Kidney and GU Conditions

what is azotemia?

retention of urinary waste products in the kidney

what is oliguria?

production of abnormally small amounts of urine

what is anuria?

complete lack of urine production

what is uremia?

elevated serum urea levels

what is pyuria?

purulent material in urine

what is lipiduria?

lipids in urine

what is considered acute kidney disease?

hours-days

what is considered chronic kidney disease?

months-years

what blood tests can be used to determine kidney function?

glomuler filtration rate, BUN, and creatinine clearance

what is a urinalysis?

a tool that aids in the diagnosis of urologic conditions, kidney damage and systemic conditions that impact the kidneys

what are the chemical properties of a urinalysis?

- specific gravity

- urinary pH

- hematuria

- proteinuria

- glycosuria

- ketonuria

- nitrites

- leukocyte esterase

- bilirubin/urobilinogen

a urine dipstick can not distinguish between what?

hematuria, myoglobinuria, or hemoglobinuria

what are the most common causes of hematuria?

renal conditions

what is proteinuria a hallmark of?

renal disease

what is proteinuria?

excessive protein excretion in the urine

what are the causes of proteinuria?

- functional proteinuria

- overload proteinuria

- glomerular proteinuria

- tubular proteinuria

what two causes of proteinuria are indicative of renal pathology?

glomerular and tubular proteinuria

what is evaluated in the microscopic exam of the UA?

examination of formed elements including crystals, cells, casts, and infectious organisms

what cells can be present in the UA?

- WBCs

- RBCs and dysmorphic erythrocytes

- epithelial cells

- renal tubule cells

what are casts?

tube-shaped particles that arise from the renal tubule lumen

what are casts utilized for?

to localize the disease to a specific location in the GU tract

what is the significance of hyaline casts?

not indicative of kidney disease, seen with fever, concentrated urine, diuretic use, after strenuous exercise

what is the significance of red cell casts?

glomerulonephritis

what is the significance of white cell casts?

indicative of infection or inflammation

what is the significance of renal tubular cell casts?

acute tubular necrosis, interstitial nephritis

what is the significance of granular, "muddy-brown" casts?

nonspecific, can indicate acute tubular necrosis

what is the significance of broad waxy casts?

indicative of stasis in enlarged collecting tubules as in chronic kidney disease

what can crystals represent in the UA?

healthy patients or indicate possible pathology

how is bacteriuria evaluated in the UA?

high-powered magnification allows distinction between gram-negative rods, streptococci, and staphylococci

what is a renal ultrasound used to diagnose?

obstruction or hydronephrosis

what can the renal ultrasound screen for?

polycystic kidney disease

what is the gold standard for diagnosing nephrolithiasis?

noncontrast helical CT

what are the benefits of using a MRI to evaluate the kidney?

- evaluation of sold lesions

- stage renal cell carcinoma

- reliable for diagnosing renal artery stenosis

what is an intravenous pyelogram?

administration of contrast to assess kidneys, ureter, and bladder

when is an intravenous pyelogram contraindicated?

patients at risk for AKI

what is evaluated in a renal arteriography?

evaluation of renal artery blood supply to the kidneys

what is an acute kidney injury?

the sudden loss of kidney function (hours-days) resulting in the inability to maintain electrolyte, acid-base, and water balance

what are non-modifiable risks for an acute kidney injury?

- AIDS

- CKD

- chronic liver disease

- CHF

- DM

- age over 65

- renal artery stenosis

what are modifiable risks for an acute kidney injury?

- anemia

- hypercholesterolemia

- HTN

- hyponatremia

- mechanical ventilation

what defines the stages of severity for an acute kidney injury?

improving global outcomes

what are pre-renal causes of acute kidney injuries?

conditions that cause decreased renal perfusion and GFR due to intravascular volume depletion

what are examples of pre-renal causes of AKI?

- hypovolemia (hemorrhage, GI losses)

- sepsis

- cirrhosis

- drug adverse effects

what are intrinsic renal causes of AKI?

kidney conditions characterized based on anatomical location of the injury

what are examples of intrinsic renal causes of AKI?

- renal artery stenosis

- acute interstitial nephritis

- acute tubular necrosis

- drug adverse effects

what are post-renal causes of AKI?

conditions that cause extrarenal obstruction of urinary flow

what are examples of post-renal causes of AKI?

- bening prostatic hypertrophy

- tumors of bladder, prostate, pelvis

- drug adverse effects

what is chronic kidney disease?

abnormal kidney structure or function lasting more than 3 months with associated health implications

what are indicators of CKD?

- albuminuria

- urine sediment abnormalities

- abnormal renal imaging

- serum electrolyte or acid-base derangements

- GFR < 60

what is essential for CKD?

early detection to allow earlier intervention to slow disease progression, decrease health care costs, and prevent long-term morbidity and mortality

who should be screened for CKD?

- all patients with DM or HTN

- patients with other risk factors

how should patients be screened for CKD?

- serum creatinine level

- GFR calculation

- urine albumin/creatinine ration

- UA

what are primary glomerular diseases that cause CKD?

- focal segmental glomerulonecrosis

- membranoproliferative glomerulonephritis

- membranous neuropathy

what are secondary glomerular diseases that cause CKD?

- diabetic neuropathy

- postinfectious glomerulonephritis

- collagen-vascular diseases

what are cystic diseases that cause CKD?

polycystic kidney disease

what are vascular disease that cause CKD?

hypertensive nephrosclerosis

what is stage 1 CKD?

kidney damage with normal or increased GFR, GFR >90

how is stage 1 CKD managed?

diagnose and treat, slow progression

what is stage 2 CKD?

kidney damage with mildly decreased GFR, GFR: 60-89

how is stage 2 CKD managed?

estimate progression

what is stage 3a CKD?

mildly-moderately decreased GFR, GFR: 45-59

how is stage 3a and 3b CKD managed?

evaluation and treat complications

what is stage 3b CKD?

moderately-severly decreased GFR, GFR: 30-44

what is stage 4 CKD?

severely decreased GFR, GFR: 14-29

how is stage 4 CKD managed?

prepare for renal replacement therapy

what is stage 5 CKD?

kidney failure, GFR:

how is stage 5 CKD managed?

renal replacement therapy

how is CKD treated?

- aggressive treatment of underlying disease

- dietary mangement

- avoid nephrotoxic medications

- adjust the dose of renally excreted medications

- hemodialysis

- renal transplant

what dietary components should be limited in a patient with CKD?

protein, salt, water, potassium, and phosphorus

what is the glomerulus?

the basic filtering unit of the kidney

what are the clinical manifestations of glomerular disease?

- hematuria

- proteinuria

- renal insufficiency

- hypertension

- edema

- hypercoagulability

- systemic finding

what is present in the urine of nephritic syndromes?

blood

what is present in the urine of nephrotic syndromes?

protein

what do nephritic syndromes result in?

- decreased GFR

- hematuria

- pyuria

- HTN

- pitting LE edema

- potentially oliguira

what are common causes of nephritic syndromes?

- glomerulonephritis

- IgA nephropathy

- alport syndrome

- lupus nephritis

- post-viral or bacterial infection

how are nephritic syndromes treated?

- low sodium diet

- water restriction

- anti-HTN medication

- manage underlying condition

what do nephrotic syndromes result in?

- heavy proteinuria OR

- hypoalbuminemia

- edema

- hyperlipidemia

what are primary causes of nephrotic syndromes?

- focal segmental glomerulonephritis

- membranous neuropathy

- minimal change disease

what are secondary causes of nephrotic syndromes?

- infections

- malignancies

- autoimmune disorders

- drugs

- DM

how are nephrotic syndromes diagnosed?

- confirm

- assess for common causes

- assess for underlying diseases

- assess for complications

- consider renal biopsy

what are complications of nephrotic syndromes?

- venous thrombosis

- infection

- renal failure

how are nephrotic syndromes treated?

- treat edema and proteinuria

- prevent/treat complications

- address underlying cause

what are the most common causes of end-stage renal disease?

DM and HTN

what should be screened in patients with end-stage renal disease?

declining kidney function

what is dysuria?

pain, discomfort, or burning with urination

what is frequency?

the need to urinate many times throughout the day, night, or both but in normal or less than normal volumes

what is urgency?

overwhelming, sudden sensation of the need to urinate

what is hematuria?

presence of blood in the urine, may be gross (macroscopic) or occult (microscopic)

what is retention?

the inability to completely or partially empty the bladder

what is incontinence?

the involuntary leakage of urine with multiple subtypes

what are lower urinary tract symptoms (LUTS)?

symptoms caused by outflow obstruction

what are examples of LUTS?

- hesitancy

- straining

- prolonged micturition

- dribbling

- decreased stream caliber or force

- may alse have associated frequency, urgency, urge incontinence, and nocturia

what is important patient data to assess for the GU system?

- chronic illness

- surgeries of GU t ract

- sexual history

- changes in urine or bowel habits

- screening exams

- employment/exercise

- medications and drug/alcohol use

what should the physical exam of the GU system evaluate?

external genitalia, hernia exam, and rectal exam

what blood tests can be used for GU conditions?

prostate-specific antigen (PSA)

what imaging can be conducted for GU conditions?

- plain XXR

- US

- cystoscopy

- urodynamic studies

what medication classes are used to treat GU conditions?

- antibiotics

- pyridium

- antimuscarinic agents

what medicationsa re used to treat prostatic hypertrophy?

- alpha blockers

- 5-alpha reductase inhibitors

- anticholinergic agents

what is urethritis?

inflammation of the urethra, usually caused by STIs when isolated, or with cystitis

what is cystitis?

inflammation of the bladder

what is pyelonephritis?

inflammation caused by bacterial infection of the kidney and renal pelvis