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Renal Medi > 5-6 > Flashcards

5-6 Flashcards

1
Q

Hypernatremia is defined as serum sodium > ___ and it is primarily cause by ___

A

145

Not enough water

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2
Q

Serum Na = ___

A

(Na + K)/total body water

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3
Q

Signs and symptoms of hypernatremia

A 
Lethargy
Confusion
Seizures
Dehydration (tach, dry mouth, skin tenting, oligouria)
Weakness
Weight loss
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4
Q

Hypernatremia classifications

  1. Hypervolemic
  2. Euvolemic
  3. Hypovolemic
A
  1. Na retention (water increases, Na increases more)
  2. Loss of water
  3. Loss of Na and greater loss of water
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5
Q

___ is the passage of large volumes (>3 L) of dilute urine. There are two types:

A

Diabetes insipidus

  1. Central (neurogenic) - not enough ADH
  2. Nephrogenic - cannot use ADH that is produced (but there is enough)
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6
Q

What are the symptoms of diabetes insipidus?

A

Polyuria
Polydipsia
Nocturia

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7
Q

What test can you use to differentiate between Central or Nephrogenic DI, and primary polydipsia?

A

Water deprivation test

  • deprive of water
  • follow serum osm to steady state
  • give ADH
  • measure serum osm after 1 hour
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8
Q

Interpretations of water deprivation tests

A
  1. Water deprivation - increased uOsm >800 = primary polydipsia
  2. Water deprivation - no response (uPsm <300) = nephrogenic or central DI
  3. ADH administered - corrects = central DI (⬆️uOsm >800)
  4. ADH administered - does not correct = nephrogenic DI (uOsm <300)
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9
Q

Acute vs chronic hypernatremia tx:

A

Acute (<24 hours): correct rapidly

Chronic: correct slowly due to risk of brain edema

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10
Q

What are the goals of management in hypernatremia?

A
  1. Recognize symptoms
  2. ID cause
  3. Correct volume disturbances
  4. Correct hypertonicity
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11
Q

Recommendations for acute hypernatremia:

  1. correct serum Na at an initial rate of ___.
  2. Max ___
  3. Measure serum Na every ___
A
  1. 2-3 mEq/L/hr for 2-3 hours
  2. 12 mEq/L/day
  3. 1-2 hours
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12
Q

Recommendations for chronic hypernatremia:

  1. correct serum Na at an initial rate of ___.
  2. Max ___
  3. If a volume deficit is present ___
A
  1. 0.5 mEq/L/hr
  2. 8-10 mEq/L/day
  3. Isotonic NaCl (normal saline)
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13
Q

Hypernatremia classifications TREATMENT

  1. Hypervolemic
  2. Euvolemic
  3. Hypovolemic
A
  1. Diuretics
  2. Water replacement
  3. Normal saline
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14
Q

Treatment of central DI & its MOA:

A

Desmopressin (DDAVP)
- increases cAMP in renal tubular cells which increases water permeability resulting in decreased urine volume and increased urine osmolality

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15
Q

Treatment of nephrogenic DI

A
  1. Diuretics (increase proximal tubular Na and H2O reabsorption)
  2. NSAIDs (urinary retention by inhibition of prostaglandin synthesis-mediated detrusor muscle contraction)
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16
Q
  1. High ADH in SIADH causes ___

2. Low ADH from DI causes ___

A
  1. Hyponatremia and low urine output

2. Hypernatremia and polyuria

17
Q

Lithium commonly causes ___

A

Nephrogenic DI

-hypernatremia

18
Q

Renal stones grow where? When do they become symptomatic?

A

On renal papillae or within collecting system where they do not cause symptoms
-become symptomatic when they pass into the ureter or occlude the ureteropelvic junction

19
Q

The most common type of renal stone is ___

A

Calcium oxalate and then calcium phosphate

*most stones are mixed, but the majority is Calcium oxalate

20
Q

What is the dx test of choice for kidney stones?

A

Non-contrast helical CT

  • previously it was an IV pyelogram
  • US is good for pregnant or those who need to avoid radiation
21
Q

What is the most common metabolic abnormality?

A

Idiopathic hypercalciuria

22
Q

Proximal (Type I) renal tubular acidosis can cause ___

A

Hypocitraturia

23
Q

Things that factor into kidney stones:
Hypo:
Hyper:

A

Hypocitraturia
Hypercalciuria
Hyperoxaluria
Hyperuricosuria

24
Q

Struvite stones come from ___

A

Urease producing organisms (klebsiella, proteus)

*magnesium ammonium phosphate crystals

25
Q

___ stones are most common in people with gout

A

Uric acid

  • urine pH is <5.4
  • dehydration
  • Lesch-Nyhan syndrome
26
Q

Tx for uric acid stones

A

Raise urinary pH why K citrate or K bicarbonate

-also lower excessive uric acid excretion with allopurinol

27
Q

___ stones look like diamonds

A

Uric acid

28
Q

Cystine is detected using ___

A

The urine sodium nitroprusside test

29
Q

___ crystals are hexagonal and not fluorescent

A

Cystine

30
Q

Cystine binding drugs:

A

Penicillamin
Tiopronin
Captopril

31
Q

HTN pt with uric acid stones, give them ___

A

Captopril

Renal Medi (11 decks)

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