Week 3 Flashcards by Brittany Dilegge

red blood cell casts in UA

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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white blood cell casts in UA

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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renal tubular epithelial cell casts

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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glomerularnephritis

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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nephrOtic syndrome

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

hyperkalemia

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prolactinoma. what is it?

prolactin secreting tumor

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s/s of prolactinoma

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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diagnosis of prolactinoma

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

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causes of prolactin increase

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

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medical management of prolactinoma

Cabergoline and bromocriptine

refer to endo and ophthalmology

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physical exam for pt with prolactinoma

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

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

hematuria.

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hematuria is characterized by

3+ RBC per HPR

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transient hematuria

one occasion

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persistent hematuria

two or more occasion consecutively

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hematuria H&P

drug, diet, activity, menstrual history

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diagnosing hematuria

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

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hematuria DDX

UTI, malignancy, nephropathy

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management of hematuria

urology referral

surgery

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causes of hematuria

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

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Presence of both protein and hematuria is suggestive of

glomerular or interstitial nephritis.

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causes of discolored urine

Senna, beats, pyridium, nifampin

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if there is abnormal morphology of RBC, think

glomerular cause

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non-glomerular cause of hematuria workup

urine culture, urine calcium to creatinine ratio, consider calculi

glomerular cause of hematuria workup

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

proteinuria. what is it

urinary protein excretion of more than 150mg per day

diagnosing proteinuria

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

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

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

proteinuria differential diagnosis

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

management of proteinuria

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

bright red in urine

lower uti

gross hematuria with proteinuria

refer patient!!!!!

orthostatic proteinuria

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

nephrOtic syndrome. what is it

> 3.5g /day of protein in adults | >40 mg/ hr in children

GFR stage 1

> or equal to 90

GFR stage 2

60-90

GFR stage 3a

45-59

GFR stage 3b

30-44

GFR stage 4

15-29

GFR stage 5

Kidney failure. < 15

ASKI risk factors

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

AKI is defined as

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.

AKI causes

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

prerenal causes of AKI

impaired perfusion | cardiac failure, sepsis, blood loss, dehydration, vascular occlusion.

renal causes of AKI

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

postrenal causes of AKI

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

anuria

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

oliguria

<400 ml of urine/day

types of urinary calculi

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

risks/triggers of renal calculi

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

clinical presentation

varies on size and location. | ureter colic, n/v, hematuria, fever, chills, dysuria, increased urinary frequency, vague flank or groin pain.

what stones are the most common

calcium oxalate

what is the most common stone in diabetics

uric acid

common stone types

calcium oxalate, uric acid, calcium phosphate,

management of stones

oral hydration, pain management, expectant stone passage. calcium channel blockers or alpha blockers(nifedipine or tamsulosin)

diagnosis of stones

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

ddx for stones to rule out

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

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

conservative. Iv hydration and pain medication

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

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

If urinalysis is positive for heme, think

myoglobinuria or hemoglobinurea

diagnosing myoglobinuria

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

causes of myoglobinuria

drug abuse, snake venom, exercise,dka,

myoglobinuria is defined as

massive acute muscle necrosis with impending AKI

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

angiotensin 2 receptor antagonists (ARB)

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

reducing efferent arteriolar resistance

what would you see on UA of glomerulonephritis

elevated protein, presence of RBC, and renal casts

moxifloxacin can cause

renal stones

sturvite stones are most common in what population

renal (it is phosphorus composition)

gold standard to see small kidney stone

CT scan

acceptable level for total cholesterol in children and teens in

< 170

Week 3 Flashcards

(71 cards)