NURS 5433 Renal & Urologic Disorders Exam Study
Guide
Comprehensive Exam Study Notes
Primary Care Perspective | FNP Exam Review
1. Dipstick Analysis (UA)
Nitrites: Positive → gram-negative bacteria (E. coli, Klebsiella, Proteus). NOTE: Proteus, Klebsiella, Enterobacter, some E.
coli do NOT produce nitrites → negative nitrite ≠ no infection.
Leukocyte Esterase (LE): Positive → WBCs/pyuria → infection or inflammation.
Together: Positive nitrite + positive LE = strong indication of bacterial UTI.
Protein: Indicates kidney damage; monitor albumin-to-creatinine ratio in CKD.
Blood/Hematuria: ≥3 RBCs/HPF; see Hematuria section.
Glucose: Consider diabetes or Fanconi syndrome.
WBC Casts: Positive proof of pyelonephritis.
Specific Gravity: First morning void used in enuresis workup.
2. Chronic Kidney Disease (CKD)
Definition
Kidney damage for >3 months defined by structural/functional abnormalities WITH or WITHOUT decreased GFR.
Manifested by pathologic abnormalities or markers of kidney damage.
OR: GFR <60 mL/min for >3 months with or without kidney damage. Formula:
Cockcroft-Gault Equation (or use phone app).
CKD Grades & Management (KNOW THESE)
Grad e GFR (mL/min) Management Referral?
G1 ≥90 Diagnose & treat; ACE/ARB; stop NSAIDs; slow progression Optional
G2 60–89 Estimate progression; ACE/ARB; control DM & HTN Optional
G3a 45–59 Evaluate & treat complications ★ REFER to nephrology
G3b 30–44 Evaluate & treat complications ★ REFER to nephrology
G4 15–29 Prepare for kidney replacement therapy (KRT) ★★ REFER urgently
, G5 <15 Kidney replacement therapy (dialysis) Nephrology manages
G5D On dialysis Dialysis management Nephrology manages
KEY POINT: Even at Grade 4, if patient is not maintaining homeostasis → may need dialysis early.
Albuminuria Categories (A1–A3)
Category Albumin:Creatinine Ratio Significance
A1 <30 mg/g Normal to mildly increased
A2 30–300 mg/g Moderately increased → higher kidney damage
A3 >300 mg/g Severely increased → worst prognosis
RULE: Higher albumin = worse kidney damage. Always check albumin-to-creatinine ratio in CKD monitoring.
Risk Factors for CKD
• Diabetes mellitus (top cause)
• Hypertension (2nd top cause)
• Glomerulonephritis
• Cystic kidney disease
• Unresolved AKI
• CHF, collagen vascular disease, renal artery stenosis
• Multiple myeloma, malignancy
• Aging population (GFR naturally declines)
• High-risk groups: African Americans, American Indians, Hispanics, Asians, Pacific Islanders
Assessment / Clinical Findings
• Normochromic/normocytic anemia
• Fatigue and weakness
• Pruritus
• Nausea and vomiting
• Hematuria + proteinuria
• Increased skin pigmentation
• Hypertension
• Edema
Screening
• Who: Diabetes, hypertension, CAD, CHF (LV systolic/diastolic dysfunction) → screen YEARLY
• How: GFR + spot urine albumin (spot check = 24-hour urine accuracy)
• G1/A1-A2, G2, G3a: Check once yearly
• G3a and beyond: Check TWO TIMES yearly
Non-Pharmacologic Management
• Treat underlying renal disease
• STOP nephrotoxic meds (especially NSAIDs)
• Assess volume status (avoid depletion or overload)
, • Dietary protein: 0.8–1.0 g/kg/day (high quality)
• Low-phosphorus diet if phosphorus elevated
• STOP smoking
• Fluid restriction once oliguria develops
• Sodium restriction: 2–4 g/day
• Potassium restriction if electrolytes abnormal
• Uric acid restriction if gout present
• Avoid PICC lines
• Regular exercise
Pharmacologic Management
• ACE inhibitor or ARB: Drug of CHOICE for BP control; monitor K+, BUN, creatinine; stop if creatinine >2.5–3
• Beta blockers & CCBs: Adjunct for hypertension control
• Erythropoietin-stimulating agents: For anemia
• Loop diuretics: For fluid overload
• Renal dosing: Required for Coumadin, some antibiotics — check any renally excreted drug!
Renal-Toxic Drugs (HIGH YIELD)
NSAIDs (ibuprofen, naproxen, fenoprofen)
ACE inhibitors / ARBs (at high creatinine levels)
Aminoglycosides (tubular injury)
Contrast media (iodine-based — especially with GFR <60)
⚠ RENAL
TOXIC Herbal/alternative medications
Coumadin (requires renal dosing)
Indinavir (bladder stones)
Methenamine (contraindicated in renal failure)
CKD → ESRD Progression
• CKD progresses through Grades 1–5
• Grade 4: Prepare for KRT
• Grade 5: Kidney replacement therapy (dialysis or transplant)
• Unresolved AKI can lead to CKD → ESRD
Guide
Comprehensive Exam Study Notes
Primary Care Perspective | FNP Exam Review
1. Dipstick Analysis (UA)
Nitrites: Positive → gram-negative bacteria (E. coli, Klebsiella, Proteus). NOTE: Proteus, Klebsiella, Enterobacter, some E.
coli do NOT produce nitrites → negative nitrite ≠ no infection.
Leukocyte Esterase (LE): Positive → WBCs/pyuria → infection or inflammation.
Together: Positive nitrite + positive LE = strong indication of bacterial UTI.
Protein: Indicates kidney damage; monitor albumin-to-creatinine ratio in CKD.
Blood/Hematuria: ≥3 RBCs/HPF; see Hematuria section.
Glucose: Consider diabetes or Fanconi syndrome.
WBC Casts: Positive proof of pyelonephritis.
Specific Gravity: First morning void used in enuresis workup.
2. Chronic Kidney Disease (CKD)
Definition
Kidney damage for >3 months defined by structural/functional abnormalities WITH or WITHOUT decreased GFR.
Manifested by pathologic abnormalities or markers of kidney damage.
OR: GFR <60 mL/min for >3 months with or without kidney damage. Formula:
Cockcroft-Gault Equation (or use phone app).
CKD Grades & Management (KNOW THESE)
Grad e GFR (mL/min) Management Referral?
G1 ≥90 Diagnose & treat; ACE/ARB; stop NSAIDs; slow progression Optional
G2 60–89 Estimate progression; ACE/ARB; control DM & HTN Optional
G3a 45–59 Evaluate & treat complications ★ REFER to nephrology
G3b 30–44 Evaluate & treat complications ★ REFER to nephrology
G4 15–29 Prepare for kidney replacement therapy (KRT) ★★ REFER urgently
, G5 <15 Kidney replacement therapy (dialysis) Nephrology manages
G5D On dialysis Dialysis management Nephrology manages
KEY POINT: Even at Grade 4, if patient is not maintaining homeostasis → may need dialysis early.
Albuminuria Categories (A1–A3)
Category Albumin:Creatinine Ratio Significance
A1 <30 mg/g Normal to mildly increased
A2 30–300 mg/g Moderately increased → higher kidney damage
A3 >300 mg/g Severely increased → worst prognosis
RULE: Higher albumin = worse kidney damage. Always check albumin-to-creatinine ratio in CKD monitoring.
Risk Factors for CKD
• Diabetes mellitus (top cause)
• Hypertension (2nd top cause)
• Glomerulonephritis
• Cystic kidney disease
• Unresolved AKI
• CHF, collagen vascular disease, renal artery stenosis
• Multiple myeloma, malignancy
• Aging population (GFR naturally declines)
• High-risk groups: African Americans, American Indians, Hispanics, Asians, Pacific Islanders
Assessment / Clinical Findings
• Normochromic/normocytic anemia
• Fatigue and weakness
• Pruritus
• Nausea and vomiting
• Hematuria + proteinuria
• Increased skin pigmentation
• Hypertension
• Edema
Screening
• Who: Diabetes, hypertension, CAD, CHF (LV systolic/diastolic dysfunction) → screen YEARLY
• How: GFR + spot urine albumin (spot check = 24-hour urine accuracy)
• G1/A1-A2, G2, G3a: Check once yearly
• G3a and beyond: Check TWO TIMES yearly
Non-Pharmacologic Management
• Treat underlying renal disease
• STOP nephrotoxic meds (especially NSAIDs)
• Assess volume status (avoid depletion or overload)
, • Dietary protein: 0.8–1.0 g/kg/day (high quality)
• Low-phosphorus diet if phosphorus elevated
• STOP smoking
• Fluid restriction once oliguria develops
• Sodium restriction: 2–4 g/day
• Potassium restriction if electrolytes abnormal
• Uric acid restriction if gout present
• Avoid PICC lines
• Regular exercise
Pharmacologic Management
• ACE inhibitor or ARB: Drug of CHOICE for BP control; monitor K+, BUN, creatinine; stop if creatinine >2.5–3
• Beta blockers & CCBs: Adjunct for hypertension control
• Erythropoietin-stimulating agents: For anemia
• Loop diuretics: For fluid overload
• Renal dosing: Required for Coumadin, some antibiotics — check any renally excreted drug!
Renal-Toxic Drugs (HIGH YIELD)
NSAIDs (ibuprofen, naproxen, fenoprofen)
ACE inhibitors / ARBs (at high creatinine levels)
Aminoglycosides (tubular injury)
Contrast media (iodine-based — especially with GFR <60)
⚠ RENAL
TOXIC Herbal/alternative medications
Coumadin (requires renal dosing)
Indinavir (bladder stones)
Methenamine (contraindicated in renal failure)
CKD → ESRD Progression
• CKD progresses through Grades 1–5
• Grade 4: Prepare for KRT
• Grade 5: Kidney replacement therapy (dialysis or transplant)
• Unresolved AKI can lead to CKD → ESRD
