Term
| what is the most important thing your kidney can do? what are its other functions? |
|
Definition
| most important: regulate your volume status - allows for regulation of intra and *extracellular* fluid volumes to maintain volume status. other things: excretion of waste, acid-base control, electrolyte control, essential substance control, excretion of toxins/drugs, BP regulation, and degradation of various compounds |
|
|
Term
| what are the roles of the kidney? |
|
Definition
| fluid balance, electrolyte balance, acid/base homeostasis, toxin removal, and hormone production |
|
|
Term
| what hormones does the kidney produce? |
|
Definition
| 1-25 vit D (1,25 dihydroxycholecalciferol), the active form (hydroxylated by the kidney) of vit D from diet/sun exposure, erythropoietin, insulinase, and renin |
|
|
Term
| which kidney is always lower? why |
|
Definition
| the R b/c of the liver. the L is always bigger by 1-.5 cm |
|
|
Term
| what are the 3 layers in the glomerulus? |
|
Definition
| fenestrated endothelial cells, basement membrane, and podocytes/epithelial cells on top |
|
|
Term
| what is the most important thing, besides the HPI when seeing pts with kidney disease? |
|
Definition
|
|
Term
| what is the #1 cause of kidney disease in the US? what is a close second - which is usually tied to the #1? |
|
Definition
|
|
Term
| what is an important question to ask kidney disease pts when getting their past hx? |
|
Definition
| do you have kidney disease? - they may have pathologic glomerular disease, familial cystic disease, relatives on dialysis |
|
|
Term
| can atherosclerotic disease cause kidney disease? |
|
Definition
| yes, this can result in renal artery stenosis or fibromuscular dysplasia |
|
|
Term
| if pts are female and were pregnant, what are important questions to ask if investigating kidney disease? |
|
Definition
| toxemia, proteinuria, HTN/preeclampsia (pregnancy condition in which high blood pressure and protein in the urine develop after the 20th week) |
|
|
Term
| do infections, stones (trauma due to stone), obstruction lead to kidney disease? |
|
Definition
|
|
Term
| what are symptoms of urinary tract problems? |
|
Definition
| dysuria (painful urination), frequency, urgency, and nocturia |
|
|
Term
| what is an important question to ask men in terms of kidney disease? why? |
|
Definition
| how do you pee? BPH can clamp down on the urethra |
|
|
Term
| what are different appearances urine might take on? |
|
Definition
| clear, bright orange, cloudy, bloody, look like head of a beer |
|
|
Term
| what four diseases most commonly lead to kidney disease? |
|
Definition
| DM, HTN, renal disease (glomerular/tubular/cystic), and atherosclerotic disease |
|
|
Term
| when do your kidneys start to age? |
|
Definition
|
|
Term
| could abdominal sx lead to indirect kidney trauma? |
|
Definition
|
|
Term
| what questions are important in the fam hx regarding kidney disease? |
|
Definition
| diabetes, HTN, renal disease: some are hereditary, such as ADPKD (autosomal dominant polycystic kidney disease), which is the most common or alport's |
|
|
Term
| what is ADPKD (autosomal dominant polycystic kidney disease)? |
|
Definition
| the most common inherited kidney disease, it is bilateral, a major cause of kidney failure, presents in the 3rd-4th generation, and many of the pt's relatives may have had renal disease |
|
|
Term
|
Definition
| a an inherited kidney disease affecting the glomerulus involving type IV collagen, associated with bilateral deafness and not common |
|
|
Term
| what kinds of occupational exposure can lead to kidney disease? |
|
Definition
| those involving metals such as lead |
|
|
Term
| can making moonshine cause renal toxicity? |
|
Definition
| yes, b/c often moonshine is made in lead radiators |
|
|
Term
| can NSAIDs cause renal toxicity? |
|
Definition
| yes, including: acute renal disease, chronic renal disease, tubular interstitial disease, proteinuria, edema, blood pressure issues |
|
|
Term
| can herbal supplements lead to renal complications? |
|
Definition
| yes - for ex St. John's wort can cause BP issues, some green tea extracts |
|
|
Term
| can protein loading, such as the kind bodybuilders might participate in lead to kidney pathology? |
|
Definition
|
|
Term
| is glue sniffing associated with kidney disease? |
|
Definition
|
|
Term
| what is important to remember in taking blood pressure? |
|
Definition
| use the proper size cuff, different positions, *go slow* |
|
|
Term
| *how slow should you take BP*? |
|
Definition
|
|
Term
| what is useful about fundoscopic exams in terms of kidney disease? |
|
Definition
| "the eye is the window to all vasculature" |
|
|
Term
| what is important to auscultate for when considering kidney disease? |
|
Definition
| bruits - in the neck, abdomen, flank, femoral, etc |
|
|
Term
| what is important to palpate for in consideration of kidney disease? |
|
Definition
| large bladder, malignancy, horseshoe bladder, other masses |
|
|
Term
| why is the neurological exam important in consideration of kidney disease? |
|
Definition
| diabetic neuropathy needs to be r/o |
|
|
Term
| what might be seen in the extremities in consideration of kidney disease? |
|
Definition
|
|
Term
|
Definition
| basic metabolic profile: lab test for Na, K, CL, CO2, BUN, and glucose. Ca, Mg, and phosphorus are also sometimes added on |
|
|
Term
|
Definition
| comprehensive metabolic profile - consists of the BMP along with LFTs |
|
|
Term
| what are determinants of the BUN? characteristics? |
|
Definition
| determinants: glomerular function, protein intake, and catabolism *characteristics: freely filtered in the glomerulus and reabsorbed in the PCT* |
|
|
Term
| what is creatinine? is it freely filtered? |
|
Definition
| a by product of muscle metabolsim, which is freely filtered (though some PCT secretion) |
|
|
Term
| what are the fixed rates of creatinine filtration in males/females? |
|
Definition
males: 20-25 mg/kg/day
females: 15-20 mg/kg/day |
|
|
Term
| what happens to creatinine as you age? |
|
Definition
| you lose creatinine, irrelevant of sex |
|
|
Term
| do females have less creatinine? |
|
Definition
| yes, due to lower muscle mass |
|
|
Term
| how does the creatinine level of african americans compare to that of caucasians? |
|
Definition
| african americans have a higher creatinine level |
|
|
Term
| how does being vegetarian affect creatinine levels? |
|
Definition
|
|
Term
| do muscular people have a higher creatinine level/malnourished, lower? |
|
Definition
|
|
Term
| does amputation of a limb drop creatinine? |
|
Definition
|
|
Term
| does obesity affect creatinine? |
|
Definition
|
|
Term
| what are the determinants of glomerular filtration? |
|
Definition
| glomerular capillary pressure and characteristics of the glomerular basement membrane |
|
|
Term
| why is inulin, creatinine, or urea good for determining GFR? which is the best? |
|
Definition
| these substances are freely filterable, not reabsorbed or secreted. *inulin is the best for determining GFR in a lab environement* |
|
|
Term
| what is the equation for GFR calculation? |
|
Definition
| clearance urine of inulin levels / plasma inulin levels |
|
|
Term
| what is significant about the cockcroft-gault formula? |
|
Definition
| it takes into account age and creatinine levels. ((140-age)x body weight kg)/(72x creatinine mg/dl) = GFR |
|
|
Term
| what is the current gold standard for creatinine clearance? |
|
Definition
| MDRD (Modification of Diet in Renal Disease) which also takes into account age and creatinine, as well as muscle mass or nutritional status |
|
|
Term
| *what is the proper body surface area?* |
|
Definition
|
|
Term
| what is the normal GFR? how much do you pee/day? |
|
Definition
| GFR: 180 L/day. normal urination rate: 2L/day |
|
|
Term
| what can glomerular filtration be affected by? |
|
Definition
| kidney disease, pregnancy (inc GFR due to inc blood volume, serum creatinine should dec), reduced kidney perfusion, marked extracellular fluid vol, NSAID use, acute protein load/habitual protein intake, blood glucose control (DM pts), and the level of arterial BP and class of anti-HTN agents used |
|
|
Term
| why will and should every pts creatinine level not be 1? |
|
Definition
| need to account for age, race, and sex |
|
|
Term
| what is a more important indicator of renal function than creatinine? |
|
Definition
|
|
Term
| what happens to GFR if you go from serum creatinine level 1 to 2 mg/100mL? 2 to 4? |
|
Definition
| 1-2: GFR will drop by 50% (lost a kidney), 2-4, GFR will only drop another 25% *main point - your biggest change in GFR occurs w/smaller changes* |
|
|
Term
| why do NSAIDs have a deleterious effect on the kidneys? who is this actually a consideration in? |
|
Definition
| by inhibiting prostaglandins, the afferent arteriole cannot be dilated to increase filtration in the face of volume contraction. they are also associated with both acute and chronic interstitial nephritis, as well as proteinuria (based on the glomerular basement membrane and the podocytes). this is really only a consideration in pts with chronic renal disease or who are volume contracted |
|
|
Term
| what is the normal GFR range? |
|
Definition
|
|
Term
| what should you look for in urine? |
|
Definition
| color , character, leukocytes, nitrite (evidence of bacterial activity), urobilinogen (accompanies liver disease), protein, pH, blood, specific gravity, ketones, bilirubin, ang glucose |
|
|
Term
| what are normal characteristics of urine? |
|
Definition
| yellow, clear, pH: 5-9, no ketones, specific gravity 1.003-1.035 (tells you how much stuff is in there), *osmolality: 30-1200* (KNOW THIS), tells you conc of urine, no glucose, no blood, no protein, no bilirubin, no nitrite, no leukocyte ester (nitrite/leukocyte esters: evidence of bacteria), and urobilinogen: .2-1 |
|
|
Term
| what makes up 90% of blood protein? |
|
Definition
|
|
Term
| what kind of urine samples should be used? |
|
Definition
| "spot" samples, morning is better |
|
|
Term
| what is and acceptable method of detecting proteinuria? |
|
Definition
|
|
Term
| who is at risk for proteinuria? |
|
Definition
| pts with DM, HTN, abnormal renal function - anyone with CKD (chronic kidney disease) |
|
|
Term
| if a non-at risk pt's dipstick protein test for proteinuria is negative, how often should they be checked? |
|
Definition
|
|
Term
| if a non-at risk pt's dipstick protein test for proteinuria is positive (> 1+), what is the next test that should be done? |
|
Definition
| total protein/creatinine ratio - use spot samples for protein/creatinine ratio or albumin/creatinine ratio, which negates the need for a 24 hr urine test. if the result is >200 mg/g, the person needs a full diagnostic workup |
|
|
Term
| how should at-risk pts be tested for proteinuria? |
|
Definition
| microalbuminemia tests, which if the pt tests positive for > 30 mcg/mg, further evaluation needs to be done |
|
|
Term
| how is microscopic examination of urine performed? |
|
Definition
| urine is put in a centerfuge, the top layer is taken off, and then RBC/WBC, casts (hyaline, RBC, WBC, granular, RTE, broad), crystals, and microorganisms are all looked for |
|
|
Term
| what are normal cells seen in the urine? |
|
Definition
| squamous (squarish, large w/a nucleus) and transitional cells (fried egg appearance) |
|
|
Term
| are RTE (renal tubule epithelial cell) casts normal in the urine? how do they appear? what are they? are they pathognomic for any specific diseases? |
|
Definition
| RTE casts are not normal in urine. they are larger than squamous cells, more symmetrical, and have a larger nucleus. they are a "cast" the tubule consisting of Tamm-Horsfall mucoproteins. RTE casts are pathgnomonic for acute kidney injury or acute tubular necrosis |
|
|
Term
| what is the main cause of red urine? |
|
Definition
|
|
Term
| why might there be normal looking RBCs in the blood? |
|
Definition
| trauma, catheter, or any disease affecting the collecting system of the nephrons |
|
|
Term
| why might there be dysmorphic/crenated RBCs in the blood? |
|
Definition
| diseases affecting the glomerulus |
|
|
Term
| can urine look clear/yellow to the naked eye and still have RBCs? |
|
Definition
|
|
Term
| what are WBCs in the urine indicative of? |
|
Definition
| UTIs, cystitis, polynephritis, interstitial nephritis |
|
|
Term
| what are the main pairings for locations in the kidney affected and the associated findings in urine? |
|
Definition
| problems with the glomerulus with RBCs, tubules with RTE, interstitial with WBCs |
|
|
Term
| what is sterile pyuria? what are 2 causes? |
|
Definition
| sterile pus in the urine (WBCs in urine w/a negative urine cx), which can be caused by interstitial nephritis or tuberculosis nephritis (very rare) |
|
|
Term
| what is a hyaline cast? is it pathologic? |
|
Definition
| a tamm-horsfall cast in a protein matrix that is clear and translucent . they are not pathologic, just seen in pts with proteinuria/volume contraction |
|
|
Term
| is a RBC cast pathologic? what is it composed of? |
|
Definition
| yes in every instance. RBC casts are RBCs found embedded in protein matrix |
|
|
Term
| what is a RBC cast indicative of? |
|
Definition
| acute glomerulonephritis which can be caused by: membranoproliferative nephritis, lupus, wegeners, microscopic polyangitis, goodpasture's syndrome |
|
|
Term
| how can you tell RBC and WBC casts apart? |
|
Definition
| WBCs are granular and nucleated |
|
|
Term
| what is a coarse granular cast (often muddy brown or cigar shaped) composed of unidentifiable cells indicative of? |
|
Definition
| acute tubular necrosis, acute kidney injury, or acute renal failure |
|
|
Term
| what are waxy casts associated with? |
|
Definition
|
|
Term
| what is the definition of nephrosis? |
|
Definition
| protein loss by the kidney of 3-3.5 g over 24 hrs (associated with albumin loss) |
|
|
Term
| what are imaging techniques that can be used to dx kidney disease? |
|
Definition
| plain films, ultrasound, CAT scan, IV pyelograms, MRI/MRA, voiding cystoutrethrogram, angiography, venography, and nuclear medicine |
|
|
Term
| what are plain films/X rays used for in diagnosing kidney disease? |
|
Definition
| looking at the kidneys, ureters and bladder, and obstructions |
|
|
Term
| what are ultrasounds used for in diagnosing kidney disease? |
|
Definition
| evaluation of renal size, symmetry, echogenicity, hydronephrosis/ureter, obstruction and cysts |
|
|
Term
| what is a consideration when doing cat scans in diagnosing kidney disease? |
|
Definition
| sometimes, if contrast is used, this can cause contrast-induced nephrotoxicity |
|
|
Term
|
Definition
| contrast-using (possible nephrotoxicity) diagnostics that look at caliceal anatomy |
|
|
Term
| what is a consideration when using MRIs for diagnosing kidney disease? |
|
Definition
| sometimes gadolinium is used (possible nephrotoxicity) |
|
|
Term
| do isotopes such as those used in nuclear medicine cause renal failure? |
|
Definition
|
|
Term
| what is normal-corticomedullary differentiation? |
|
Definition
| a pale cortex and dark medulla on an ultrasound |
|
|
Term
| what can the kidney be compared to via ultrasound? |
|
Definition
| the liver - which is less water than the kidney, and therefore the kidney should have a little less echo texture than the liver |
|
|
Term
|
Definition
| an intravenous pyelogram is used to outline the ureters, kidneys - it can dx an obstruction |
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