Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
39 Cards in this Set
- Front
- Back
|
describe anatomy of the kidney
|
retroperitoneal hooked to two ureter to the bladder
|
|
|
why do you do ultrasounds
|
two kidneys and size of kidney
|
|
|
what are 3 main parts of kidney
|
glomeruli, tubuloinsterstitium and blood vessels
|
|
|
ways to estimate GFR
|
creatnine
creatnine clearance eGFR calculations nuc med GFR scans |
|
|
creatnine-
|
normal breakdown product of muscle
|
|
|
male creatnine
|
53-113
|
|
|
females gfr
|
37-96
|
|
|
infant children GFR
|
30-50
|
|
|
increase in creatnine-
|
filtering less at kidneys - low GFR- kidney failure
more muscles skeletal muscle damage - high meat or creatine intake |
|
|
decrease in creatnine
|
high GFR
decreased muscle mass advanced age |
|
|
creatnine clearance is an estimate of
|
GFR
|
|
|
rise in creatnine reflects _____ in GFR
|
fall
|
|
|
normal GFR for adults
|
180 L/ day 100-125 ml/ min
|
|
|
creatnine clearance
|
amount of blood entirely cleared of a solute per unit time
UV/P |
|
|
cr clearance COckroft -gould formula
|
(140-age)x lean body weight (kg)/scr
then multiply by 1.2 if male |
|
|
why is creatnine not a perfect measure of GFR
|
filtered at glomerulus but also secreted by tubules - about 10%
but when GFR drops accounts for 40% as renal function declines crcl overestimates GFR |
|
|
urinanalysis main aspects
|
appearance
dipstick sediment cytology/culture |
|
|
urine dipstick
|
pH 4-9
specific gravity (conc or not) protein blood nitrates glucose ketones |
|
|
urine sediment
|
RBC, WBC
casts, crystals, oval fat bodies other cells- epithelial cells, bacteria, yeast |
|
|
what casts are pathological
|
cast made of red cells- and WBC
|
|
|
hematuria
|
microscopic or macroscopic
other than blood: beets, meds, uric acid crystals, |
|
|
when can dipstick be positive for blood
|
rbc, heme, myoglobin
|
|
|
where can hematuria come from
|
kidney to urethra anywhere along the tract
extra renal- tumors, vascular malformations, cystitits, prostatits, trauma stones |
|
|
where in the kidney can you get hematuria
|
glomerulus- glomerulonephritis
non-glomerular - tubulointersitital disease, pyelonephritis, polycystic disease, stones |
|
|
hematuria investigations
|
repeat - need + on 2/3
rule out extra renal - history, ultrasound, if renal - differentiate between glomerular or non-g |
|
|
what suggests glomerular hematuria
is a biopsy necessary |
dysmorphic RBC, red cell casts, significant proteinuria, more suggestive of glomerular etiology
in this case consider renal biopsy |
|
|
proteinuria normal in a day
|
<150 mg/day - made up of albumin and proteins from the tubule
|
|
|
when does proteinuria become pathologic
|
>300 mg a day
|
|
|
proteinuria detection
|
start with dipstick - but low sensitivity - need to quantify
24 hr urine collection is the gold standard |
|
|
what is a urine protein:cr ratio
|
validated to correspond to daily protein excretion rate
mg protein/mm cr norma <0.02 rough rule multiply by 8.8 to convert to mg/day |
|
|
etiology of proteinuria
|
benign
orthostatic proteinuria- when standing- benign pathologic: glomerular- esp disruption of Glomerular BM tubular overflow |
|
|
if you have a lot of proteinuria where is it coming from
|
glomerulus
|
|
|
benign proteinuria
|
do 3X- 2/3 = +
hours to few days fever excercise, cold stress normal renal funciton and BP no further investigations |
|
|
orthostatic proteinuria
|
only when upright, intermittent
asymptomatic, normal renal and BP diagnose with split urine collection (day vs night) night time no protein- orthostatic |
|
|
glomerular proteinuria
|
increased permeability of GBM (idiopathic, immunologic)
300 mg to 40 g a day glomerulonephritis - many etiologies |
|
|
tubular proteinuria
|
tubulointerstitial disease - impairs ability of prox tubule to reabsorb small MW proteins that are filtered.
Can range from 300 mg to 1 mg/ day - 2 mg a day |
|
|
overflow protienuria
|
increased serum levels of small MW protein which overwhelms tubular reabsorption
seen in myeloma 300mg - 10 g a day |
|
|
approach to proteinuria
|
hx and physical
urinanalysis with examination of urine sediment abnormal: nephrologist normal repeat positive: work up |
|
|
what are common ways in which kidney disease manifests
|
isolated hematuria/proteuria
renal failure/ (acute or chornic) nephrotic syndrome nephritic disorders of acid base disorders of salt and balance HTN |
