Approach to the Kidney Patient

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  1. What are signs of acute kidney dz?
    • Rapidly increasing BUN and creatinine (azotemia)
    • Oliguria
  2. What are signs of chronic kidney dz?
    • Loss of renal function over months to years
    • Slowly increasing BUN and Cr
    • Anemia
    • Renal Atrophy
  3. Hormonal functions of the kidney
    • BP control
    • RBC production
    • Calcium regulation
  4. Where is filtrate converted into urine?
    Tubule system
  5. What is the first step in urine formation?
    Fluid collects in Bowman's capsule and is transported to the PCT
  6. What does the PCT do?
    Responsible for reabsorbing NaCl, H20, bicarb, glucose, and amino acids
  7. What does the Loop of Henle do?
    • Reabsorbs NaCl, K, Cl, and H20
    • Controls fluid balance
    • Involved in concentration of urine
  8. Where do loop diuretics work?
    The ascending loop of Henle
  9. What does the DCT do?
    • Reabsorbs NaCl, Ca, and K
    • Involved in PH balance
    • Very little water permeability
  10. Where do thiazide diuretics work?
    The DCT
  11. What regulates the final composition of urine?
    Collecting Duct
  12. Where does hormone regulation of Na and H2O balance take place?
    Collecting duct
  13. What encourages filtration and opposes filtration across the glomerular capillary wall?
    • Encourages: hydrostatic pressure
    • Opposes: oncotic pressures in capillary lumen
  14. How is Angiotensin II involved in GFR?
    If it feels a reduction in blood flow, it will vasoconstrict
  15. How does GFR react in a state of shock or with dehydration?
    It decreases to maintain ions
  16. How does GFR react if pt has severe uncontrolled HTN?
    Arterioles would constrict because there is so much pressure going at the kidney, it is a protective mechanism
  17. How is GFR measured?
    Through plasma
  18. What is a nl GFR?
    9-120 mL/min
  19. What is the relationship between serum creatinine and GFR?
    When serum Cr is increased, GFR is decreased (there is an inverse relationship)
  20. What components make up a GFR?
    • GWARS
    • Gender
    • Weight and Height
    • Age
    • Race
    • Serum Creatinine
  21. What GFR levels are a sign of chronic kidney dz?
    GFR < 60 for 3 or more months
  22. What creatinine level is an indication for dialysis?
    CrCl < 15
  23. What are nl serum creatinine levels?
    0.6-1.2 mg/dL
  24. Describe how creatinine is dealt with in the body
    • It's cleared by renal excretion
    • Not bound to plasma proteins
    • Freely filtered by the glomerulus
  25. What factors can increase serum creatinine levels?
    • Ketoacidosis
    • ASA, Cimetidine, or probenicid
    • ASA or NSAIDS (via analgesic nephropathy)
  26. What factors can decrease serum Cr levels?
    • Age
    • Cachexia
    • Liver dz
  27. How is CrCl measured?
    24 hour urine collection and plasma creatinine on the same day
  28. What is the CrCl formula?
    • (140-age) x (weight in kg)
    • Serum creatinine x 72
  29. Name certain meds that might have to be changed with renal function
    • Vanco
    • Januvia
    • Levaquin
  30. What is urea?
    An end product of protein catabolism that is synthesized in the liver
  31. What is a nl BUN?
  32. What is a nl BUN:Cr ratio?
  33. What can cause an increased BUN?
    • GI bleed
    • Cell lysis
    • Corticosteroids
    • CHF
    • High protein diet
    • Dehydration
  34. What can cause a decreased BUN?
    • Hepatocellular dz
    • SIADH
    • Malnutrition
    • SCA
    • Chronic dialysis
  35. Why is Urea NOT a better predictor of renal function as Cr is?
    • It's not as sensitive in picking up smaller decreases in GFR
    • It's affected by outside factors:
    • Protein intake
    • Hydration status
    • GI bleeding
  36. How soon should a UA be done?
    • Within 1 hour of collection
    • WBCs should be done 2 mins after you dip
  37. Describe clinical albumin levels
    • <30 is nl
    • 30-300: microalbuminuria
    • >300: macroalbuminuria
  38. What can cause functional proteinuria?
    • Acute illness
    • Exercise
    • Orthostatic proteinuria
  39. An abundance of Bence Jones proteins is what type of proteinuria?
    Overload proteinuria
  40. What are examples of overload proteinuria?
    • Multiple myeloma (Bence Jones)
    • Rhabdo (myoglobinuria)
    • Hemolytic anemia (hemoglobinuria)
    • Amyloidosis (overproduction of proteins)
  41. What it tubular proteinuria?
    Decreased reabsorption of proteins in the proximal tubules
  42. What can cause tubular proteinuria?
    • ATN
    • Toxins (lead, aminoglycosides)
    • Hereditary metabolic disorders (Wilsons, Fanconi)
  43. What can cause a false positive with hematuria?
    Myoglobin, beets, and rhubarb
  44. What causes hyaline casts to be in urine?
    • Concentrated urine
    • Fever
    • Exercise
    • Diuretics
  45. What causes red cell casts to be in urine?
  46. What causes white cell casts to be in urine?
    • Pyelonephritis
    • interstitial nephrities
    • any inflammation or infection
  47. What causes renal tubular casts to be in urine?
    • ATN
    • Interstitial nephritis
  48. What causes coarse, granular casts to be in urine?
    • Nonspecific
    • ATN
  49. What causes broad, waxy casts to be in urine?
    • CKD
    • Indicative of statis in the tubules
  50. What imaging method do you use for hydronephrosis?
  51. What imaging method do you use for pyelonephritis?
    CT scan
  52. What imaging method do you use for PCKD?
    CT scan
  53. What imaging method do you use for cysts?
    • U/S for regular
    • CT scan for complex
  54. What are indications for a renal bx?
    • UUU(cap)TASS
    • Unexplained chronic kidney dz
    • Unexplained acute kidney dz
    • Unexplained proteinuria/hematuria
    • Treatment guide
    • Acute nephritic syndrome
    • Systemic dz with kidney involvment (DM, SLE)
    • Suspected transplant rejection
  55. What are contraindications of a renal bx?
    • Solitary kidney
    • Horseshoe kidney
    • Severe uncontrolled HTN
    • Uncontrolled bleeding d/o
  56. What do you need in order to be cleared for a renal bx?
    • d/c anticlotting Rx
    • Well controlled HTN
    • HGB, platelet count, Pt, PTT
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Approach to the Kidney Patient
2011-05-08 18:15:13

For my upcoming nephrology exam
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