Awesome Review Flashcards
Which type of AGMA causes nephrolithiasis?
Ethylene Gycol making glycolic acid; calcium phosphate kidney stones
Tx- Fomepizole
Which type of AGMA can cause blindness and papilledema?
Methanol from too much formic acid
If osmolol gap is greater than 20?
What if osmolol gap is greater than 50?
Give Fomepizole
Hemodialysis
Tx Type 2 RTA
Thiazides and alkali depletion
Problem with proximal CT, can’t reabsorb bicarbonate or NaCl
Looks like Fanconi Syndrome
Tx Type 1 RTA
Give potassium citrate
Distal CT can’t acidfy urine, urine pH > 6 and hypocitaturia
Features of type 4 RTA
Aldosterone deficiency or resistance causing hyperkalemia
Tx- try fludrocortisone
Features of Barter’s syndrome
Like loop diuretic
Hypokalemia, low BP, urine Cl > 15
Tx- inhibit prostaglandin production with indomethacin and ibuprofen
Features of Gitelman syndrome
Like thiazides
Problem with DCT sodium receptor
Hypokalemia, low BP, urine Cl > 15
Uric acid
Salicylate overdose causes…?
Respiratory alkalosis followed by metabolic acidosis
Features of Liddles Syndrome
Increased transport defect in distal tubule causing hyperaldosteronism
High BP
If you see hyponatremia and urine sodium
Hepatorenal syndrome
Lab findings in SIADH
Low serum sodium
High urine sodium
High urine osmolarity
Tx: demeclocycline or tolvaptan
(Demeclocycline in CI in liver cirrhosis)
How to fix it when you overcorrect hyponatremia?
Desmopressin with Dextrose 5%
When to give calcium gluconate in hyperkalemia?
Flattened P waves or wide QRS
Best test to measure microalbuminuria
spot urine protein/urine creatinine ratio, if >0.3
List 5 causes of papillary necrosis
Analgesics Sickle cell trait Sickle cell disease DM Pyelonephritis Obstruction TB Chronic EtOH RV thrombosis
Treat ADPKD-
Autosomal Dominant Polycystic Kidney Disease
Tolvaptan (also used to treat SIADH)
Associated with Hepatic Cysts and Berry Aneurysms and mitral Valve Prolapse and elevated hematocrit
Fatty Oval Bodies associated with
Nephrotic Syndrome
Light Microscopy Finding of
Focal Segmental
Sclerosis in some parts of some glomeruli
Focal/segmental
Etiology of
Focal Segmental
Obese Black patient with HIV and Sickle Disease using Heroin
Electron Microscopy Finding of
Membranous
Subepithelial deposits
LM- thickened capillary loops
Etiology of Membranous
Hep B, Hep C, Syphillis, Solid Tumor, Lymphoma, malaria, NSAIDs, SLE, ACE-I, Gold, Pencillamine
Etiology of Minimal Change Disease
Hodgkin’s lymphoma, thymoma, leukemia, NSAIDs, Lithium
Electron Microscopy of Minimal Change
Effacement of Epithelial Foot Processes
Etiology of MembranoProliferative
Hep B, Hep C, SLE, Cryoglubinemia, SBE, monoclonal gammopathy
Which nephrotic syndrome has low Complement levels?
MembranoProliferative
Treatment for Nephrotic Syndrome
Steroids
Then consider cyclophosphamide, calcineurin inhibitors, mycophenolate,rituximab
IM finding of Rapidly Progressive Glomerulonephritis
Linear IgG deposition along glomerular basement membrane
Treatment of Rapidly Progressive Glomerulonephritis
Hint- Goodpastures
Plasmapheresis to remove the antibody
Cyclophosamide and steroids
Biopsy finding of IgA nephropathy
Mesangial Proliferation
Treatment of IgA Nephropathy
Fish Oil with omega 3 Fatty Acid
Lab findings with
Infection Related GN
(Hint- complement)
Low C3
Low CH50
Normal C4
Lab Findings in pre-renal Azotemia
BUN:Cr >20:1
Urine Osm >500
Urine Na
Anemia goal in CKD
Hgb, ferritin, transferrin sat
Hgb -10
Transferrin sat >30%
Ferritin >500
Compensation for Metabolic Acidosis
1.5 (HCO3) + 8
Compensation for Metabolic Alkalosis
40 + 0.7(change in HCO3)
Compensation for Respiratory Acidosis
Acute- increase by 1 for 10 mmHg in PCO2
Chronic- increase by 3.5 for 10 mmHg in PCO2
Compensation for Respiratory Alkalosis
Acute: decrease in 2 for 10 mmHg decrease in PCO2
Chronic: decrease in 5 for 10 mmHg decrease in PCO2
Serum Complement levels decreased in which nephritic syndrome?
Post Streptococcal GN
MembranoProliferative
(SLE, SBE, Cryoglobulinemia)
Atheroembolism (livedo reticularis/blue toe syndrome, eosinophilia, eosinophiluria)
Name 5 causes of Acute Tubular Necrosis
Aminoglycosides Amphotericin B Cyclosporine Tumor Lysis Rhabdo Atheroembolism Ethylene glycol Calcium oxalate crystals Contrast
5 cause (Meds) of Acute Tubulointersitial Nephritis
Beta Lactam PCN Sulfa Phenytoin Quinolone Mesalamine NSAIDs PPI
Which macrolide causes AKI?
Clarithomycin
Difference btwn Rhabdo and Tumor Lysis Syndrome
Heme dipstick is positive in Rhabdo
Both have increased CPK Increased Uric acid Increased Potassium Low calcium Increased phosphate
Treatment of Uric Acid Stones
Adequate urine output of 2 liters in 24 hours
Alkalinize urine (potassium citrate or potassium bicarbonate)
Allopurinol only if hyperuricososuria
Acquired Cystic Kidney Disease have high risk of … What?
Renal Cell Carcinoma
Which VEGF causes Thrombotic Microangiography?
Bevacizumab and Sunitinib
Orliastat causes which type of nephrolithiasis?
Calcium Oxalate due to hyperoxaluria
Bonds intestinal calcium so more oxalate is absorbed intestinally and more peed out (enteric hyperoxaluria)
Post transplant kidney patients have higher risk of which cancer?
Squamous cell cancer (skin)
Pneumococcal vaccine administration in CKD
23 valent 1 year 13 valent 5 years 23 valent
Treatment for calcium Oxalate stones
Avoid oral oxalate
Calcium carbonate/calcium citrate to bind intestinal oxalate
Cholestyramine to bind oxalate as bile salts
(Pyridoxine only for rare primary hyperoxaluria)
