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137 Cards in this Set

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When taking pt family history, 3 family related red flags for possible kidney problems?
Polycystic, nephritis, stone
What the heck is polycystic kidney disease?
Polycystic kidney disease (PKD) is the fourth leading cause of kidney failure. PKD is a hereditary disorder. Polycystic kidney disease is when fluid-filled cysts grow in the kidneys. Many cysts form in each kidney which can lead to renal failure.
What systemic diseases cause kidney problems (there are 4)?
What's potentially toxic to a kidney?
etals, radiographic allergy
What drugs can cause kidney problems?
Antibiotics, NSAIDS, diuretics
What are symptoms of kidney disease?
Fever, weight loss, fatigue, rash, pruritis (that's itching) sore throat, dyspnea, chest pain, edema, anorexia, N/V, the kitchen sink
Are there MORE symptoms of kidney disease?
Polyuria (too much urine),
dysuria (difficut/painful urination),
flank pain, hematuria
What are some of the cardio findings related to kidney disease?
Edema, BP (loww maybe or high),
pericardial rub
What are some of the genito/urinary findings related to kidney disease?
Prostate problems or palpable kidney
What are some of the neurological findings related to kidney disease?
Peripheral neuropathy
Any encephalopathies?
Yes - stupor due to excess nitrogens in blood.
what's asterixis and what does this have to do with the kidneys?
when you find muscle tremors due to acidosis - asterixis is involuntary, jerking or flapping movements, especially of the hands.
diabeties and kidney disease - what's the link?
Diabeties can damage the glomeruli and damage nerves needed for micturation
What findings do you see with a fundoscope (in the eye) that are red flags for kidney disease?
diabeties, Htn
Lab exams for kidney?
Urinalysis using dipstick or 3 glass collection.
What are you looking for in the urinalysis?
Protein, glucose, blood, nitrates, WBC, pH, casts
What areas are the three glass collection method testing in men?
urethra, prostate, bladder
What are you looking for in a Chem screen?
BUN, Creatinine, GFR
What are you looking for in a CBC?
anemia, infection
What are you looking for in imaging?
Using an Xray you will see radiopaque calculi.
What might you see in an ultrasound?
Masses, cysts, and hydronephrosis
What is hydronephrosis?
Abnormal enlargement of a kidney, which may be caused by blockage of the ureter (such as by a kidney stone) or chronic kidney disease that prevents urine from draining into the bladder
What is an IVU and what does it have to do with kidneys,
IVU is when you inject dye and xray its journey through the urinary system. Called a pyelogram
What is a retrograde pyelogram?
Hmmm dye moving backwards I suppose - wonder how they do that.....
What are you looking for in an MRI/CT scan?
Masses in/around the kidneys.
Common sx of kidney disease?
Frequency, Urgency, Dysuria.
what could cause frequency (9 of them)?
UTI, pregnancy, prolapsed uterus, foreign bodies, stones, excessive fluids, diuretics, DM, food sensitivities.
What would cause urgency?
UTI, small amounts of urine each time
What causes dysuria?
pain, UTI, STI (he emphasized that this was an Infection NOT an ST'D' disease)
What are other symptoms of kidney disease?
back pain, pyuria, casts, discharge
What's pyuria?
Pus (WBC's) in the urine - makes it cloudy
What's the difference between pyuria with bacteria and pyuria without
with bacteria = UTI
without bacteria = TB of the kidney
Leukocyte casts in a line - sign of:
renal infection
What is the cutoff for colony count in urine?
Greater than 100,000 colonies means a problem (less could be normal).
What could back pain mean?
prostate or fibroids
Wht could discharge mean?
What could nocturia be a sign of?
evening fluid intake, DM, BPH, early stage of disease
What's enuresis?
Bed/pants wetting
What could cause enuresis?
delayed neuro maturation,
hypoglycemia, bladder size, food sensitivities (he says - eat turkey at night for the tryptophan)
What can cause incontinence (5)?
Urge, reflexes gone, stress, distended bladder, spastic bladder
What are other stresses to the urethra causing incontinence?
increase in pressure, cough, sneeze, valsalva, laugh
What can cause a spastic bladder?
Neuro, obstruction (ie tumor), childbirth
What is renal colic?
Pain that is unilateral,
crescendo,decresc pain,
starts in flank, across costal-angle, across abdomen, along ureter, down inner thigh.
What causees renal colic?
most often - renal calculi
What are some other sx of renal calculi?
N/V, chills, fever, hematuria, freq
Hematuria alone is a sx of?
Bacteria and pyuria alone are sx of?
Xrays usually show stones
not always
most diagnostic test?
U/S and IVU (the dye thing we discussed above)
What volume defines polyuria?
> 2.5L urine/day
Could this be diabeties insipidus?
yes, or just response to diuretics, sodium, or just drinking alot of fluids
what's diabeties insipidus?
A condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. This condition may be caused by a defect in the pituitary gland or in the kidney. In diabetes insipidus, blood glucose levels are normal.
What could the pituitary problem be?
Anti diuretic hormone or vasopressin imbalance
What is nephrotic Diabeties Insipidus?
When the prob is in the kidney and not the brain.
What are the pos causes of nephrotic DI?
Kidney not responsive to ADH, renal failure, acute infection, drugs,
More causes?
High Ca, low K
What are other concerns due to polyuria?
dehydration, electorlyte loss
What is psychogenic polydipsia?
compulsive drinking (of H2O)
What is Oliguria?
Decreased urine <.5L/day
What's anuria?
Prerenal decrease due to?
heart failure, liver cirrhosis, volume depletion
What can cause renal disease?
arterial obstruction and acute kidney disease.
What can cause problems post renal?
Obstruction, BPH, stones, trauma, (all these things cause decease peeing)
Urine colors - Colorless?
low concentration, DM, DI
Cloudy White?
alkaline urine, infection, epithelial cells, WBC, bacteria
B vitamins, concentrated tetracycline
Liver issue here! urobilinogen, bile, pyridium, carrot juice.
Beets, candies, hemoglobin, cascara
liver issue - biliverdin, drugs, pseudomonas
coca cola, bilirubin, glomeruloneph, hepatitis
Blood in the urine?
What's TITS?
Trauma, Infection, Tumor, Stones
What's Cascara by the way?
A common ingredient used in weight loss products. One of the few herbs approved by the FDA as an over-the-counter drug. It is a strong stimulant laxative.
A green pigment, occurring in bile and sometimes formed by oxidation of bilirubin.
What's pyridium?
analgesic (trade name Pyridium) used to treat urinary tract infections
What's urobilinogen?
a chromogen formed in the intestine from the breakdown of bilirubin
What kind of history do you have with hematuria?
Frequency, urgency, pain, stones trauma drugs, duration and d/c (what's d/c?)
What could hematuria be caused by if its painless?
could be a tumor, cysts, exercise, UTI, sickle or renal and prostate problems
What if it's painful?
Stones and UTI
Blood at the begining when you pee?
Urethritis, cystitis,
Blood at the end?
Blood throughout?
prostate, bladder, kidney
What about gross hematuria? (lots of blood)
vaginal, beets and.... most serioslyy...coumarin!!
What about microscopic blood?
UTI, stone, tumor, exerrcise
What do RNC casts and /or protein mean?
glomerular probs has a smokey color.
Big gross clots?
a distal tumor
When do you you get anemia as a result of hematuria?
Very rarely
What do you think when you think anemia?
chronic disease, hematologic condition
What labs for hematuria?
Physical exam for hematuria?
bleeding disorders, petechia, ecchymosis
What else should you check when you have hematuria?
check spleen, lymph, prostate, flank pain, suprapubi tenderness and there may be a fever
He has 3 slides on edema - lots is review like what's pitting edema etc.
I skipped it
Diseases where edema is prominent?
Lymphedema, stroke (unilateral), trichinosis (worms), myxedema (hypothyroid, non pitting edema
What are the sx of acute renal failure?
Increasing azotemia, BUN
What's azotemia?
increase of nitro in the blood
Renal failure - does it have oliguria (scanty urine production
Can be with or without
In 60 - 70% of renal cases - sx are?
trauma, drugs, surgery obstruction, calculi, aneurysm, hemorrhage
In 20-30% of renal failure cases?
glomerulonephritis, SLE, Goodpasteure's
What are some of the pre renal causes of Renal failure?
dehydration, cardiac/hepatic failure, shock, burns
What about post renal causes?
Glomerular/tubular dysfunction, calculi, prostate, tumors
What about renal causes of renal failure?
Renal ischemia, drugs, glomerulonephritis, tubular necrosis
Some sx of renal failure?
lethargy, pulmonary edema, HT, CHF, oliguria, anuria
What does the chem screen look like?
elevated BUN/Creatinine note creatinine rises slower
What are the other sx?
Hyperkalemia, inc CO2, acidosis
What di you see in a CBC?
What's in your urine for renal failure?
RBC, WBC, possible casts and protein
What if you have oliguria greater than 3 days?
Severe renalfailure
Treatment for renal failure?
dialysis, limit water, sodium, potassium, protein
Chronic renal failure is secondary to?
HTN, CHF, SLE, NSAIDS, polycystic kidney, glomerulonephritis
What happens if you take 2 ibuprof/day for 7 years?
Chronic renal failure
Chronic renal failure sx?
Elevated BUN, creatinine, nocturia, fatugue, m twitch, neuropathy pruritis, bad taste, anorexia, diarrhea
What happens in advanced renal failure?
Decreased Na, and CA
Inc. Phos, K, CO2
normochromic anemia or normocytic
What else do you see in chronic renal failure?
waxy casts, decreased protein and water intake
What is nephrotic syndrome?
Basement membrane of glomerulus
Sx of nephrotic syndrome?
severe proteinuria, hypoalbumenemia, edema, lare lipiduria. NOTE NO BLOOD
Systemic dz that cause nephrotic syndrome?
DM, tumor, leukemia, SLE, HIV
What are other sx of mephrotic syndrome?
Frothy urine, edema, anorexia, weakness, SOB, DOE, abdominal pain
Lab results of Nephrotic?
waxy casts - they get stuuck
Pe of nephrotic?
edema, m wasting, vertical white lines on nail, hypotension
Nephiritic - aka glomerulonephritic caused by?
Auto immune
SX of nephritic?
BLOOD!!!, RBC casts, slight proteinuria
Other sx?
HTN from increased blood volume by sodium retention and reduced GFR
What causes this auto immune response in nephritic?
Immune complexes, post strep, URI, pharyngitis, OM, staph
Other sx of glomerulonephritis/ nephritic?
lethargy, h/a, malaise, fever, flank pain, oliguria, dark urine, edema, HTN,
sometimes asymptomatic
What ELSE (goodness this sx list is even longer)?
RBC casts, inc BUN/Creatinine, ESR up,
Recovery from this?
Good - though HTN and CHF can complicate
What's glomerulonephritis?
Sclerosis of glomeruli, proteinuria, hematuria, HTN, loss renal ftn
Sx of chronic glomerulonephritis?
N/V dyspnea, pruritis, fatigue
what else in the blood for chronic?
RBC, waxy casts
Rare, hypersensitivity disorder against the basement membrane of the kidney and the lungs
Poor - renal and lung hemorrhage, hematuria, hemoptysis
Bergers DZ?
AKA IgA nephropathy
Sx of Berger's?
recurrent hematuria, proteinuria, IgA onthe glomerular membrane. Serum has high IgA - shows on biopsy
What's Henoch-Schonlein Purpura?
I cant figure out what this has to do with kidneys other than you have hematuria, proteinuria, inc ESR, BUN, creatinine, sooo I guess kidneys....
Sx of HSP?
Vasculitis in skin, joint, and GI
Other Sx?
Arthritis in hands and feet, GI pain, vomiting, occult blood
Post URI leads to symetrical purpura over extensor surfaces and buttocks. There's a RASH