Shared Flashcard Set

Details

Nephrology
NOVA spring
67
Medical
Graduate
03/15/2011

Additional Medical Flashcards

 


 

Cards

Term
what is the normal lenght of kidney? and what are three layers surronding kidney?
Definition
renal capsule, adipose capsule and renal fascia.
10-12 cm
Term
what is the first step of urine produciton?
Definition
glomerualar filtration
Term
what are 3 components of filtration membrane? (layers)
Definition
Glomerular endothelial
basal lamina
slit membrane of filtration slits
Term
what is the normal net filtration pressure?
Definition
10mmHg
Term
what are two main GFR regulation mechanisms
Definition
control blood flow in and our of glomerular

or

control glomerular surface area via contraction or relaxation of mesangial cell
Term
when ADH is produced in excess what is it called?
Definition
syndrome of inappropriate ADH (SIADH)
Term
what are the clinical menifestation of SIADH?
Definition
There is resorption of excessive amounts of free water, with resultant hyponatremia. The clinical manifestations of SIADH are dominated by hyponatremia, cerebral edema, and resultant neurologic dysfunction
Term
if kidney is less than 9 cm then...what should be suspected.
Definition
irreversible renal dz
Term
what should be suspected when hydronephrosis is seen in US?
Definition
obstruction like prostate enlargement
Term
what is the dx test for ADPKD>
Definition
US
Term
for renal stone which test is best?
Definition
Noncontrast helical CT to detect renal stones is 95% sensitive and 98% specific in pts presenting with acute flank pain
Term
for difinitive stating of renal neoplasms what test ..ct or us
Definition
CT: Definitive role in staging renal neoplasms, and imaging kidneys following trauma
Term
to visualize renal cortex and medulla. + to stage renal cell carcinoma
Definition
MRI :

Loss of corticomedullary function (GN, hydronephrosis, renal vascular occlusion, renal failure) will be evident on MRI
Term
most sensitive test for renal artery stenosis?
Definition
MRA
Term
what is VCUG? and what is it used for?
Definition
Voided Cystourethrography.Preferred method for eval of urinary reflux
Consider for any child who presents with UTI prior to toilet training, because reflux results in significant, permanent scarring. If dx…tx with long-term antibx – cover for E. coli
mostly used in peds who gets freq uti.
Term
what is one half of total urinary solids? and what is the serum marker for that substance?
Definition
Urea. --> BUN
Term
BUN normal value? when does it inc?
Definition
8-20 mg/dl

Usually increased with acute and chronic renal failure, and urinary obstruction

other causes Increased with dehydration, reduced renal perfusion (CHF, hypovolemia), increased dietary protein, and accelerated catabolism (fever, trauma, GI bleeding), steroids, tetracycline
Term
what is the serum marker for estimating GFR?
Definition
Creatinine
Term
is creatinine reabsorbable? what is it anyways?
Definition
Is a product of muscle metabolism produced at a relatively constant rate and cleared by renal excretion. It is freely filterable by the glomerulus and not reabsorbed/secreted by the renal tubules
Term
when does creatinine inc?
Definition
Usually increased with acute or chronic renal failure, and urinary tract obstruction
May also be increased with increased cooked meat intake, increased muscle mass, and meds such as cephalosporins, cimetidine, probenecid, and trimethoprim
Term
what is most commonly used to estimate GFR? and what is the gold standard for GFR
Definition
MC: creatinine clearance.
Gold S.: Glomerular filtration rate is measured by determining the plasma concentration and excretion of a marker substance.
Term
what is the normal GFR?
Definition
100-120
Term
if GFR is between 30-59? less than 15?
Definition
<15: kidney failure
30-59: moderate dec in filtration rate
Term
what is the formula for cr clearance?
Definition
Ccr = (140-age) x weight (kg)
_______________________
Pcr x 72
Term
what is the name of formula that calculates the amount of sodium actually excreted by body relative to amount filtered by kidneys?
Definition
FENa
Term
wht do you tell the pt when collecting urine sample?
Definition
first morning void and mid-stream
Term
what is the normal Specific gravity and wht is the significance?
Definition
Gives important insight into hydration status and concentrating ability of kidneys
Normal range: 1.003-1.030
Term
if you trace nitrites in the urine what do you suspect? and leukocyte esterase?
Definition
Many gram-neg bacteria can reduce nitrate to nitrite, which is thus an indicator for bacteriuria

Leukocyte esterase: enzyme produced by neutrophil
Term
when is pyuria suspected?
Definition
Presence of > 5 leukocytes per high power field is considered significant pyuria
Term
what is the function of tamm-horsfall mucoprotein?
Definition
thy are uromodulin: Uromodulin may act as a constitutive inhibitor of calcium crystallization in renal fluids. Excretion of uromodulin in urine may provide defense against UTIs.
Term
what kind of cast is seen that indicates intraparenchymal bleeding?
Definition
Red Cell Casts
Term
what kind of cast characteristic for pyelonephritis and useful in distinguishing this d/o from lower tract infection?
Definition
WBC casts
Term
what type of cast do you see in acute tubular necrosis? when do you see granular casts?
Definition
Tubular cell casts

granular casts: Consist of finely or coarsely granular material. Nonspecific, but usually pathologic. Can be seen in ATN, GN, or tubulointerstitial dz
Term
what casts: Form in tubules that have become dilated and atrophic due to chronic parenchymal dz. Freq. seen in CRF
Definition
Broad, Waxy Casts
Term
define Acute renal failure.
Definition
A condition in which the glomerular filtration rate is abruptly reduced, causing a sudden retention of endogenous and exogenous metabolites (urea, potassium, phosphate, sulfate, creatinine, administered drugs) that are normally cleared by the kidneys
Term
out of pre,post and intrinsic renal, which one is MC cause of renal failure.
Definition
MC: prerenal azotemia
Term
what happen if hypoperfusion of kidney is not restored back?
Definition
If immediately reversed with restoration of blood flow, renal parenchymal damage
does not occur
If hypoperfusion persists, ischemia can result, causing intrinsic renal failure
Term
Decreased renal perfusion can occur in one of three ways -- what are they?
Definition
Decrease in intravascular volume
Change in vascular resistance
Low cardiac output
Term
would urine sodium be less or more in prerenal asotemia?
Definition
less than 20.
Term
when does postrenal azotemia occure?
Definition
Occurs when urinary flow from both kidneys, or a single functioning kidney, is obstructed…usually a urologic problem

Each nephron has an elevated intraluminal pressure, causing decrease in GFR
Term
MC cause of postrenal azotemia in men/
Definition
prostatic hyperplasia
Term
pt is polyuric and c/o lower abdominal pain. PE showed distended bladder, and mass palpable with pelvic exam.
what kind of renal failure. pre, post or intrinsic.
Definition
post renal azotemia
Term
FEna and Una for post renal azotemia would be?
Definition
FEna: >1
Una>20
BUN: >20:1
Term
intrinsic renal disease account for what?
Definition
50% of all ARF cases
Term
what are 4 sites that could be injured in intrinsic renal diease?
Definition
Sites of injury are the tubules, interstitium, vasculature, and glomeruli.


Three examples are acute tubular necrosis, acute interstitial nephritis, and acute glomerulonephritis.
Term
this pt present with acute renal insufficiency and has granular casts with some epithelial cells in urine sedimentation. what do you think he has?
Definition
Acute tubular necrosis. pt may have hx of toxin exposure.


Pts may present with generalized swelling, n/v, oliguria, decreased LOC, anorexia, muscle weakness. Check for pulm. edema
Term
what are two major causes of Acute tubular necrosis?
Definition
ischemia and nephrotoxin (endogenous or exogenous)
Term
in which cases ischemic acute tubular necrosis happens?
Definition
Ischemia
Causes tubular damage from states of low perfusion and is often preceded by a state of prerenal azotemia. Ischemic ARF characterized not only by inadequate GFR but also by renal blood flow inadequate to maintain parenchymal cellular formation. Occurs in setting of prolonged hypotension or hypoxemia such as dehydration, shock, sepsis, major surgery, or trauma
Term
give me name of
antibiotic
antineoplastic
heavy metal
and other 3 causes of exogenous nephrotoxins
Definition
Exogenous nephrotoxins
Aminoglycosides, Vancomycin, and several cephalosporins
Radiographic contrast media
Cyclosporin
Antineoplastics, such as cisplatin
Heavy metals, such as mercury, cadmium, and arsenic
Term
what are some endogenous toxins that could casues Acute tubular necrosis?
Definition
Endogenous nephrotoxins
Heme-containing products
Myoglobin, hemoglobin
Uric acid
Paraproteins
Bence Jones
Term
muddy brown casts main noticed in?
Definition
acute tubular necrosis: in urine smapleHyperkalemia and hyperphosphatemia common
Term
what happens in maintenance phase of A. tubular necrosis?
Definition
Maintenance phase is either oliguric or nonoliguric. Nonoliguric ATN has better outcome. This phase is 1-3 wks. Cellular repair and removal of debris occur
Term
why do people die from A. tubular necrosis?
Definition
Mortality rate varies 20-70%
Most common cause of death is infection
Term
what are two major causes of Chronic renal failure?
Definition
HTN majority
and DM
Term
isosthenuria and broad casts are mainly noticed in what disease?
Definition
CRF -- on US: Bilateral small kidneys
Term
what is the GFR and how long it should be at that level to consider chronic renal failure?
Definition
GFR < 60 mL/min for 3 or more months
Term
what other than DM and HTN could cause CRF?
Definition
Other causes:GN, cystic diseases, and other urologic diseases account for another 12%
Term
pt present with fatigue, malaise, and weakness. he also has metallic taste with uremic fetor (fishy breath) and hiccups with weight loss of 20 lbs over last yr. what could he have?
Definition
CRF
Term
on lab value for UA you notice

GFR of <60 with waxy casts and broad casts.
+ protein
elevated BUN/crn
what must be in our DDx
Definition
CRF
Term
what lab value could be same for ARF and CRF?
Definition
May see anemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, and hyperkalemia…with both ARF and CRF

Further eval needed to differentiate between ARF and CRF
Evidence of previously elevated BUN and creatinine, abnormal prior UA, and stable but abnormal serum creatinine on successive days is most consistent with a chronic process
Term
what could be seen on EKG for Hyperkalemia
?
Definition
peaked T waves
Term
what is the MC complication of ESRD?
Definition
HTN - tx -> control salt and H2O intake.
ACEI or ARB
goal BP <130/80 --if + protein uria,125/75
Term
what kind of anemia could CRF pt present with?
Definition
Normochromic, normocytic
Due to decreased erythropoiesis and RBC survival
Term
what kind of neurologic sx CRF present with?
Definition
Uremic encephalopathy does not occur until GFR falls below 10-15 mL/min
Symptoms begin with diff. concentrating and can progress to lethargy, confusion, and coma
Neuropathy found in 65% of pts on or nearing dialysis but not until GFR is 10% of normal
Term
what is the MC mineral metabolism D/O in CRF?
Definition
Most common d/o is osteitis fibrosa cystica – the bony changes of secondary hyperparathyroidism…affecting 50% of pts nearing ESRD
Term
when should dialysis be started on CRF pt?
Definition
Dialysis should be started when pt has GFR of 10 mL/min or serum creatinine of 8 mg/dL
Diabetics should start when GFR reaches 15 mL/min or serum creatinine is 6 mg/dL

Uremic symptoms such as pericarditis, encephalopathy, or coagulopathy
Fluid overload unresponsive to diuresis
Refractory hyperkalemia…>7
Severe metabolic acidosis (pH < 7.20)
Neurologic symptoms such as seizures or neuropathy
Term
what is the MC complication of peritoneal dialysis?
Definition
peritonitis. S. Aureus
Supporting users have an ad free experience!