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Flashcards in Urology/Renal Deck (102)
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What are the average values for acid/base disorders?

"24/7 40/40"
-24 (HCO3, base)/ 7.40 (pH), 40 (CO2, acid)


What is the three-step approach to acid-base disorders?

Look at your PH (7.35-7.45 normal)
- < 7.35 = acidosis
- > 7.45 = alkalosis
Next look at your PCO2 is it normal, low, or high (35 to 45 normal)
- increased CO2 and decreased PH = respiratory acidosis
-decreased CO2 and increased PH = respiratory alkalosis
-If you don't see a change in the CO2 in relation to the PH then take a look at the HCO3
Finally look at the HCO3 is it normal, low, or high (20-26 normal)
-decreased HCO3 and decreased PH = metabolic acidosis
-Increased HCO3 and increased PH = metabolic alkalosis


What is acute renal failure?

-Stage 1: Normal GFR (>90)
-Stage 2: Early GFR (60-90)
-Stage 3: Moderate GFR (3a 45-59) (3b 30-44)
-Stage 4: Severe GFR (15-29)
-Stage 5: Kidney failure (GFR < 15 = dialysis)


What are the causes of renal vascular disease?

Diabetic kidney disease #1
-vascular disease aka renal artery stenosis
-glomerular disease
-renal cysts
-genetics (autoimmune, SLE, polycystic kidney disease, Alport's syndrome)


What is the presentation of acute kidney injury or acute renal failure?

-an abrupt or rapid decline in renal filtration function
-elevated serum creatine and decrease GFR
-azotemia a rise in blood urea nitrogen (BUN) concentration


What are the causes of acute renal failure?

prerenal, intrinsic, ans postrenal


What are the causes of prerenal (before the kidneys) acute renal failure?

-this is due to decrease blood flow to the kidneys
-remember the nephrons are intact
-hypovolemia (most common)
-NSAIDs, IV contrast, ACEI, ARBS (renal artery stenosis)
-treatment = creatine improves with IV fluids
-low blood pressure
-heart failure


What are the causes of intrinsic (in the kidneys) acute renal failure?

-renal aka intrinsic direct damage to the kidneys
-nephrotoxic drugs = aminoglycosides (Gentamicin)
-tumor lysis syndrome
-vasculitis (SLE, sarcoidosis)
-crystals from gout
-myoglobin from rhabdomyolysis


What are the pearls of intrinsic renal failure?

cellular casts is the hallmark = RBC CASTS
-tx: IV fluids remove drugs if present and sometimes Lasix to get the kidneys moving


What are the causes of post renal (downstream from the kidney) acute renal failure?

-there is some type of obstruction in the ureters such as kidney stones
-BPH, tumors
-congenital or structural abnormalities
-remove the obstruction or fix the structural abnormality


What are the causes of acute renal failure?

rapid but usually reversible reduction in renal excretory function sufficient to cause azotemia
-ATN, interstitial nephritis, glomerulonephritis
-azotremia: retention of nitrogenous waste
-uremia: symptomatic azotemia, with n/v/lethargy
-acute: sudden, hours/days and is reversible
-chronic: progressive, irreversible
-oliguria: urine output < 400 ml/day


How is acute renal failure dx?

CBC, BUN, Cr, electrolytes (Ca, phosphate), UA, postvoid residula bladder volume
-tx: depends on cause


What is the prerenal mechanism?

perfusion (50%) - kidney working fine but things that perfuse it aren't
-ex: volume loss, heart failure, loss of peripheral vascular resistance (espies/anesthesia)
-weak, decreased urine output, dizziness, sunken eyes, tachy, orthostatic
-fractioal excretion of sodium is normal
-urine specific gravity >1.030, Bun/Cr > 20, urine osm > 500
-tx: fluids, cardiac support, treat shock


What is renal mechanism?

-RC casts = glomerulonephritis
-WBC casts = pyelonephritis
-muddy casts = ATN
-hyaline casts = normal
-waxy = chronic renal disease
-urine specific gravity <1.010, BUN/Cr <10, urine ism < 300


What is post-renal mechanism?

obstructive - most likely prostate
-usually low/no urine output
-place foley Cath to find the source of obstruction; renal US to look for tumor/hydroephrosis


What is ATN?

from kidney ischemia/toxins; UA shows muddy brown casts
-damaged tubules means can't concentrate urine = high FENa
-prerenal failure is MC cause
-drugs: amp B, cisplatin, aminoglycosides, NSAIDs, ACE
-ischemic: dehydration, shock, sepsis
-fraction excretion of sodium > 2% + muddy, pigmented granular casts + high urine osm


What is interstitial nephritis?

-immune-mediated response
-drugs: PCN, sulfa, NSAIDs, phenytoin
-US: WBC casts + eos + hematuria
-dx: renal biopsy, discontinue offending drug, steroids, dialysis if needed, usually self-limiting


What is glomerulonephritis?

IGA nephropathy, post infectious, membranoproliferative
-UA: oliguria, hematuria, RBC casts
-causes: group A strep, IGA, anti-GBM, ANCA
-post-strep glomerulonephritis = MC infectious cause of acute glomerulonephritis: either from strep pharyngitis or strep skin infection (impetigo) = hematuria, HTN, periorbital edema
-dx: proteinuria + RBC in urine; usually caused by group A beta-hemolytic strep


What is chronic kidney disease?

a progression on ongoing loss of kidney function (GFR) defined as less than 60 mL/min/1.73 m2 or presence of kidney damage (proteinuria, glomerulonephritis or structural damage from polycystic kidney disease) for > 3 months
-measurement of GFR is the gold standard - the Cockcroft - gault formules (requires age, body weight, and serum creatinine) or Modificationof diet in renal disease equation


What is the etiology of chronic kidney disease?

diabetes, hypertension, glomerulonephritis


What are the findings of chronic kidney disease?

fatigue, pruritus, Kussmaul respirations, asterisks (flapping tremor), muscle wasting, broad waxy casts


What are the stages of chronic kidney disease?

-Stage 1: GFR > 90 mL/min
-Stage 2: GFR 60-89
-Stage 3: GFR 30-59
-Stage 4: GFR 15-29
-dialysis and kidney transplant
-Stage 5: GFR < 15
-kidney transplant


What is the management of chronic kidney disease?

blood pressure control <130/80, ACE or ARB A1c 6.5-7.5%
-patients with chronic renal failure typically present with hypocalcemia, hyperphosphatemia, and metabolic acidosis


What is acute interstitial nephritis?

-etiology: immune-mediated response
-drugs: PCN, sulfa, NSAIDs, phenytoin etc.
-Immunologic and infectious disease: strep, SLE, CMV, Sjogren's, Sarcoidosis
-urinalysis: WBC casts and eosinophils


What are the characteristics of acute interstitial nephritis?

-eosinophils, WBC casts, and hematuria
-acute azotemia (accumulation of nitrogen waste)
-major causes - immune-mediated response
-drugs: PCN, sulfa, NSAIDs, phenytoin etc.
-Immunologic and infectious disease: strep, SLE, CMV, Sjogren's, Sarcoidosis


How is acute interstitial nephritis dx?

diagnose with renal biopsy - will see interstitial inflammatory cell infiltrates


How do you tx acute interstitial nephritis?

by discontinuing the offending drugs, corticosteroids, dialysis if needed, usually self-limiting if caught early


What is benign prostatic hyperplasia?

a disease of elderly men (average age is 60-65 years caused by hyperplasia of prostatic epithelial, stroll cells - formation of nodules in periurethral (transition) zone - narrowing of urethras canal - urethral compression - obstruction of the urinary outlet


What are the characteristics of benign prostatic hyperplasia?

-50% of men develop BPH by 60 and >90% by age 85
-features: decreased force of urinary stream, hesitancy (stop and start) and straining, postvoid dribbling, incomplete empything, frequency, nocturia, urgency, recurrent UTIs
-in men with BPH avoid the use of anticholinergic and antihistamines
-this type of prostate enlargement isn't thought to be a precursor to prostate cancer


How is benign prostatic hyperplasia dx?

accurately diagnosing BPH is extremely important as more serious conditions, such as prostate cancer must be ruled out
-DRE = enlarged rubbery prostate
-urinalysis/culture - microscopic hematuria may be present - pyuria, bacteriuria in case of concomitant UTI
-blood tests - often PSA often elevated > 4 - electrolytes, blood urea nitrogen (BUN), and creatinine to evaluate for renal impairment
-ultrasound - evaluate bladder size, prostate size, degree of hydroenphrosis
-cystoscopy - reveal bladder diverticula/calculi before scheduled invasive treatment