Term
|
Definition
Blood Urea Nitrogen
Sensitive to volume status,
Less reliable than Cr |
|
|
Term
|
Definition
Creatinine
Broken down by muscles, excreted by kidney, not reabsorbed. |
|
|
Term
|
Definition
Filter wastes,
Controls blood volume (Na /H2O),
Balances electrolytes,
Erythropoetin,
Controls BP (Renin),
Calcitriol (Active form of Vit D) |
|
|
Term
|
Definition
|
|
Term
| What levels of BUN /Cr and Cr ratio suggest renal dysfunction? |
|
Definition
BUN > 20, Cr > 1.2,
Cr ratio = or < 15 |
|
|
Term
| If BUN /Cr = or > 20 what is suggested? |
|
Definition
|
|
Term
| What are some (3) causes for elevated Cr? |
|
Definition
| High protein diet, Medications (Tagemet, Bactrim), GI bleed (PUD) |
|
|
Term
|
Definition
| Glomerular Filtration Rate, the amount of plasma being filtered across the glomerular capillaries |
|
|
Term
| What are 3 ways to calculate GFR? |
|
Definition
Creatinine Clearance,
Cockcroft-Gault,
MDRD |
|
|
Term
| What happens to BUN when dehydrated? |
|
Definition
| Increased BUN (increased urea reabsorbtion) |
|
|
Term
| What are 5 causes for elevated BUN? |
|
Definition
| GI Bleed, High protein diet, CHF, decreased renal perfusion, cell lysis |
|
|
Term
| What does an ultrasound tell us about the kidneys? |
|
Definition
| Length /size, masses, obstruction of flow, echogenicity |
|
|
Term
| How long is a normal kidney? |
|
Definition
|
|
Term
| How would you describe a kidney that is less than 9 cm? |
|
Definition
| Atrophied. This is irreversible kidney damage. |
|
|
Term
| Describe Unilateral Disease |
|
Definition
| Kidneys that differ in size by > 1.5 cm. |
|
|
Term
| What is an IVP? And what does it show? |
|
Definition
Intravenous Pyelogram, Dye injected and then Xray to look for perfusion, obstruction, renal pelvis and ureter.
Contraindicated in DM and Cr >2 |
|
|
Term
|
Definition
If abnormal US or IVP,
If abnormal BUN /Cr and pt can not tolerate dye,
To determine cystic vs solid lesions
Use contrast unless looking for hemorrhage or stones |
|
|
Term
|
Definition
Plain frontal supine radiograph of kidneys, ureter and bladder.
Investigates bowel obstruction, gallstones and kidney stones. |
|
|
Term
|
Definition
Easily determines kidney function,
determines cystic vs solid masses,
Stages Renal Cell CA |
|
|
Term
| What does an angiogram investigate? |
|
Definition
| Arteriosclerosis, stenosis, aneurysms, vasculitis, renal masses /lesions |
|
|
Term
When is a kidney biopsy indicated?
Contrindicated? |
|
Definition
Indicated for Acute Nephrotic Syndrome
Contraindicated when bleeding disorder, HTN or renal infection |
|
|
Term
| Stage 1 /Normal GFR levels |
|
Definition
|
|
Term
| Stage 5 - End Stage Renal Disease GFR levels |
|
Definition
|
|
Term
| #1 cause of Kidney dysfunction |
|
Definition
|
|
Term
| Symptoms of Kidney Disease |
|
Definition
Fatigue, dizziness, trouble concentrating, feeling cold,
Metallic taste, ammonia breath, skin rash, itching
SOB, N/V, Flank /Back pain,
Changes in urination, swelling |
|
|
Term
| Symptoms when elevated BUN /Cr? |
|
Definition
Mental status changes,
N/V,
decreased urine output (oliguria),
fluid retention (edema, SOB /DOE) |
|
|
Term
| Categories of Acute Renal Disease and percentage of cases |
|
Definition
Pre-renal (Insufficient blood supply to kidneys)50-80%,
Renal /Intrinsic - 10-30%,
Post-Renal (Obstruction of urine flow)5-10% |
|
|
Term
| Causes of Pre-Renal Disease |
|
Definition
| CHF, Sepsis, Medications, low BP, blood loss, anaphylactic shock, Renal Artery Stenosis, Burns, MI, PE |
|
|
Term
| Causes of Intrinsic Renal Disease |
|
Definition
Ischemia (ATN),
Toxins (NSAIDS, GENT, Etc.),
Autoimmune (GN, Lupis, Good Pasture's),
IN (Allergy to Tagamet) - eosinophils, Wright stain |
|
|
Term
| Causes of Post Renal Disease |
|
Definition
Medications (anticholenergics),
BPH,
CA,
Bilateral stones,
Clot (hematuria),
Neurogenic bladder,
Obstructed Cath |
|
|
Term
|
Definition
AEIOU - Acidosis,
Electrolyte imbalance (K+ > 6),
Ingesting toxins /poison,
Volume Overload,
Uremia |
|
|
Term
|
Definition
| Elevated BUN with symptoms (i.e. N/V, itching, Mental Status changes, uremic pericarditis) |
|
|
Term
|
Definition
| Elevated BUN without symtoms. |
|
|
Term
|
Definition
Elevated K+
Decreased Ca++
Decreased Na
Elevated Phos
Metabolic Acidosis
Azotemia /Uremia
Fluid Overload |
|
|
Term
| Name some nephrotoxic drugs. |
|
Definition
| NSAIDS, Aminoglycosides - Gent, Amph B, IV contrast |
|
|
Term
| What is the most common diagnosis for Intrinsic ARF? |
|
Definition
| ATN (Acute Tubular Necrosis) - Caused by ischemia and nephrotoxic injury |
|
|
Term
| What causes severe ischemia leading to ATN? |
|
Definition
| Dehydration, Shock, Sepsis, Surgery |
|
|
Term
| ATN labs: Describe UA, electrolytes and BUN:Cr |
|
Definition
| Dark brown muddy casts, elev. K+ and Phos, <20:1 |
|
|
Term
|
Definition
| Hydration, forced diuresis (convert to non-oliguric), Ca Carbonate (for Phos), Monitor Mag, Tx K+, stop nephrotoxic drug, may need dialysis |
|
|
Term
|
Definition
| Allergic Interstitial Nephritis - Tubular damage caused by drugs (PCN, NSAIDS, Allopurinol) or infection (Strep, CMV, RMSF) |
|
|
Term
|
Definition
|
|
Term
| Unique to Interstitial Nephritis... |
|
Definition
| Eosinophils in UA determined by the Wright stain |
|
|
Term
| What Past Medical History would contribute to diagnosis of Kidney Disease? |
|
Definition
| DM, recent infection, autoimmune disease, HTN |
|
|
Term
| What are important symptoms to note within the review of systems? |
|
Definition
| Back /Flank Pain, changes in urination, SOB, fatigue, edema, fever, skin rash, joint pain, hemoptysis |
|
|
Term
| What are some Phys Exam findings in Renal Disease? |
|
Definition
| Skin rash, hearing /vision impairment (Alport's), sinus drainage, tenderness (Wegener's), JVD, lung crackles, CVA tenderness, bladder distention, abd bruits, joint pain |
|
|
Term
| What labs are needed to diagnose kidney disease? |
|
Definition
| BUN /Cr, UA with Micro, CBC, Urine Na, ANA (Lupis), ANCA (Wegener's) and GBM Antibodies (Good Pasture's) |
|
|
Term
| What imaging studies are used in diagnosing Kidney disease? |
|
Definition
| U/S, IVP, CT, MRI, angiogram /venogram, MRA |
|
|
Term
| What is a quick and easy way to check bladder volume at the bedside? |
|
Definition
| Cath and measure urine volume. |
|
|
