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113 Cards in this Set
- Front
- Back
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what are the two major metabolic probs that happen because of acute kidney disease
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acidosis and hyperkalemia
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what are the risk factors for acute kidney disease
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Chronic kidney disease, diabetes, volume depletion, heart failure, liver failure, age >50
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what is teh main dx criteria for chronic kidney disease
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Kidney damage or glomerular filtration <60 mL/min of 3 months duration or more
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what are the risk factors for chronic kidney dz
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Diabetes, hypertension, obesity, lower socioeconomic status, and age
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what are the 5 stages of chronic kidney disease and the gfr's that correlate
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I – GFR >90
II – GFR 60-89 III – GRF 30-59 IV – GRF 15-29 V – GRF <15 or being on Dialysis |
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what is the most common complaint of chronic kidney disease
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fatigue
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what are the sx that correlate with stages 1-2 and 3-4 of chronic kidney disease
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Stage 1-2 asymptomatic often – with proteinuria
Stage 3-4 usually have symptoms of cardiovascular disease, bone and mineral metabolism abnormalities and anemia |
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what is the assoc cv prob that comes with ckd
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Decreased GFR is associated with vascular elasticity and increased cardiovascular mortality
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what is the anemia assoc with ckd
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epo- usu stage 4 and 5
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what is the chronic mineral and one metab disorder that is assoc with ckd
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Stimulation of parathormone through hyperphosphatemia, hypocalcaemia and deficiency of 1,25-Dihydroxycholecalciferol
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what is this: Hematuria – dysmorphic red cells and red cell casts
Immune complex disposition Pyuria, cellular/granular casts Rapidly progressive glomerulonephritis - urgent |
glomerulonephritis
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what are the four main causes of acute glomerulonephritis
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iga, henoch schonlein purpura, post step, endocarditis and other deep infectins, RPGN
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what is the most common cause of nephritis worldwide
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iga nephropathy
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HS purpura is a __ __ vasculitis
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small vessel
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RPGN has multiple inflam and __ mediated etiologies
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autoimmune
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what is this: Sudden significant/massive proteinuria and mild hematuria
Children Steroid sensitive often relapses in adulthood |
min change disease
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what is this:Microscopic hematuria, hypertension and renal insufficiency
Most common in African-Americans |
FSGN
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what is this: Idiopathic, Caucasians associated with thromboemboli
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membranous nephropathy
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what is this :Uncommon
Associated with Hepatitis B & C |
MPGN
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what is this:Hematuria
Asians and Caucasians Usually IgA immune complex nephropathy, but sometimes idiopathic Gluten enteropathy (celiac disease) |
mesangia prolif
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what are the main primary nephrotic syndromes
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f, M M MM
FSGN, Min change, membranous neph, membranoprolif, mesangial prolif |
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what are the main secondary causes of nephrotic syndrome
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diabetes, amyloidosis, multiple myeloma, hiv, hep b
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what type of diabetes has more renal failure, what are risk factors for RF from diabetes
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Renal failure more prevalent in type I diabetes, non-Caucasians
Risk factors: smoking, poor diabetes control, older age and hypertension |
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what is the name of this cause of nephrotic synd: Immunoglobulin accumulation in the distal nephron without albuminuria
Eosinophilic mesangial glomerular nodule Presents primarily as tubule obstructing insult |
multiple myeloma
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what is the name of this cause of nephrotic synd: glomerular viral infection, Most common in African-Americans
Segmental glomerulosclerosis |
HIV
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what is the name of this cause of nephrotic synd:Membranous nephropathy pattern
Worse prognosis than primary membranous nephropathy |
hep b
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UV reflux and HIV resemble what primary cause of nephrotic syn
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fsgn
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what secondary cause of nephrotic synd resembles mem nephropathy
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inInfection, toxins/drugs, CA
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what secondary cause of nephrotic synd resembles min change disease
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Lymphoma/NSAIDS, Li
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what secondary cause of nephrotic synd resembles membranoprolif
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SLE, Hepatitis C
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what secondary cause of nephrotic synd resembles mesangial prolif
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Henoch-Schonlein Purpura, SLE
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what are sx of acute tubulointerstitial diseaese
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Hematuria, pyuria, eosinophilia, eosinophiluria in the urine sediment
Acute tubular necrosis |
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what are signs and sx of chronic tubulointersitital disease
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Polyuria and nocturia
low urine sediment/non-nephrotic range proteinuria Non-AG renal tubular acidosis Atrophic kidney’s Biopsy with lymphocytic infiltration and fibrosis, |
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what must you rule out for chronic TI dz
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obstruction and hydornephrosis
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what is the approx urine specific gravity of chronic ti dz
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1.010
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what are the primary risk factors for TI disease
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female gender and increased age
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what are the meds that can cause ti dz
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Non-steroidal anti-inflammatory medication (NSAIDS)
Phenacetin Cyclosporine Lithium – usually dose related IV radio-contrast dye |
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what usu causes obstruction assoc with ti dz
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Prostatic hypertrophy
Cervical cancer |
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what malignancies are assoc with Ti dz
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Multiple myeloma
Tumor lysis syndrome |
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what infections are assoc with TI dz
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Epstein-Barr, cytomegalovirus and polyomavirus (immune compromised patients)
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how long can obstruction be present before RF is permanent
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8-12 weeks
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how is rhabdo assoc with TI dz
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tubular precip of myoglobin and obstruction
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how is SLE related to TI disease
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Deposition of immune complexes
Unusual as a primary tubulointerstial diease – usually presents secondarily to SLE related glomerular disease |
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how is sjogren related to TI dz
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autoimmune disorder
Distal RTA and loss of concentrating function |
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how is sarcoidosis related to TI disease
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noncaseating granulomatous disease
Associated with elevated 1,25 dihydroxycholecalciferol and resultant hypercalcaemia, hypercalciuria and nephrolithasis and nephrocalcinosis |
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how is lead related to ti disease
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Painters, battery workers, welders, home distillers using lead instead of copper
Proximal tubules/Fanconi syndrome |
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what are the primary TI diseases that dont cause glom involvement
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sle, sjogrens, sarcoidosis, lead
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what are the two large- medium renal vascular diseases
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Renal artery stenosis
Usu atherosclerotic Fibromusclar Disease Most common in females ages 20-50 |
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who gets polyarteritis nodosa
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hep b, hiv, and rarely hep c
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what does green urine mean
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Pseudomonas spp., bile, exogenous chemicals (foods and medications)
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what does orange red urine mean
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Phenazopyridine, rafampin
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what does brown urine mean
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Urobilinogen, Porphyria, exogenous chemicals (foods and medications)
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what does cloudy/milky urine mean
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Phosphates, leukocytes, bacteria, and chyluria
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what does pink/red urine mean
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Red cells, myoglobin, hemoglobin, exogenous chemicals (foods and medications)
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wat is the average ph
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5.5- 6.5
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when is urine ph not the reflection of the whole body ph
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in RTA type I and II
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what can cause alkaline urine >7
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Urea-splitting organisms, i.e. Proteus mirabilis
Gastric suctioning/vomiting Vegetarian diet |
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what can cause acidic urine <5.5
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Metabolic acidosis – lactate production
Foods (cranberry) Diarrhea |
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specific gravity can be used to showq
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how the kidney concentrates urine
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specific gravity can be falsey high at __ and falsly low at __ ph
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low ph
high ph |
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what causes increased specific gravity
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Dehydration/hypovolemia
Administration of osmotic diuretics/contrast agents |
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what causes decreased specific gravity
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Diabetes insipidus
Excess water intake |
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Eight hour fasting plasma glucose >
Two hour post glucose load > |
126mg/d
l200mg/dl |
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Renal threshold for glucose is
Most chemistry strips detect as little as |
160-180 mg/dl
50mg/dl |
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what happens why myoglobin cross reacts
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CPK (creatine phosphokinase) elevated
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how much albumin does the dipstick detect per 24 hours
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200-500mg
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a ph of what can give a false pos on dipstick
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> 7
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dipstick is a great screening tool for what
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diabetic nephropathy
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what do you see ketones on urinalysis
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Diabetic
Alcoholic ketoacidosis Fasting and Starvation |
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when do you see conjugated bilirubin on urinalysis
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conjugated bilirubin
Obstructive jaundice and hepatocellular injury Hemolysis – positive urobilinogen |
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what is released frm wbc's that can be detected on urinalysis
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esterase
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what is nitrite useful for on urinalysis
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Pseudomonas, fungi and Gram positive organisms do not metabolize nitrate
only notes the presence of bacteria |
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what sort of diseases are assoc with extraglomerular hematuria with intact morphology of the rbc
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Cancer, infection, nephrolithiasis, medications and traum
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what sort of things can cause leukocytes in the urine
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Glomerular or tubular inflammation
Infection Allergic nephritis Eosinophils |
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what is the normal range of serum creatinine
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.5-1.2
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what can cause a falsy low level of creatinine
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Advanced age, liver failure, malnutrition
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what can cause a falsy high level of creatinine
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Rhabdomyolysis
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what is the normal range of BUN
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7-11
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where is BUN reabsorbed
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inthe proximal tubule
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la gare
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the station
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what is the normal range of bicarb
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18-30
it is co2 on the chemistry report |
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what is the normal range of bicarb
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18-30
it is co2 on the chemistry report |
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what is the cockcroft gault eq for creatinine clearance
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[(140-age) x wt (kg) x (0.85 in female)/ 72 x (Scr)
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what is the cockcroft gault eq for creatinine clearance
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[(140-age) x wt (kg) x (0.85 in female)/ 72 x (Scr)
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what is the equation for fraction excretion of sodium
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FE Na = (urine Na)/(serum Na) /(urine Cr)/(serum Cr) } all of it times 100%
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what is the equation for fraction excretion of sodium
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FE Na = (urine Na)/(serum Na) /(urine Cr)/(serum Cr) } all of it times 100%
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FeNa < than 1% reflects avid tubular reabsorption suggests
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prerenal azotemia
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FeNa < than 1% reflects avid tubular reabsorption suggests
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prerenal azotemia
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fena > than 3% (some texts say 2%) suggest
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tubular necrosis
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fena > than 3% (some texts say 2%) suggest
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tubular necrosis
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Fena Must be interpreted with caution in
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preexisting kidney disease and with diuretic use
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Fena Must be interpreted with caution in
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preexisting kidney disease and with diuretic use
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when do you do a kidney biospy
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Acute glomerulonephritis
Transplant rejection Suspected malignancy Clinical findings inconsistent/inconclusive In order to direct therapy |
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when do you do a kidney biospy
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Acute glomerulonephritis
Transplant rejection Suspected malignancy Clinical findings inconsistent/inconclusive In order to direct therapy |
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what are some risks assoc with kidney biopsy- or reasons why not to
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risk of spreading malig cell, single kidney
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what are some risks assoc with kidney biopsy- or reasons why not to
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risk of spreading malig cell, single kidney
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what stage of kidney injury is this: Elevated specific gravity
Elevated BUN and creatinine BUN of 20:1 or higher Often an elevated sodium, but may be normal or low Fractional excretion of sodium <1% |
prerenal
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what stage of kidney injury is this: Elevated specific gravity
Elevated BUN and creatinine BUN of 20:1 or higher Often an elevated sodium, but may be normal or low Fractional excretion of sodium <1% |
prerenal
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what are causes of prerenal kidney injury
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Volume depletion – lack in intake, diuretics
Congestive Heart Failure Poor kidney perfusion – i.e. sepsis, CHF, cirrhosis, blood loss |
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what are causes of prerenal kidney injury
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Volume depletion – lack in intake, diuretics
Congestive Heart Failure Poor kidney perfusion – i.e. sepsis, CHF, cirrhosis, blood loss |
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in prerenal kidney injury what is assoc with underestim of kidney function
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gi bleed, high protein diets
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in prerenal kidney injury what is assoc with overestimation of kidney function
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liver failure, and protein malnutrition
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Muddy casts
Ischemia and nephrotoxicity Severe liver disease often associated with poor renal profusion and vasoconstriction |
acute tubular necrosis
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what is this cause of kidney injury: Prolonged immobilization, myotoxic medication, infection,
Heme positive urine |
rhabdo
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what is this: Contrast in creatinine greater than 1.5, DM, metformin
Prevented with pre-contrast IV hydration |
radiocontrast kidney injury
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what is intrarenal kidney injury
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BUN and Creatinine ratio < 20:1, fractional excretion of sodium > 3%
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what are 4 classifications of intra renal injury
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acute tubular necrosis, radiocontrast, hypoperfusion, rhabdo
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what is this cause of intrarenal kidney injury: History of Medications (PPI’s & NSAID’s)
Coarse granular casts – eosinophils, rash, and pruritus |
intersitial nephritis
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what is this: Small kidneys on ultrasound, decreased GFR and non-anion gap RTA
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chronic TI dz
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Hyperkalemia
BUN and creatinine – ratio < 20:1 (exceptions can occur with severe/prolonger disease - greater than 1 week) Hydronephrosis – renal ultrasound Hematuria, no red cell casts |
post renal injury
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Urine output may be low; paradoxically, can be high due to loss of tubular function
Pain, Can lead to decreased renal blood flow resulting in altered filtration, tubular function, and potentially causing ischemia and fibrosis if uncorrected |
post renal
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what are causes of post renal injury
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Nephrolithiasis
Tumors (including GI and retroperitoneal) Prostatic hypertrophy Catheters – mechanical dysfunction of the catheter Bladder atony – i.e.. neurogenic bladder Constipation/impaction – GI encroachment Urethral scaring /trauma |
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what are the indications for dialysis
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Volume overload
Hyperkalemia - severe Metabolic acidemia Encephalopathy Pericarditis Bleeding diathesis – uremia induced platelet dysfunction Toxin elimination if dialyzable |
