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86 Cards in this Set

  • Front
  • Back
typical pH of urine
5 - daily net acid exretion
1+ on dip = for protein
renal threshold for glucose
positive in UTI (E.coli)
Leukocyte estrase
WBC's (not very useful Jackie says)
microscopic hematuria
>2 rbc/HPF (always check LMP)
> 4 wbc/HPF
casts are always of what origin?
RENAL- problem in renal tubles itself
RBC casts
Tubular casts
Muddy brown casts
WBC casts
Waxy casts/broad casts
Hyaline casts
not significant- normal
24 hour urine for protein excretion- what number indicates glomerular disease?
>3.5gm/24 h
best test to due most accurate test to fin the amount of urine protein lost
24 hour urine analysis
another way to check for protein quickly
protein-to-creatine ratio
-spot urine for prtoein and fro creatinine-quick test
ratio of 3= 3 g of protein /24 hopurs
<1% FENA
prerenal azotemia- bun and creatinine are rising and hs nothing to do with the kidney
-has to do with shock - anything that causes a decrease perfusion to the renals
>1% FENA
ATN/renal disease
-IV contrast dye, all the renal diseases, obstructive diseases
>2 L/day urine output
-DI (ADH deficiency)
-Partial obstruction (prostate)
<20 ml /hour (500mg/day)
-common in ARF
-but most drug induced nephrotoxicty is not oliguric
< 4 ml/hour (100ml/day) NO URINE
-complete obstruction **PROSTATE- most cmmon
-severe ARF- renal necrosis
What is creatinine clearance used for
clinically to estimate GFR
*increase in S. Cr from 0.6 to 1.2 indicates a 50% reduction in GFR (even though both values are wnl)
-want to clear almost 100% of what the person makes
-need to order a 24 hour urine for creatinine clearance
water retention
Na retention
DI for volume depletion
no ADH
adrenal insufficencey or volume depletion
no aldosterone
volume excess
primary hyperaldosteronism
in the absence of functioning kidneys, S. creat rises how much per day
1-1.5mg/dL per day (or faster)
what is complete renal shutdown defined as?
a rise in creatinine of 0.5mg/dL or more, and urine output less than 400mL/day
CO2 increases
acidosis (respiratory)
CO2 decreases
alkalosis (respiratory)
decrease in bicarb, increase in H ion
acidosis (renal)
increase in bicarb, decrease in H ion
alkalosis (renal)
decreased secretion oh H by kidneys
-normal anion gap
-ATN, postassium spring diuretics, CRF
loss of alkali by GI tract
normal anion gap
increased production of nonvolatile acids
widened anion gap
Anion Gap equation
AG= Na -(Cl + HCO3)
12 (+/- 2) is normal anion gap
metabolic alkalosis
volume loss with chloride depletion
-gastric lavage
Tachypnea suggests hyperventilation which indicates ______.
respiratory alksolosis (blowing off CO2)
obstruction to airflow, or inability to breathe (sedation) increases CO2 concentration which indicates ________.
respiratory acidosis (retaining the CO2)
nausea and vomiting (loss of chloride) indicates ________.
metabolic alkalosis
diarrhea (bicarb loss)
normal anion gap metabolic acidosis
chronic renal insufficiency (early) indicates ________.
normal anion gap metabolic acidosis
acute respiratory failure for respiratory acidosis
-drug intox
-cardiopulmonary arrest
chronic respiratory failure indicates _______.
morbid obesity
neuromuscular disease
hyponatremia- what should you check?
s. osm
-**hypo-osmolar (SIADH- pitutiary mass, drugs (SSRI's), post op, psychogenic polydipsia, lung-small cell carcinoma
-hyperosmoalr= hypergycemia
Hypernatremia- due to?
**DI (nephrogenic)- tubule is impermeable to water
-excess water loss (usually not Na gain)
what are the 3 mechanisms of acute renal failure?
1. prerenal- perfusional, kidnesy are fine, just not perfusing
2.renal- (intrarenal problems) - glomerular, rubualr, instersitial- a kidney problem
3.postrenal - obsturctive- big problem in older men (prostate- and it is correctable)
urine specific gravity for ARF for prenal and renal
S. bun/s. creat for pre renal and renal
urine osmolality for pre-renal and renal
>500 (goes up as person is volume contracted)
FENA for pre-renal and renal
< 1- aldosterone is causing body to retain Na+ b/c trying to retain water
pre-renal etiologies
Diuretic therapy- we are making them too dry!
hemorrhagic/septic/anaphylactic shock
morphine/heroin overdose
intra renal casuses
intersistial nephritis
ATN- give some clues to this
azotemia- nitrates build up in blood
FENA >1%
microscopic- renal tubular epithelial cells, muddy brown casts, granular casts, (come for the tubes) pathonomonic for ATN usually
major causes of ATN
toxin exposure (aminoglycosides, amphotericin, iodinated contrasts, NSAIDS, ACEI's)
ischemia (dehyrdation, shock, sepsis)
-red cell casts
-hematuria, HTN, oliguria, azotemia
-mild proteinuira, mild edema
-RBC casts, rbc's, and dysmorphic rbc's
-massive proteinura with no cells
-hypoalbuminemia, hyperlidpidemia, generalized edema
-oval fat bodies but "bland" microscopic- nothing to see when you spin down the urine
nephritic syndromes
interstitial nephritis
glomerulonephritis (post strep GN)
Zebras (Pauci-immune GN, wegener's, microscopic polyangitis, goodpasture's, IgA nephropathy?berger's, HSP
fever, rash, arhralgias, eosinophila, acute azotemia, wbc casts, hematuria, eosinophiluria
interstitial nephritis
how do you diagnose interstitial nephritis?
renal biopsy
treatment of interstital nephritis
stop offending drug
self limited usually
dialysis if needed
autoimmune body starts to make antibodies
-Edema, HTN, acute azotemia, hematuria, dysmorphic rbc's, casts, mild proteinura, recent strep group A infection
what you do for a vasculitic disease
get cbc, 24 hour urine, and REFER!!! :)
ANCA associated
Pauci-immune GN
systemic inflammatory disease: fever, weight loss, malaise
microscopic polyangitis
granulomatous changes in upper and lower respiratory tract
ARF associated with plumonary hemorrhage
goodpastures syndrome
tries to get rid of massive amount of IgA and gums of the kidney
IgA nephropathy/Berger (adults)
IgA deposition in the mesangium, presesnts with gorss hematuria 1-2 days after infections or as aymptomatic microscopic hematuria and nephrotic range proteinuria
HSP (kids) -get an URI
Tetrad of IgA nephropahty and HS Purpura
abdominal pain
renal diesase

purpruic skin lesions
renal insufficiency with nephritic sediment
usually mild proteinuria

SEEK expert consultation!!! :)
essentials of diagnosis of nephrotic syndrome
Proteinuria of >3.0-3.5 g/day (get a quant and qual)
hypoalbuminemia < 3 g b/c spilling so much protein--hallmark sign
name some reasons for nephrotic syndrome
1. lupus, amyloidosis, diabetes
2.idiopathic (2/3)
-minimal change
-focal glomerulsclerosis
-membranous nephropathy
-membranoproliferative GN
management of nephrotic syndrome
Na and fluid restirction for edema
statins for hyperlipidemia
coumadin for hypercoaguable state
nephrotic syndrome usually in kids, don't see much wrong . the basement membrane is not gone but still spilling protein. will see edema, infections, thrombotic events, hyperlipidema
minimal change disease
most common cause of nephrotic syndrome in audlts
immune mediated with immune complex depostion in the subepithelial areas
secondarily associated with hep B, syphilis, lupus, thyroidits, carcinomas, gold, penicillamine, and captorpil
membranous nephropahty
a type of nephrotic syndrome that is usually idiopathic. Some causes include: cocaine, heorin, extreme obseity, HIV. more nephritic than the othothers with RBC's on UA and HTN- ESRD develops within 5-10 years
focal segmental glomerulosclerosis
Both nephritic and nephrotic components (more so nephrotic), idiopathic syndrome, < 30 yo, 1/3 occur after URI
membranouoprofliferative GN
Accumulation of prtoein in various organs
congo red showing green birefringence
most common cause of ESRD
Diabetic nephropathy (type I)
renal impairment
renal insufficiency
GFR 50%, (Cr. 1.3-1.9)
20-40% (2.0-4.0)
<10-15% ( > 4)
clinical manifestations of CRF
nausea and vomiting
peripheral neuropathy
present with flank pain or hematuria (micro or gross), family history, HTN, palpable kidneys, hepatic and pancreatic cysts, may not be found until age 40
ADPKD- autosomal dominant polyscystic kidney disease
how to diagnose ADPKD