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Urology > Week 3 > Flashcards

Week 3 Flashcards

1
Q

definition of AKI?

A

GFR reduced abruptly (<48 hrs) w/sudden retention of normally cleared endogenous and exogenous metabolites

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2
Q

death dt AKI occurs how?

A

due to acidosis, high K, fluid accumulation

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3
Q

groups at increased risk of AKI and KD failure?

A

DM T2, those w/HTN, geriatrics

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4
Q

general presentation of AKI?

A

Azotemia (N&V, malaise, altered sensorium) Arrythmias from hyperkalemia
Ecchymoses from platelet dysfunction Pericardial effusion, cardiac tamponade
Seizures from electrolyte imbalance Fasciculations and muscle cramps
Perioral paresthesias from hypocalcemia Peripheral edema
Skin/nail pallor Hyper- or hypo volemia

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5
Q

general lab findings w/AKI?

A

increased serum Cr
decreased urine output (<0.5 mL/kg/hr)
BUN rises first

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6
Q

MC type of RF?

A

prerenal failure

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7
Q

causes of prerenal failure?

A

decreased intravascular volume
changes in vascular resistance
low CO

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8
Q

ssxs of prerenal failure?

A

dehydration, thirst, dizziness, mental status changes

poor skin turgor, collapsed neck veins, dry mucous membranes, hypotensive, orthostatic BP changes, tachycardia

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9
Q

Oliguria (<400ml/d) (IF<100 mL emergency!)
Dipstick: little protein, SG >1.020
Normal microscopic UA: no cells or casts seen Urine osmolality (>350 mOsm/kg)
Urine sodium < 20 mEq/L
FeNa <1%
HIGHER BUN/creatinine >20:1 (faster inc in BUN–azotemia)

A

prerenal failure UA findings

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10
Q

management and tx of prerenal failure?

A

tx underlying cause
rapid fluid replacement, IV vol expansion
may need vasopressor drugs (dopamine) to elevate BP and increase renal flow
discont anti-HTN or diuretics
support for reperfusion to KDs: silymarin, garlic

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11
Q

prognosis of prerenal failure?

A

good and reversible if not damage to renal cells persists and renal blood flow doesn’t fall below 20% of normal

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12
Q

causes of intrarenal failure?

A 
injury in renal tubules, interstitium and vasculature leading to loss of fxn
ATN
AIN
acute GN
acute PN
vascular diseases
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13
Q

presentation of intrinsic renal failure?

A 
salient hx of URI, diarrhea
use of abx or IV drugs
back pain, gross hematuria, fever (PN)
maculopapular rash (possible with AIN)
dehydration and shock
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14
Q

UA: SG <1.010 if tubular cz, ≥1.020 if glomerular cz Urine osmolality; <300 mOsm/kg
Urine sodium >30 mEq/L if tubular cz, <20 if glomerular cz
FeNa >2-3%
Casts: Granular=ATN, AIN
WBC casts=PN
RBC casts=PSGN
Eosinophiluria=AIN
CBC: anemia or infection
CMP: Inc BUN and Creatinine levels
BUN/Creatinine ratio is LOWER: 10-15:1 (as Cr rises)
Early in course Cystatin C will rise when creatinine is still normal (more specific marker)
Dec serum complement, circulating immune complexes
Renal BX will show characteristic changes

A

intrarenal failure

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15
Q

postrenal failure is dt what?

A

urinary flow from BOTH KDs obstructed which leads to increased nephron intraluminal back P and decreased GFR

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16
Q

causes of postrenal failure?

A

obstruction of urine flow dt prostatic enlargement, tumors, urolithiasis, renal V stenosis, neurogenic bladder, post-surgical or trauma, meds

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17
Q

ssxs of postrenal failure?

A

renal pn and tenderness, lower abd pn, post-surgery urine lead, over-hydration, edema, ileus w/abd distention, enlarged prostate on DRE, distended bladder

18
Q 
Lab: urine osmolality variable;  
Urine spec gravity >1.010 early, <1.010 late
Urine sodium <20 early, >40 late
high BUN and creatinine, BUN/Cr 10-20 
Microscopic UA: crystals or hematuria
US: may show hydronephrosis
Cystoscopy may show ureteral obstruction
CT or MRI may show mass causing obstruction, hydronephrosis, kinked ureter, Contrast agent-use
A

postrenal failure

19
Q

management and tx of postrenal failure?

A

rapidly tx the obstruction with catheterization or stent

20
Q

general pt management for all types of AKI/ARF?

A

determine and treat cause
assess pts vital force
initiate appropriate referral
assess degree of uremia, electrolyte/mineral imbalance and HTN
assess need for ECG, CXR
cystatin C to monitor KD injury
protein intake decreased
monitor vitals, fluid intake and urine output daily; monitor BUN/Cr, electrolytes until stable and then 2-3x/wk with total protein, albumin, glucose, Hct, Hgb 3x/wk
consider rheum, salvia, cordyceps, urtica
antioxidants and anti-inflammatories: vit C, vit E, CoQ10
remove food allergens
support reperfusion: Renafood, silymarin, garlic

21
Q

criteria for CKD?

A

GFR < 60 mL/min per 1.73m^2

22
Q

common causes of CKD?

A 
glomerulopathies
tubulointerstitial nephropathies
heredity
obstructive nephropathy
vascular abn
23
Q

general symptoms of CKD?

A

HTN, edema, osteodystrophy, anemia of chronic dz, uremia

24
Q 
symptoms of uremia?
General
Skin
ENT
Eye
Pulmonary
CV
GI
GU
Neuromuscular
Neurologic/ME
A 
Fatigue, weakness
Pruritis, easy bruising
Metallic taste, epistaxis
SOB
Dyspnea on exertion, retrosternal pn on inspiration
Anorexia, N&amp;V, hiccup
Nocturia, impotence
Restless legs, numbness, cramps in legs
Irritability, poor concentration
depression
25
Q 
signs of uremia? 
General
Skin
ENT
Eye
Pulmonary
CV
GI
GU
Neuromuscular
Neurologic/ME
A 
Sallow-appearing
Pallor, ecchymosis, edema
Urinous breath
Pale conjunctiva
Crackles, pleural effusion
Hypertension, cardiomegaly, friction rub
Isosthenuria
Stupor, asterixis, myoclonus, peripheral neuropathy
26
Q

stages of CKD?

A

1 GFR >90 - normal or high
2 GFR 60-89 - mildly decreased
3a GFR 45-59 - mildly to moderately decreased
3b GFR 30-44 - moderately to severely decreased
4 GFR 15-29 - severely decreased
5 GFR <15 - kidney failure

27
Q

treatment considerations for CKD

A 
monitor BP/temp/pulse/weight
optimize nutrition
limit protein, Na, Ph; optimize Ca
maintain close Ca and Ph balance; keep Ca x Ph below 65 to avoid metastatic calcifications
monitor fluid intake and urinary output
keep emunctories functioning (charcoal enema, skin brushing, hot mud baths, fever tx, salt bath, mineral bath, wet sheet wrap)
support diuresis as needed
tx and control: HTN, hypercholesterolemia, hyperglycemia
support blood vessel integrity: vaccinium, cratageus, quercetin, bioflavonoids 
decrease or eradicate renal inflammation: anti-inflam diet, fish oil, ground flax, Salvia, panax, gingko, urtica 
carnitine
replenish tyrosine
renal protomorphogen 
epoetin alfa
good quality multivitamin
uva ursi, juniper, solidago, eupatorium
protective antioxidants - curcumin, coptic, CoQ10, vit C, ALA
PUFAs
melatonin 3 mg
homeopathics 
diathermy to KDs, COPs
gentle resistance exercise
manipulation
smoking cessation
acupuncture/acupressure/ ear seeds
mindfulness meditation
monitor thyroid fxn, heart fxn, hormones
28
Q

major indications for dialysis?

A

ARF, CRF (Cr clearance <8 mL/min), anuria

29
Q

two forms of dialysis?

A

peritoneal (intracorporeal)

extracorporal (hemodialysis and hemofiltration)

30
Q

a. Can do at home or in the office
b. One year of treatment can cost $53,000.
c. Risk of peritoneal infection.

A

peritoneal dialysis

31
Q

a. Dialysis unit 3-4 hrs/d, 3-4 times per wk (some possibility of home)
b. One year of treatment can cost $72,000
c. Requires artificial AV shunt

A

extracorporeal dialysis

32
Q

3 forms of peritoneal dialysis?

A

CAPD
CCPD
IPD

33
Q

indications for peritoneal dialysis?

A 
ARF
awaiting hemodialysis
infxn in CRF pts
long-term home care for non-ambulatory pts, elderly, kids
preoperatively to transplant
34
Q

benefits of peritoneal hemodialysis over extracorporal?

A

peritoneal reduces protein loss, much better control of K and Ph levels and rarely need water and Na restriction b/c 2 L/d removed in peritoneal fluid

35
Q

SEs of peritoneal hemodialysis

A

large amount of CHOs –> hyperglycemia, obesity, dyslipidemia, hypotension from sodium depletion, decreased appetite
hypokalemia
infections and sepsis
perforate an abd organ
chronic use can cause sclerosis, BO, hypothyroidism, seizures, pneumonia, hypoalbuminemia, arrhythmias

36
Q

protective and replacement herbs and nutrients for pt on peritoneal hemodialysis?

A

carnitine, fish oil, pantethine, iron citrate or bisglycinate, pyridoxine and cobalamin, biotin, vit E, capsaicin for pruritus
EPO to offset anemia
anabolic steroid to stimulate EPO and counter sarcopenia

37
Q

extracorporeal hemodialysis requires what concomitant txs? each tx can cause what?

A

heparin to offset clots

each tx reduces BUN by 50%, relieves hyperK, corrects metabolic acidosis but all are fleeting effects

38
Q

SEs of extracorporal hemodialysis?

A 
nutritional deficiencies
fever and sepsis
seizures
hyperhomocysteinemia
hypotension
muscle cramps/restlessness
hyperlipidemia
arrhythmias
insomnia
hypoalbuminemia
pruritus
dementia
39
Q

concomitant therapies with extracorporal hemodialysis?

A 
moderate protein restriction
sufficient carb to maintain kcal
water 400-500 mL plus urine lost/d
restrict K, Na
EFA supplementation
water soluble vitamin supplementation
40
Q

advantages and disadvantages of renal transplant?

A

advantages: reestablishment of nearly normal constant body physiology and chemistry
dis: BM suppression, susceptibility to infxn, cushingoid body habitus, psychological uncertainty of homograft’s future, later there can be dz in transplanted KD, increased incidence of CA, GU infxn

41
Q

post renal transplant support?

A

fish oil to decrease thrombosis
control HTN, hypercholesterolemia, hyperglycemia
support bvs
supportive care: CoQ10, centella, rheum, salvia, magnesium
protect KD and liver from cyclosporine: gingko, cordyceps, silybum
treat cyclosporine induced gout: flaxseed oil, urtica
decrease risk of rejection: ginkgo, silybum, fish oil
protect from renal re-perfusion injury: ALA, quercetin, curcumin, NAC, coptis, garlic

Urology (9 decks)

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