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NURP 533 > Week 3 > Flashcards

Week 3 Flashcards

1
Q

red blood cell casts in UA

A

The finding of RBC casts suggests an underlying proliferative glomerulonephritis, for which numerous etiologies exist. However, due to their limited sensitivity, the absence of RBC casts, particularly in a patient with hematuria and a high pre-test probability, does not rule out a proliferative glomerulonephritis. RBC casts are not exclusive to the setting of proliferative glomerulonephritis. In one study, 6 of 21 patients (nearly 30 percent) with biopsy-proven acute interstitial nephritis in one study had RBC casts in the urine. This implies that RBCs which extrude into the renal tubules from an inflamed interstitium can also lead to cast formation.

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2
Q

white blood cell casts in UA

A

White blood cell (WBC) casts are indicative of interstitial or, less classically, glomerular inflammation. In a biopsy series of patients with confirmed acute interstitial nephritis, only 3 percent of patients had WBC casts in their urine sediment. This highlights that, in the presence of a reasonable clinical suspicion for acute interstitial nephritis, the absence of WBC casts should not diminish consideration of this important diagnosis.

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3
Q

renal tubular epithelial cell casts

A

These may be observed in any setting where there is desquamation of the tubular epithelium, including acute tubular necrosis (ATN), acute interstitial nephritis, and proliferative glomerulonephritis.

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4
Q

glomerularnephritis

A

cause: antigen antibody complex from recent strep infection. IgA complex, common in school age males.
patho: antigen antibody complex in glomeruli causing inflammation and decreased GFR.
s/s: headache, HTN, facial/periorbital edema, lethargic, low grade fever, weight gain (edema). Urine :protienuria, hematuria, oliguria and dysuria.

rope red urine, oliguria, proteinuria, elevated BP/BUN. LOW c3= Strep, SLE, membranoproliferative

tx: antihypertensives and diuetics.
prognosis: good, reoccurance is rare.

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5
Q

nephrOtic syndrome

A

main characteristics:proteinuria, hypoalbuminemia, edema, hypovolemia, ages 2-7 and in males.
causes: idiopathic glomerular damage, congenital, glomerular changes are membrane damage causes permeability for protein/albumin.

s/s: edema, proteinuria, hypoproteinemia, fatigue, edema, decreased urine output, elevated LDL, hypergoagulability (increased fibrinogen, factor V).

treatment: corticosteroids. relapses occur.

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6
Q

what do you check for. when initiating patient on an ACE?

A

hyperkalemia

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7
Q

prolactinoma. what is it?

A

prolactin secreting tumor

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8
Q

s/s of prolactinoma

A

women: oligomenorrhea, amenorrhea, galactorrhea, vaginal dryness,hirsutism

Males: ED, decreased body and facial hair, gynecomastia
both: infertility, headaches, low bone density.

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9
Q

diagnosis of prolactinoma

A

prolactin hormone, bun/creat (rule out), pregnancy, ths, t4 (rule our hypothyroidism)
Then MRI of pituitary gland

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10
Q

causes of prolactin increase

A

consider pregnancy, lactation, tumor, medications (antipsychotics, CCB, tricyclics, opioids), pcos, renal disease, food consumption.

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11
Q

medical management of prolactinoma

A

Cabergoline and bromocriptine

refer to endo and ophthalmology

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12
Q

physical exam for pt with prolactinoma

A

opthalmic exam, neuro exam, visual field defect, hirsutism in women, thyroid exam

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13
Q

what is the most common s/s of bladder cancer?

A

hematuria.

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14
Q

hematuria is characterized by

A

3+ RBC per HPR

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15
Q

transient hematuria

A

one occasion

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16
Q

persistent hematuria

A

two or more occasion consecutively

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17
Q

hematuria H&P

A

drug, diet, activity, menstrual history

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18
Q

diagnosing hematuria

A

history, pelvic exam/prostate exam, UA/ sediment analysis, IVU, ultrasound, ct, cyscoscopy

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19
Q

hematuria DDX

A

UTI, malignancy, nephropathy

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20
Q

management of hematuria

A

urology referral

surgery

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21
Q

causes of hematuria

A

glomerular, nonglomerular, pseudohematuria, or misc (drug induced or exercise induced)

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22
Q

Presence of both protein and hematuria is suggestive of

A

glomerular or interstitial nephritis.

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23
Q

causes of discolored urine

A

Senna, beats, pyridium, nifampin

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24
Q

if there is abnormal morphology of RBC, think

A

glomerular cause

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25
Q

non-glomerular cause of hematuria workup

A

urine culture, urine calcium to creatinine ratio, consider calculi

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26
Q

glomerular cause of hematuria workup

A

BMP, CBC, albumin, urine protein to creatinine ratio, throat culture, ASO titer.

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27
Q

proteinuria. what is it

A

urinary protein excretion of more than 150mg per day

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28
Q

diagnosing proteinuria

A

24 hour urine or spot urine for protein-creatinine ratio is gold standard.

dipstick of 1+ on 2 occasions

Fasting BG, hgb a1c, cbc with diff, urine c/s, cmp, lipid profile, BP, bence jones proteins

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29
Q

Routine screening for proteinuria should be done in pregnant women before 24 weeks gestation BECAUSE?

A

if this occurs before 24 weeks it is glomerular in origin, if it is after 24 weeks, it is likely to be preeclampsia

30
Q

proteinuria differential diagnosis

A

glomerulonephritis, hepatitis induced vasculitis, urate related renal disease, diabetes, systemic disease, structural abnormalities

31
Q

management of proteinuria

A

depends on underlying cause. eliminate triggers. sodium and protein restricted diet
ACE’s can help reduce proteinuria by decreasing interglomerular pressure

32
Q

bright red in urine

A

lower uti

33
Q

gross hematuria with proteinuria

A

refer patient!!!!!

34
Q

orthostatic proteinuria

A

most common in males. excretion of protein when pt is in upright position for 4-6 hours. benign

do urine protein to creatinine test in the morning

35
Q

nephrOtic syndrome. what is it

A

> 3.5g /day of protein in adults

>40 mg/ hr in children

36
Q

GFR stage 1

A

> or equal to 90

37
Q

GFR stage 2

A

60-90

38
Q

GFR stage 3a

A

45-59

39
Q

GFR stage 3b

A

30-44

40
Q

GFR stage 4

A

15-29

41
Q

GFR stage 5

A

Kidney failure. < 15

42
Q

ASKI risk factors

A

age, comorbidities, drugs, CHF, chirrosis, contrast dye (can lead to intrinsic AKI), blood loss, diarrhea, dehydration, sepsis

43
Q

AKI is defined as

A

creatinine as an increase 0.3mg/dl over 48 hours or increased creatinine to 1.5 times baseline over 7 days OR urine output of < 0.5 ml per kg per hour for 6 hours.

44
Q

AKI causes

A

obstruction to renal pelvis,ureter, bladder, urethra, malignancy, neurogenic bladder, kidney stones, constipation

45
Q

prerenal causes of AKI

A

impaired perfusion

cardiac failure, sepsis, blood loss, dehydration, vascular occlusion.

46
Q

renal causes of AKI

A

glomerulonephritis, small vessel vasculitis, acute tubular necrosis (drugs, toxins, prolonged hypotension), interstisial nephritis (inflammatory disease, infection, drugs, toxins)

47
Q

postrenal causes of AKI

A

urinary calculi, retroperitoneal fibrosis, benign prostatic enlargement, prostate cancer, cervical cancer, urethral stricture/valve, meatal stenosis.

48
Q

anuria

A

<100ml of urine output per day. usually associated w high creat

49
Q

oliguria

A

<400 ml of urine/day

50
Q

types of urinary calculi

A

kidney (nephrolithiasis), urinary(urolethisasis), ureters (ureterolithiasis),

51
Q

risks/triggers of renal calculi

A

diet (salt, oxalate, calcium), dehyrdration, high mineral content water, tea, grapefruit/apple juice, cola, sedintary lifestyle, occupation, family hx, gout, PHPT,

52
Q

clinical presentation

A

varies on size and location.

ureter colic, n/v, hematuria, fever, chills, dysuria, increased urinary frequency, vague flank or groin pain.

53
Q

what stones are the most common

A

calcium oxalate

54
Q

what is the most common stone in diabetics

A

uric acid

55
Q

common stone types

A

calcium oxalate, uric acid, calcium phosphate,

56
Q

management of stones

A

oral hydration, pain management, expectant stone passage.

calcium channel blockers or alpha blockers(nifedipine or tamsulosin)

57
Q

diagnosis of stones

A

strain urine for stones, UA and C/S,m24 hour urine collection, KUB, IVP Us, CT,
cbc, calcium, vitamin D.

58
Q

ddx for stones to rule out

A

appendicitis, cholecystitis, pancreatitis, ectopic pregnancy, PUD, AAA

59
Q

if stone is < 8 cm, what type of management?

A

conservative. Iv hydration and pain medication

60
Q

if stone is > 8 cm, what type of management?

A

surgical management or ESWL (shock wave lithotripsy), or percutantous lithotripsy.
lifestyle adaptation/ surveillance

61
Q

If urinalysis is positive for heme, think

A

myoglobinuria or hemoglobinurea

62
Q

diagnosing myoglobinuria

A 
Ua- shows few or no rbc
urine dipstick will have +heme
Elevated CK >1000
Rhabdomylosis
Cmp
Muscle enzymes:aldolase, lactic acid dehydrogenase, ast
63
Q

causes of myoglobinuria

A

drug abuse, snake venom, exercise,dka,

64
Q

myoglobinuria is defined as

A

massive acute muscle necrosis with impending AKI

65
Q

what medication can precipitate ARF in patient with bilaterally renal artery stenosis

A

angiotensin 2 receptor antagonists (ARB)

66
Q

ACE inhibitors can limit the progression of some forms of renal disease by

A

reducing efferent arteriolar resistance

67
Q

what would you see on UA of glomerulonephritis

A

elevated protein, presence of RBC, and renal casts

68
Q

moxifloxacin can cause

A

renal stones

69
Q

sturvite stones are most common in what population

A

renal (it is phosphorus composition)

70
Q

gold standard to see small kidney stone

A

CT scan

71
Q

acceptable level for total cholesterol in children and teens in

A

< 170

NURP 533 (7 decks)

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