HTN, coke colored urine

Labs: RBC Casts

Question 14

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis - Post strep

Answer 14

MOSTLY KIDS
Cause: recent GAS infection of any kind

Labs: High- ASO titer / Low: C3 & C4 compliment
RBC casts, blood and protein

TX: supportive, dec diuretics

Question 15

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis - IgA nephropathy (Berger’s dz)

Answer 15

cause: IgA deposits in mesangium of glomeruli
Si: commonly asx but can have norm intrinsic renal sx
Labs: High- IgA. complement levels norm
Tx: supportive care, resolve on own

Question 16

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis - Henoch Schonlein Purpura

Answer 16

common Kids

cause: IgA deposition in affected tissues-vasculitis
affecting skin and mucous membranes
Si: rash on back of extremities THAT are PALPABLE

Labs: High- serum IgA level

Tx: ACE and diuretic. corticosteroids for renal disease

Question 17

AKI: Intrinsic Renal- Glomerulus

Glomerulonephritis- HUS

Answer 17

cause: Shigga Toxin

Sx: first abd pn N/V/D, HTN, Oliguria, GI bleed

Labs: High- bilirubin. proteinuria, Anemia thrombocytopenia

Tx: Supportive fluids, control HTN, transfusion

Question 18

AKI: Intrinsic Renal- Interstitium

Acute Interstitial Nephritis

Answer 18

Cause: Drugs, NSAIDs

Labs: WBC Casts, Biopsy (to differentiate between ATN, glomerulonephritis and interstitial nephritis)

Tx: remove agent

Question 19

AKI: Postrenal

Answer 19

cause: obstruction
si: suprapubic pain, oliguria

Labs: High- B/C, K+, P, Mg, FENa: >2%
Low- pH (metabolic acidosis w/inc anion gap)

Question 20

Acute Urinary Incontinence causes

Answer 20

DIAPPERS. delirium, infection, Atrophy, Pharmaceuticals, Psychoogical, Endocrine, Restricted mobility, Stool impaction

Question 21

Stress Incontinence

Answer 21

caused by increased abd pressure, dec pelvic support,
loss of bladder control during activity (cough sneeze laugh), obesity, preg.
Post Voidal Residual low/normal <50-100
Tx: pelvic floor exercise, biofeedback

Question 22

Urge Incontinence

Answer 22

sudden urge bc of an overactive bladder leading to involuntary void. Detrusor muscle is overactive.
will have a strong urge then void, cant make it to toilet, unpredictable leakage and frequent

PE: DELAYED leak upon stress test
tx: bladder retraining, PME, anticholiergics (but do PVR first)
PVR low/normal <50-100

Question 23

Overflow incontinence

Answer 23

problem emptying bladder leading to overflow.
small leakage, dribble all day. weak stream hesitancy, nocturia.

tx: schedule toileting, alpha antagonist.
PVR high 100-400

Common in men due to enlarged prostate

Question 24

Risk factors for Pyelonephritis

Answer 24

diabetic, immunosuppressive therapy, chronically ill, cathether, prostate cancer

Question 25

Common bugs for complicated UTIs

Answer 25

PEEK: Pseudomonas (-), E coli (-), Enterococcus (+), Klebsiella (-)

Question 26

Common bug for UTI in diabetics

Answer 26

Klebsiella

Question 27

``` These Colors on a Urinalysis mean: Blue green Red Gold Orange CLoudy ```

Answer 27

``` Blue green- pseudomonas red- hematuria Gold- UTI or dehydration Orange- medications phenazopyridine cloudy- infection ```

Question 28

UA Specific gravity normal 1.005-1.030

Answer 28

< 1.008 dilute, pyelonephritis, diabetes insipidus >1.020 concentrated, dehydration, SIADH, glycosuria

Question 29

UA normal pH

Answer 29

4.5-8

Question 30

UA content you might see in UTI patient

Answer 30

``` Blood Nitrates (phenazopyridine can give false positive) Leukocyte Esterates (pyuria) WBC in urine ```

Question 31

WBC casts from Urine indicates.

Answer 31

pyelonephritis | Urine C&S is gold standard and necessary to dx

Question 32

UTI Cystitis (bladder) Sx Labs Tx

Answer 32

Sx: dysuria, frequency, urgency, hematuria suprapubic pain Labs: UA. Can get a culture if reccurent or STI possible Tx: TMP-SMX (bactrim) NItrofurantoin

Question 33

UTI Pyelonephritis (kidneys) SX Labs TX

Answer 33

SX: dysuria, frequency, urgency, hematuria, Flank pain, fever, N/V Labs: UA, C&S w/WBC casts TX: FQ and Aminoglycosides (avoid if renal disease) Hospitalize if: >60, immunocompromised, persistent vomiting

Question 34

In what cases would you treat Asymptomatic UTI

Answer 34

immunosuppresed pregnant- Nitrofurantoin about to undergo renal/urinary tract surgery risk of endocarditis

Question 35

UTI due to Candida Risk Factors TX

Answer 35

RF: antibiotic therapy and old age Tx: Antifungal

Question 36

When should you do a PVR? post void residual

Answer 36

Before prescribing for urinary incontinence

Question 37

Tx for urinary incontinence

Answer 37

Anticholinergics

Question 38

what kind of stones do these pH indicate? Norm 5.8-5.9 ph <5.5 ph 5.5-5.8 ph >7.2

Answer 38

ph <5.5 Uric Acid or Cystine Stone ph 5.5-5.8 Calcium Stone ph >7.2 Struvite stone

Question 39

Calcium Oxalate or Calcium Phosphate Stones casues

Answer 39

Oxalate: excess purine, low calcium diet Phosphate: Family Hx, lyperparathyroid

Question 40

Uric Acid stones casues

Answer 40

high protein diet | gout

Question 41

Struvite Stones

Answer 41

staghorn caliculi in renal pelvis | casue: cather, abnormal anatomy

Question 42

Cystine Stones causes

Answer 42

genetic disorder, cystinuria

Question 43

Stone in these location will have pain radiate to... - upper ureter - lower ureter - UVJ

Answer 43

abdomen ipsilateral groin, testicle/labia cause urine frequency, urgency, lower pelvic pain

Question 44

Procedues for kidney stones

Answer 44

Lithrotripsy: shockwave for <10mm Utererorenoscopy: stones >1cm

Question 45

Dietary Prevention of calcium stones, uric acid stones,

Answer 45

calcium stones- low sodium, low protien | uric acid- rich in alkali (fruits veggies), low in acid (meat)

Question 46

Criteria for Dx AKI

Answer 46

absolute inc in serum creatinine of 0.3 mg/dl 50% inc in serum creatinine Oliguria <400 mL in 24 hrs