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Renal Labs

Renal

QuestionAnswer
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