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124 Cards in this Set
- Front
- Back
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How are renal disease is found |
They are found it accidentally they're often asymptomatic incidental elevation of serum creatinine abnormal urinalysis protein urea hematuria or pyuria |
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What are some nonspecific symptoms found in renal disease |
Malaise worsening hypertension dependent or generalized edema and decreased urine output |
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What is the focus of the initial evaluation for renal disorders |
Does the patient need emergency dialysis |
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What would warrant emergency dialysis |
Acidosis hyperkalemia and fluid overload are the main reasons for dialysis |
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Does hematuria mean red blood cells |
Know if you have shivering you will have positive hematurea But what you are seeing is the myoglobin not red blood cells |
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What a diagnostic testing that you can order for a renal work |
Chemistries electrolytes with calcium and phosphorus Urine studies with proteins blood glucose leukocytes nitrites ph and specific gravity Renal ultrasound Radionuclide scanning MRI and MRA CT Intravenous urography Biopsy |
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What does a reano ultrasound assess |
Kidney size hydronephrosis or renal cyst stenosis Stones does not assess pyelonephritis |
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What does intravenous urography assess |
Evaluation of nonglomerular hematuria urea stone disease and voiding disorders |
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What does an MRI and MRa assess |
Renal masses artery stenosis renal vein thrombosis |
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What can a biopsy help assess |
Polycystic kidney disease glomerulonephritis |
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Can you order a renal ultrasound for pyelonephritis |
No |
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If you're ordering ct to look for Stones how do you order |
Order a plane CT without contrast |
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You suspect your patient has a kidney stone or bladder stone what kind of imaging do you order |
Plane CT without contrast |
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What kind of imaging do you order for pyelonephritis |
Order a CT with contrast |
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Before ordering imaging how can you differentiate between kidney stone and pyelonephritis |
Ordered a urinalysis patient with the kidney stone will have hematuria but not pyuria |
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Presence of this in the urine is more diagnostic of glomerular disease |
Protein urea |
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Presence of this alone in the y urine is generally not indicative of serious pathology |
Hematuria |
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True or false blood or protein in the urine maybe normal |
True it can be normal transient finding or an indicator of a kidney or urinary track disorder |
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True or false normal excretion of red cells can be greater after exercise |
True |
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What will c cause an increase in red blood cells to pass through the urine |
Glomerular inflammation which causes damage to capillarity endothelium and basement membrane |
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Blood from glomerular but appear what |
Brown or tea colored |
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Part of the upper urinary tract |
Glomerulus collecting tubules Interstitum |
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Part of the lower urinary tract |
Calyx Pelvis ureter bladder urethra |
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Steps in differential diagnosis of macroscopic hematuria |
Obtained a urine analysis If it's positive for hematuria check RBCs if is positive for RBCs check protein if it's negative for rBCs check heme
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Positive RBCs with proteinuria |
Glomerular prompt evaluation for kidney disease |
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Positive RBCs without proteinuria |
extraglomerular |
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Negative RBCs with a positive heme |
Hemoglobin or myoglobin |
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Negative RBCs with a negative heme |
Drugs or dye |
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He materia in the elderly suggest what |
Malignancies |
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evaluation of hematuria should address these three questions |
Are there any clues from the history or physical that suggest a particular diagnosis Does that shemateria represent glomerular or extraglom bleeding is the hematuria transient or persistent |
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Goal in a Reno work up is to quickly identify what |
Infection kidney stones and malignancies |
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These medications will give you a prerenal failure |
nsaids ace inhibitors |
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Expensive exercisable cause an elevation in what enzyme and can lead to what |
CPK and can lead to rhabdomyolysis |
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Sore throat and renal disease |
Possibility of strep infection which can lead to glomerulonephritis |
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Joint pain and renal disease |
Possible soft tissue or rheumatic fever you may see eosinophilia |
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What question will you ask for a history in renal disease |
Abdominal or flank pain In dysuria frequency or urgency trauma strenuous exercise menstruation reset upper respiratory infection or sore throat skin rashes or skin infection joint pain or swelling medications of toxins history of sickle cell disease or trait |
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What r afferentarterials controlled by |
Prostaglandin they mediate vasodilation |
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What are Efferentarterial controlled by |
Angiotensin II which controls constriction |
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Explain how an inflammatory process affects the renal arteries |
And inflammatory process will affect CO X1 which causes the release of prostaglandin prostaglandins dilate afferent arteries and Raas is activated and constricts efferent this balance allows fluid to come in and out which increases GFR this is normal |
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How does nsaid affect GFR |
It blocks Cox1 and inhibits prostaglandins this prevents vasodilation butt efferent arteries are still Constrivcted there is less coming in prevents dilation |
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If patient is in acute renal failure and are taken nsaids what must you do |
Stop nsaid |
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How does ace inhibitor alter GFR |
Prostaglandins will continue to dilate and are not affected ace inhibitor is preventing the construction by blocking angiotensin II everything is open and there was no pressure on the inside |
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The food and medication can discolored urine |
Beats Berry Hydroxychloroquine plaquenil Nitrofurantoin pyridium rifampin |
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And these medications cause hematuria through interstitial nephritis |
Cephalosporins Cipro lasix nsaid Prilosec rifampin silvadene bactrim |
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These medications cause hematuria by papillary necrosis |
Aspirant nsaid |
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Medications that cause hematuria by hemorrhagic cystitis |
cytoxan ifex
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These medications cause hematuria by causing urolithiasis |
Carbonic anhydrase inhibitors Remeron triamterene
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What does Periorbital edema signify |
Nephrotic syndrome loss of protein |
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pyuria and dysuria |
UTI bladder malignancy |
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Recent upper respiratory infection |
Glomerulonephritis |
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Family history of renal disease can suggest what disorders |
Hereditary nephritis polycystic kidney disease sickle cell |
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Unilateral flank pain that radiates to the groin |
Pyelonephritis urolithiasis nephrolithiasis urethral obstruction from a calculus or blood clot |
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Hesitancy and dribbling |
Prostate obstruction BPH cellular proliferation in BPH is associated with increased vascularity and the new vessels can be fragile |
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Vigorous exercise or trauma |
Rhabdomyoma lysis |
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History of bleeding disorders or bleeding from multiple sites |
Uncontrolled anticoagulant therapy |
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What does sickle cell trait or disease lead to |
Papillary necrosis and hematuria |
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What will the urine in glomerular hematuria look like |
Brown tea colored urine protein urea deformed urinary rbc rbc casts |
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renal causes of glomerular hematuria |
IGA nephropathy thin glomerular basement membrane disease membranoproliferative glomerulonephritis |
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Multi system causes of glomerular hematuria |
sle nephritis goodpasture syndrome hemolytic uremic syndrome sickle cell disease |
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What causes hemolytic uremic syndrome |
Preceded by gastrointestinal symptoms like nausea vomiting diarrhea or you will have a decrease in GFR |
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thin glomerular basement membrane disease |
Genetic Benign chronic hematuria nothing to do |
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Upper urinary tract causes of hematuria |
Pyelonephritis Acute tubular necrosis thrombosis malformations tumor polycystic kidney disease |
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Lower urinary tract causes of hematuria |
Cystitis Urethritis urolithiasis trauma coagulopaty heavy exercise ureteropelvic junction obstruction |
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Define a cute renal failure |
Abrupt decrease in glomerular filtration rate with an increase in serum creatinine resulting in the inability to maintain fluid and electrolyte balance it can occur over hours or days |
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What is diagnostic of the acute renal failure |
Creatinine increase of .3 -.5 Decreased GFR of about 50% oliguric vs nonoliguric
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Phases of acute renal Fellion |
oliguric Diuretic recovery or convalescent |
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oliguric phase |
Lasts about 8 to 15 days the longer the duration the last chance of you covering GFR decreases dropping urine output less than 400 per day hypertension hyperkalemia sodium may be normal or decrease depending on fluid status fluid overload elevatedBUN and creatinine |
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Diauretic phase 7 |
GFI begins to increase Urine output rises slowly then diuresis occurs with 4 to 5 L per day excessive urine output indicates recovery of damaged nephron hypotension tachycardia improvement in level of consciousness hypokalemia hyponatremia hypovolemia gradual decline in BUn and creatinine |
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Recovery phase 6 |
Slow process complete recovery takes one to two years Urine volume is normal increase in strength increase in level of consciousness B UN is stable and normal at this stage the patient can develop chronic renal failure |
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Prerenal intervention |
Hydrate you can use vasopressors if you have already hydrated but it did not work |
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Main form of intrarenal failure |
Acute tubular necrosis |
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Prognosis for a cute tubular necrosis |
Have a less chance of full recovery one third will go on to chronic kidney disease |
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Common reason for acute tubular necrosis |
A prerenal cause hypovolemia |
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Most common acute renal failure |
Prerenal |
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Causes of prerenal acute failure |
Intravascular volume depletion decreased cardiac output vascular failure secondary to vasodilation or extraction |
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Intrarenal failure causes |
Sivula the process nephrotoxicity alterations in Reno bloodflow |
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Post renal failure causes |
Of structure urine flow between the kidneys and that urethral meatus and bladder neck obstruction |
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Intrinsic causes of post renal failure |
Stenosis prostate's |
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Extrinsic causes of post renal failure |
Pregnancy tumer |
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Post renal obstruction can leed to |
Hydroureter hydronephrosis this stops urine flow and can severely damage the kidneys |
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What is the best diagnostic tool for hydronephrosis |
Ultrasound |
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To differentiate between prerenal at intrarenal what do we look |
B UN and creatinine ratio urine sodium fena |
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Prerenal qualities |
BUF and creatinine ratio will be elevated 20 to 1 because bun is rising and creatinine has not had a chance to catch up fena less than 1% to try and conserve sodium Urine sodium less than 20 |
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Intrarenal qualities |
Nephrons lost the ability to retain sodium urine sodium greater than 20 fena greater than 1% B UN creatinine ratio greater than 20 to 1 castes in urine signify nephrons better sloughing off |
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Presents at this point to words and intrinsiccause of acute renal failure |
Urinary casts |
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Granular casts inurine |
atn |
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White blood cell casts |
Inflammatory or infectious interstitial process |
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Rbc casts |
Glomerular disease |
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mi Will cost what type of acute renal failure |
Prerenal |
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Vascular obstruction Will cost what type of renal failure |
Prerenal |
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Severe muscle exertion Will cause what kind of acute renal failure |
Intrarenal |
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Infectious disease metabolic disorders vascular lesions Will cause what type of renal failure |
Intrarenal |
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Treatment of potassium less than six |
Potassium restriction potassium binding residence like Kayexalate |
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Treatment of hyperkalemia that is moderate to severe greater than six |
Insulin D50 sodium bicarb albuterol is EKG changes calcium gluconate |
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Treatment of mild acidosis 7.2 and above |
Oral sodium bicarb 650 to 1300 mg three times a day |
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Treatment severe metabolic acidosis less than 7.2 |
IP sodium bicarb monitor for fluid overload the rebound alkalosis and hypocalcemia |
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What is the risk of getting IV sodium bicarb |
flash pulmonary edema related to sodium retention of fluid overload rebound alkalosis hypocalcemia |
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If acidosis is refractivity to medication management what is the next |
Dialysis |
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Treatment of oliguric phase |
Diuretics |
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When is dialysis indicated for volume overload |
Overload causing respiratory compromise |
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Contraindication of Kayexalate |
If dialysis is within 24 hours |
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Why are venal failure patients predisposed to having bleeding disorders |
They ose erythropoetin and plateletes lose ability to stick together |
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Signs of acute tubular necrossis |
Presentation can range from asymptomatic cyst symptoms of uremia like lethargy nausea delirium seizures eczema and dyspnea |
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Cause of acute tubular Necrosis |
Ischemia: Renal hypoperfusion prolong enough to cause cell death toxins: IV contrast aminoglycosides myoglobin |
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Cause of in-hospital acute renal failure |
Acute tubular necrosis it from multiple insults like hypotension sepsis and nephrotic drugs |
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How do you distinguish acute tubular and close it from prerenal state |
Urine electrolytes urinalysis B UN and creatinine |
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How to distinguish acute tubular necrosis from obstruction |
Ultrasound |
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Urine sodium prerenal versus acute tubular necrosis |
Prerenal less than 20 Acute tubular necrosis greater than 40 |
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When will the urine sodium being misleading in differentiating prerenal versus acute tubular necrosis |
It is increased in prerenal state if the patient has taken a diuretic or has received IV fluids before collecting the sample it will be low in acute tubular necrosis 22 rhabdomyolysis myoglobinuria hemolysis sepsis cirrhosis and CHf It will be low in the early stages of obstructure and high in obstructions lasting greater than four days |
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False low urine sodium in ATN tdue too |
Rhabdomyoma lysis myoglobinuria hemolysis sepsis cirrhosis CHF early on in the disease process |
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fena in prerenal versus ATN |
Less than 1% in prerenal and greater than 2% in ATN |
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Intrarenal failure from dye treatment |
Acetylcysteine or sodium bicarb with IV fluids |
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First choice in prerenal management |
Crystalloids |
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Management of intrarenal failure |
Stop the causative agent maintain renal perfusion |
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Management of post renal failure |
Remove the obstruction check the Foley |
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Defined renal insufficiency |
Decrease in renal function resulting in a decrease in glomerular filtration rate although GFR decreases naturally with age |
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Causes of renal insufficiency |
Hypertensive nephrosclerosis Glomerulonephritis diabetic nephropathy interstitial nephritis polycystic kidney disease |
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When Do u start seeing systemic changes in renal insufficiency |
When Brenl function is less than 20% normal |
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These are the stages of renal reserve |
Diminished renal reserve renal insufficiency end stage renal disease |
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Diminished renal reserve |
50% nephrons lost creatinine is double |
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Renal insufficiency Quality |
75% nephrons lost mild azotemia |
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End-stage renal disease quality |
90% nephron damage azotemia metabolic alterations |
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GFR stage 1 to 5 |
Stage one is GFR greater than 90 with the presence of protein urea hematuria States to GFR between 60 and 89 Space three GFR 59 to 30 GFR 29th at 15 TFR 15 or less |
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Five reasons for dialysis |
Acidosis electrolyte imbalances intoxicants oliguria or volume overload uremia |
