Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/110

Click to flip

110 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Among all ethnic groups the number of pts who develop kidney failure is from what?
Diabetes
What is the #1 cause of Renal Failure?
Diabetes
What is the best overall measure of kidney function?
GFR
Normal GFR
about 120
Normal Serum Creatinine levels?
Male < 1.5
Female < 1.2
Is serum Creatinine reliable to measure kidney function?
No.
very unrealiable esp in elderly females. Usually decreased with decreased muscle mass
What critical Creatinine value can indicate serious impairment in renal fxn?
>4mg/dl
What is Creatinine?
Catabolic byproduct of creatinine phosphate, which is used in skeletal muscle contraction.
Why is Creatinine not considered
reliable?
The elderly and young normally have lower Creatinine levels as a result of reduced muscle mass. This may potentially mask renal disease in pts of these age groups.
Correlation (reason why it can't be reliable) between SCr and GFR?
-SCr can be int he normal range even with GFR close to 60cc/min/
-In early renal disease, the initial drop in GFR will be missed if only the SCr is considered*
What is the Gold Standard for GFR calculation?
Inulin Clearance,
not done much though, requires a big lab...Creatinine is the easiest predictor of GFR
What else is used to measure fxn of the kidney?
Creatinine Clearance.
requires a 24 hour urine collection and is a hassle, not done much.
What 2 equations are used in assesing GFR?
Cockroft-Gault Equation
MDRD Equation
(MDRD may be more helpful in with African American Pts.)
What do you do if you suspect low GFR?
Watch BP
Watch for infxn
May have to be dialized
Creatine does not go up until you have lost a lot of----
Kidney function
Pt with slightly high creatinine calls c/o of stomach flu, diahrrea, what do you do?
Make sure they are hydrated, can't have more nephrons die.
May need IV fluids in hospital.
Almost 85% of pts with CKD will have....
Hypertension
What is the single most important factor in slowing the progression of renal disease?
BP!
What should BP control tx include?
Asides from lifestyle change

It should include:
1) ACEI or ARB
2) a diuretic also
What is the goal BP in all pts with kidney disease?
<130/80
What is a major cause of morbidity in pts with chronic kidney disease?
Anemia-it is a major cause of morbidity with pts with CKD
What is anemia in CKD defined as?
<11 in females

< 12 in males
Anemia is primarily a deficiency in?
Erythropoietin, made in the kidney
Anemia increases as what goes down?
GFR
If GFR<60, Hgb<12 in males and <11 in females requires a...
Initial workup
What should be evaluated with initial workup?
-Hgb or Hct
-Fe studies
-Reticulocyte count
- Stool Guaiac
- Erythropoietin is not useful and not recommended*
What is the target Hgb with pts with CKD?
11-12
What needs to be done to get vascular access when the GFR<25?
Preserve the Non-Dominant Hand
What else with a GFR<25?
Refer to a vascular surgeon!
What is the vascular access of choice?
Fistulas:
1) Radiocephalic fistula
2) Brachiocephalic fustula
What is the concern with vascular access via grafts?
Higher infxn and clotting rates compared with fistula, but far superior to a hemodialysis catheter.
What is the most common cause of mortality in CKD and dialysis pts?
Cardiovascular disease
Anemial of renal failure and hypertension can lead to what?
LVH
Hyperlipidemia should be treated....
Aggressively.
All CKD pts should have a goal LDL<100
Diet?
Appropriate protein intake
Restriction of dietary Na, K, and Phosporous.
CKD causes hypo....
hypocalcemia and hyperphosphatemia
Should intact PTH levels be checked for CKD pts?
Yes!
What kind of binder be avoided with CKD pts...
Aluminum based binders.
due to chronic aluminum toxicity in CKD pts.
What kind of acidosis happens when the kidney's can't excrete the daily adic load?
Metabolic Acidosis
When should you refer to a Nephrologist?
1) GFR<30
2) Stage III CKD
3) CKD pts with difficult to control htn
4) pts with nephrotic proteinuria regardless of renal fxn.
Specific Gravity?
weight of urine vs wt. of distilled water
1.010=equivalent to plasma
<= 1.005?
Dilute
1.015-1.030
Increasing osmolarity
RBC in Urine?
acute glomerular nephritis
WBC in urine?
UTI, pyelonepthiris
Casts in Urine?
Pathology in the KIDNEY
What is Renal Failure?
-reduction of GFR that is expressed as retention of nitrogenous wastes (BUN, CR)
What is Azotemia?
Increased BUN/Creatinine
What are the lab abnormalities in RF?
-Azotemia
-Hyperkalemis
-Hyperphosphatemia
-Acidemia
Clinical abnorm of RF?
-Uremia
-Volume overload with loss of UOP
Pre-renal failure?
Prerenal: Anything that’s influencing flow to the kidney (the person who’s terribly dehydrated or in CHF with low C.O., or renal artery stenosis
-volume depletion
-hypotension
-Third space loss
-CHF
Intrinsic Renal failure?
Intrinsic: Post streptococcal glomerulnephritis (antibodies that attack renal), lupus, acute tubular necrosis
*Most common cause of intrinsic RF is *ATN
Post Renal falilure?
Postrenal: Obstruction some place after the kidney. The guy with BPH. Bladder fills up and there’s back pressure up to the kidney. Can also be a woman post radiation for cervical cancer. The radiation down the road can cause scar tissue that obstructs ureter. Back pressure on the kidney.
Think Obstruction.
Tumor, prostate.
Thiazide diuretic?
25mg to 50mg only a little improvement in BP but side effects go way up. Stay 25 mg and below.
Glomerular Nephropathies?
Abnormalities of glomerular fxn.
Damage to glomerulus and its
Nephritic Syndrome?
-Proteinuria
-hematuria
-reduced GFR
-Edema
-Hypertension
-Hematuria (with or without casts)
Nephrotic Syndrome?
-Significant Proteinuria (>3.5/24 hours)**
-hypoalbuminemia(<3)
- hyperlipidemia
-peripheral edema
What is the hallmark of Nephrotic syndrome?
Peripheral Edema!
Acute tubular necrosis?
-Acute Renal insufficiency
-Urine segment or pigmented granualr casts and renal tubular epithelial cells.
What are the two major causes of ATN?
1) Ischemia: shock/sepsis

2) Toxin Exposure: NSAIDS/Iodinated IV contrast/ACEI/ARB
Aminoglycosides/Ampho B, etc...
Non-anion gap metabolic acidosis?
-loss of HC03 from body
Renal losses(Renal tubular acidosis)
GI losses: Diarrhea, vomitting, pancreatic or biliary secretions
If anion gap is elevated a ? is present?
metabolic anion-gap acidosis is prestent
Anion gap metabolic acidosis=think?
Acute renal failure
Causes of Metabolic Alkalosis?
-Acid loss from stomach
-Diuretics
-Mineralocorticoid excess
-Congenital Syndromes
Calculate Anion Gap?
NA - CL + HC03
Example:
140-104+(-15) = 21
Things that will give an anion gap?
-ASA overdose will have an anion gap.
-Diabetic ketoacidosis: Metabolic byproduct of fat/protein digestion. These will have an increased anion gap.
What is the single most important factor in slowing the progression of renal dz?
BP control!!
What is the goal BP with kidney dz pts?
<130/80
Kidney failure tx should include ?
ACE1 or an ARB as long as is tolerated. A diuretic is needed
Anemia with CKD?
-deficiency in EPO
-slowly** give EPO
which renal disease can have Eosinophils in the urine?
Interstitial Nephritis
Triad: Eosinophilia,Fever, Rash!
Which renal disease has hematuria and proteinuria?
Nephrotic Syndrome
Pts that present with heavy proteinuria but few formed elements(casts, cells, etc..) in their urine?
Nephrotic syndrome
What is the most common form of glomerulonephritis Worldide?
IgA Neuropathy
Once again, Nephrotic Syndrome?
-Heavy Proteinuria > 3.5
-peripheral edema
-hypoalbuminemia
-hyperlipidemia
-hypercoaguable state(maybe)
Which of the following is the most common cause of Intrinsic Renal Failure?
A. Prerenal Azotemia
B. Glomerulonephritis
C. Interstitial Nephritis
D. Acute Tubular Necrosis
E. Obstructive Neuropathy
D. Acute Tubular Necrosis**
The leading cause of chronic renal failure is?
Diabetes mellitus!!!!
What are the common fluid or electrolyte abnormalities seen in chronic renal failure?
-metabolic acidosis
-hyperkalemia
-hyperphosphatemia
-hypocalcemia
M.H.H.H.
What are findings that may indicate the chronicity of renal failure?
-Azotemia for 3-6 months
-bilaterally small kidneys by sonogram
-broad casts in urinary sediment
-anemia
Urine output of <400ml/day is defined as?
-Oliguria
The most common electrolyte imbalance in a hospitalized population is?
Hyponatremia
What is the most important complication of peritoneal dialysis?
Peritonitis

-Organism responsible=Staphylococcus
Calculation of anion gap is helpful in determining the cause of?
Metabolic acidosis
Normal Anion Gap?
8-16
Increased anion gap in these?
-Ketoacidosis
-lactic acidosis
-renal failure
-Salicylate overdose
Pt with Abrupt onset of edema, proteinuria, and Cola colored urine has?
Acute Glomerulonephritis
Methicillin hypersensitivity
Fever
Rash**
Eosinophilia
Pyuria
WBC casts
Hematuria
Think Interstitial Nephritis
All of the following renal stones are radiopaque except?
A. Calcium Oxylate
B. Uric Acid
C. Cystine
D. Stuvite
E. Calcium Phosphate
B. Uric Acid
They are Radioluscent
The most serious consequence of rapid correction of hyponatremia is?
Severe Brain Damage
factors associated with adverse prognosis in HTN?
-Black Males
-Diabetes Mellitus
-Cardiomegaly
Single dose antibiotic therapy in acute uncomplicated cystitis is not good for?
Male pts with urinary tract infections, males UTI are considered complicated and require more than a single dose abx.
Hypertonic saline is indicated for the tx of?
Fever, symptomatic Hyponatremia
ex: Na of 115
Normals are 135-145
What can cause hypercalcemia?
-Primary hyperthyroidism
-Thyroxicosis
-Malignancy
-Thiazide diuretics
Clinical signs of hypoclacemia?
-positive Chovstek's sign
-Cramps and tingling
-Tetany
-Siezures
What may suggest that the pt does not have non-glomerular source of bleeding?
-Hematuria and PYURIA(usu urinary tract stuff)
What is the tx for RCIN?
-Acetylcsteine
-Hydration with D5W
-3 ambs bicarb
Stop diuretics/NSAIDs/ACE1/ARB
Vasculature Atheroembolic dz?
Renal failure 2ndary to occlusion of renal arteries, arterioles, and glomerular capillaries.
AED see notes many symptoms,
The Great Masquerader, many problems
-course is usu progressive over weeks to months
-prognosis is very poor
-unlikely to recover renal fxn
-affects multiple organs
-can be recurrant or intermittant.
Hyperkalemia
Acidemia
Hyponatremia
Azotemia
Reduced GFR
Anuria
Oligura??
All sxms of Acute renal failure...
Three primary mechanisms by which a nephritic state can be induced?
-Cirlculating antibodies directed against the glomerular basement membrane
-immune complex formation
-circulation antibodies directed against neutrophil cytoplasmic agents
Secondary hyperparathyroidism with CKD?
CKD causes:
-hypocalcemia
-hyperphosphatemia
-decreased Vit D synthesis by kidney
-Secondary hyperparathyroidism occurs
Check PTH levels**
Causes of AG Metabolic Acidosis
MUDPALES
Causes of an AG Metabolic Acidosis (MUDPALES)

Methanol (Wood alcohol)
Uremia
Diabetic Ketoacidosis
Paraldehyde
Alcoholic Ketoacidosis
Lactic Acidosis
Ethylene Glycol (anti-freeze)
Salicylates (Aspirin overdose)
Prerenal Azotemia?
Prerenal Azotemia: is the most common cause of acute renal failure
True or False:
The MDRD equation used to predict GFR is more accurate for advanced dz and for African Americans?
True

*results debatable though
Signs of Azotemia in ARF are?
-Nausea
-Vomitting
-Malaise
-Altered sensorium
What accounts for 85% of acute renal failure?
Acute Tubular Necrosis
Azotemia over months to years is known as?
Chronic Renal Failure
The highest anion gap acidoses are seen with?
-Lactic Acidosis
-Ketoacidosis
-Toxins
Non-anion gap acidosis
-HCO3 loss -GI (diarrhea, pancreatic)
-Renal/tubular(renal tubular acidosis)
Causes of metabolic acidosis
Acid loss from stomach
Cong. syndromes
Diuretics
Mineralocorticoid excess