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Renal Labs
Renal
| Question | Answer |
|---|---|
| Metabolic alkalosis: Dx studies | if hypertensive, w/u for hypercorticism (Cushing, or 2/2 renal art stenosis) |
| Resp alkalosis Dx studies | ABG (inc pH, low PCO2, low bicarb in chronic) |
| Resp acidosis Dx studies | ABG (inc bicarb, dec pH) |
| Nephrotic syndrome labs | Frothy urine, (>3.5 g protein/24hr), lipiduria, glycosuria. Serum albumin <3g/dL, hyperlipidemia, mildly elevated platelets, factors V, VII, VIII, X |
| Glomerulonephritis Dx studies | bx & stain (immunofluorescent) |
| ARF imaging | Renal US; IVP; CT; MRI |
| ARF dx studies | |
| Dx imaging for renal stones | noncontrast CT; US only ID stones in kidney, proximal ureter, or UVJ |
| renal cyst on US | oval, thin walled, without internal echoes, and with posterior acoustic enhancement (Enhanced back wall) |
| Hyaline casts = | Normal (may be present after febrile illness, strenuous exercise) |
| Increased BUN/Cr, low FeNa; bland sediment = | Prerenal azotemia |
| Hematuria, RBC casts, proteinuria, HTN = | Glomerulonephritis (nephritic syndrome) |
| RBC casts: possible causes | glomerular damage: Wegener granulomatosis, SLE, post-streptococcal glomerulonephritis or Goodpasture; assoc w/renal infarction and subacute bacterial endocarditis |
| postinfxs glomerulonephritis labs | high Cr, ASO; urine RBC (acanthocytes), rbc/wbc casts, sterile pyuria; LOW C3, nl C4; high IgA (MRSA) |
| ATN on micro | brown gran cast/tubular epi |
| RBC Casts = | Glomerulonephritis |
| WBC casts = | AIN, pyelonephritis, inflammation |
| Epithelial casts = | ATN, AIN (also see eosino casts), GN |
| Granular casts = | parenchymal |
| Waxy casts = | nonspecific; advanced CKD |
| Fatty casts = | proteinuria |
| FENa in prerenal ARF | FENa <1, Na<20, U osmo 500, BUN:Cr 20:1 |
| CKD Stage 1 GFR = | >90 mL/min/1.73 m2 (normal) + persistent albuminuria |
| CKD Stage 2 GFR = | 60-89 |
| CKD Stage 3 GFR = | 30-59 |
| CKD Stage 4 GFR = | 15-29 |
| CKD Stage 5 GFR = | <15 |
| Nephrotic syndrome microscopic | Casts (RBC, hyaline, granular, fatty); oval fat bodies (Maltese cross or grape clusters under polarized light microscopy) |
| ADPKD dx | anemia; hematuria, pro, pyuria |
| ADPKD imaging | US is TOC = fluid filled cysts; xray = lg kidneys; urography = multiple lucencies; angio = sm vessels bend around cysts; CT = thin walled cysts |
| renal stones on imaging | radiolucent: uric acid, cystine; radiopaque: Ca ox, struvite |
| urine osmo <250 (despite hypernatremia) = | DI |
| volume depletion labs | High Hct & albumin; low urine Na; high BUN, normal Cr |
| serum Ca result must be corrected for: | serum albumin: measured Ca + [0.8 * (4-albumin)] |
| if high serum Ca, then do: | 24 hr urine Ca (high: malig or hyperPTH; low: primary hyperPTH); serum vit D |
| Winter's formula is used to: | calculate expected PCO2 compensation in metab acidosis: [1.5*bicarb + 8 +/-2] |
| Normal anion gap = | Na - (bicarb + Cl) = 8 +/-4 (so, 12) |
| anion gap & hypoalbuminemia: for q 1 g/dL decrease in albumin, AG should be inc by: | 2.5 |
| Pyelonephritis bugs | E coli (85%), proteus, klebs, enterobacter, pseudomonas |
| bladder ca studies: | gold std = cystoscopy (100% s/s); bx to confirm; also IV urogram; abd/pelvic CT, CXR, bone scan, retrograde pyelogram |
| Renal cell ca studies | normo anemia, high ESR; do US to r/o stone; CT is TOC to dx (poss also MRI & arteriography) |
| Initial study of choice to evaluate abd masses: | U/S |
| Wilms tumor imaging | intial: U/S; abd CT to tumor extension & LN; poss MRI; CXR to r/o lung mets |
| Hgb normal values: M vs F | 3 g/dL higher in men |
| Uric acid normal value: M vs F | 2 mg/dL higher in men |
| TOC to dx renal cell ca = | CT |
| ARF labs | BUN/Cr, may see high K, uric acid, PO4, low Ca |
| Prerenal ARF labs | UA: increased spec grav & hyaline casts. Decreased urine Na. High osmo & urea. |
| FENa in infrarenal ARF | FENa >1, Na>40, U osmo 250-300, BUN:Cr <15:1 |
| Labs (UA) in AGN / vascular infrarenal ARF | UA: proteinuria, hematuria, RBC casts |
| Labs (UA) in AIN (ARF) | UA: WBCs, eosinophils, WBC casts |
| Labs in ATN (ARF) | UA: low spec grav, high urine Na, muddy brown casts. BUN:Cr <20:1, high K & PO4, low Ca |
| Pigmented casts are seen in: | Rhabdo and hemolysis |
| ARF labs | Serum BUN/Cr, may see high K, uric acid, PO4, low Ca |
| Finding supports dx of renal failure in U/S: | bilateral small (<10 cm) kidneys |
| Elevated serum cholesterol & TG seen in nephrotic syndrome due to: | increased liver production of proteins to compensate for albumin loss |
| "ring shadow" sign on IVP suggests: | renal papillae destruction in obstructive uropathy (as in CTIN) |
| IgG (anti-GMB / basement membrane) vs lungs/kidneys | Goodpasture |
| C-ANCA: small & medium vessels vs lungs/kidneys | Wegener |
| Esosinophilic polyangiitis (P-ANCA) | Churg-Strauss |
| IgA nephropathy AKA: | Berger disease |
| muddy brown casts | ATN |
Created by:
Abarnard
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