Kidney Punch

This is a Test, Only a Test

100

With renal impairment, which are the key "KIDNEY FUNCTION" lab levels that you expect to GO UP

Serum Creatinine and Serum BUN (which stands for Blood Urea Nitrogen)

200

During AKI or CKD, when we see Glucose going UP in the Blood (serum), would we see Glucose go UP or DOWN in the Urine? 

Glucose in urine also goes UP!  Because Glucose goes everywhere, and these both are a symptom of Secondary Diabetes (aka Renal DM)

300

THIS SPECIFIC of renal disease shows urine that appears DARK and FROTHY and the UA presents hematuria, proteinuria, RBC casts and WBC cast

GLOMERULAR NEPHRITIS (the dark and frothy urine is a "cardinal sign," the dark color due to the blood in the urine/hematuria;  in contrast, recall that FOAMY URINE is a sign of the NEPHROTIC Syndrome due to the massive protein loss/ proteinuria)

400

This test uses a RADIOPAQUE dye that can cause an AKI

INTRAVENOUS PYELOGRAM (this is not done often as it could cause renal failure; the patient is told to drink lots of water to avoid the dye hanging around in the kidneys too long, which causes significant damage)

500

In a Urinalysis (UA) with normal results, one would expect to see what lab values

MINIMAL PROTEIN; No WBS and no RBC; No GLUCOSE; No Ketones; No Bilirubin; Some urobilogen; a SPECIFIC GRAVITY (the concentration of the urine, in relation to the blood) that is NOT FIXED

You say Nephritic, I say Nephrotic

100

Which of the two syndromes (Nephritic or Nephrotic) does one associate with Kidney INFLAMMATION

NEPHRITIC SYNDROME

200

In the NEPHRITIC syndrome, aside from the cardinal sign of MASSIVE INFLAMMATION, name at least one other important main signs

Aside from INFLAMMATION, the two other major signs of NEPHRITIC syndrome are:

(1) Hematuria and (2) Hypertension

300

In the NEPHROTIC SYNDROME, proteinuria (massive protein excretion in urine) and hypoalbunemia (low protein levels in the blood) lead to LIVER to do THIS

the LIVER tries to help in an unhelpful way: HEPATIC STIMULATION of LIPOPROTEINS and PROCOAGULANTS leads to more clotting ->atherosclerosis, DVT, Renal Vein thrombosis and potentially a Pulmonary Embolism.

400

What three renal disorders can lead to the NEPHROTIC SYNDROME (which is not itself a disease, but rather a collection of symptoms)

(1) GLOMERULAR NEPHRITIS;
(2) DIABETIC NEPHROPATHY;
(3) MINIMAL CHANGE DISEASE

500

In NEPHROTIC syndrome, due to the increase in the permeability of the Glomerular membrane, one finds the INCREASED EXCRETION in the urine of FOUR DIFFERENT THINGS that causes THESE FOUR RESULTS

(1) increased excretion of IgG -> Infection;
(2) increased excretion of Thyroxine -> Hyperthyroidism;
(3) increased excretion of Iron&Transferrin->Anemia;
(4) increased excretion of binding prot. for VitD-> Osteomalacia

Why are you being so ACUTE?

100

True or False: Acute Renal Injury is defined as "sudden severe decrease in renal function that is potentially reversible."

TRUE

200

Aside from decreased GFR, AKI is characterized by oliguria and azotemia.  Define both of these terms.

Oliguria: decreased or scant amount of urine produced, could result in "anuria" or lack of urine output.
Azotemia: In the blood serum, a rise in the three main nitrogenous products, namely urea, uric acid, and creatinine.  "Uremia" is when azotemia gets out of control (exacerbates) and turns into a disease process

300

List the THREE SUBTYPES of AKI, and what general types of conditions cause each

(1) PRERENAL Failure: Due to lack of blood profusion to kidneys starting from above, primarily conditions related to the heart; (2) INTRARENAL failure: due to something that attacked the kidneys DIRECTLY; (3) POSTRENAL failure: Often caused by some sort of BLOCKAGE from below the kidneys.

400

List the THREE PHASES of AKI and describe in general what characterizes each.

(1) OLIGURIC PHASE (1-2 wks), characterized by reduced urine output (<500 ml/day); (2) DIURETIC PHASE (2days-2wks): urine output greatly increased but still dangerous since pt. is NOT CONCENTRATING the urine yet; (3) RECOVERY Phase (3-12 mo), kidneys gradually regain normal function. NOTE: a patient can DIE in any one of these three phases.

500

RISK FACTORS for AKIs include the following (list at least THREE)

Atherosclerosis, HTN, DM, CHF, Liver disease, advanced AGE, medicines that raise one's risk including ACE inhibitors, diuretics, NSAIDS and aspirin

Those Dirty Little Rocks

100

THIS is the MOST COMMON type of Renal Caliculi

CALCIUM OXALATE

200

URIC ACID form in conditions that are too acidic (rather than all the other stones, that form under alkalotic conditions). List one or more factors (diet or otherwise) that could cause these URIC ACID stones to form

GOUT, low urinary pH, a HIGH PURINE diet (eating anchovies, meats of liver, kidneys, etc), TUMOR LYSIS Syndrome (because the breaking up of tumors releases uric acid), and MYELOPROLIFERATIVE DISEASE (when bone marrow makes immature RBCs that break down releasing uric acid)

300

STRUVITE Stones, which can cause large STAGHORN-type stones, are caused by ONE OF THESE TWO BACTERIA

They are caused by a CHRONIC INFECTION (such as a UTI) of mainly PROTEUS or KLEBSIELLA bacteria

400

With the passing of "those dirty rocks," the CLINICAL MANIFESTATION of the s/s include these three descriptions of the PAIN of its passing

(1) Pain is ACUTE (sudden onset);
(2) Pain is INTERMITTENT (hence "colic" pain);
(3) Pain is EXCRUCIATING (intense, severe, sharp).
Pain starts in the FLANK, migrates to the ipsilateral groin, N/V accompanies. In treatment, be sure to treat pt with PAIN MEDS FIRST before rehydration

500

In the creation of renal calculi, after the crystals PRECIPITATE & AGGREGATE, one these THREE PATHWAYS will occur (list the three possible results, as well as naming which is MOST COMMON among them)

(1) STONE PASSES THROUGH the Urinary System without any obstruction or pain;
(2) OBSTRUCTION of PAPILLAE-> HYDRONEPHROSIS (urine filling the kidneys);
(3) STONE DESCENDS THROUGH URETER -> SEVERE PAIN, HEMATURIA, DYSURIA (this third pathway is the MOST COMMON)

Heading toward the End

100

True or False: Chronic Kidney Disease (CKD) is defined as the progressive loss of renal function, defined as a GFR of GREATER THAN SIXTY for at least ONE YEAR. 

FALSE. It is the progressive loss of renal function, defined as a GFR of LESS THAN SIXTY for at least THREE MONTHS.  Note that once you're in CKD, the disease "can be slowed but is ultimately irreversible."

200

True or False: The NUMBER ONE CAUSE of CKI is DM.

TRUE.  Other systemic diseases (HTN, SLE/Lupus, etc) can lead to this condition, but diabetes is the #1 cause.

300

Describe the PATHOGENESIS of CKI

Loss of nephrons ->glomerulosclerosis -> glomeruli die, putting more strain on the remaining surviving glomeruli and their associated nephrons->decreased GFR, and the cycle continues with more and more nephrons and glomeruli dying off, reducing GFR further and further until kidney.

400

With lowered GRF that is a continuous process in CKI, as a result of the azotemia and uremia in the blood, urea deposits get deposited on TWO ORGANS where they are not normally found. Describe which two and how the urea deposits manifest there.

(1) Urea deposits on the HEART: PERICARDITIS;
(2) Urea deposits as precipitates on the SKIN: "Uremic Frost," a white film developing on the skin that is very itchy (i.e. causes pruritis)

500

List as many of the lab values that you can recall that develop from CKD (this was the list that Tom asked us to memorize, from the handout below the table labelled "Stages of CKD")

Serum Blood: Creatinine UP, BUN UP, Glucose UP, Na+ normal or down, Albumin DOWN, H/H DOWN, K+UP, Ca2+DOWN, PO4-UP, Mg2+UP, HCO3-DOWN, Arterial pH DOWN (i.e. overly acidic blood).
Urine: Creatinine DOWN, Glucose UP, Protein UP, RBC UP, WBC UP, Specific Gravity DOWN (or if really bad: fixed)