Block 65, 66: Renal Flashcards
bladder pain that is worsened by filing and relieved by voiding, diagnosis? other symptoms?
interstitial cystitis
- urgency, frequency, and chronic pelvic pain
cystocele
bladder prolapse into anterior vaginal wall
what sodium level do patients have severe SIADH and how do you treat? how do you treat mild SIADH
less than 120
hypertonic (3percent) saline
normal fluids
Diagnosis of SIADH
- hyponatremia
- serum osmo less than 275
- urine osm less than 100
euvolemic patient
initial corner stone therapy for renal stone diasese
Hydration
left lower abdominal pain radiating to the groin, vomiting, and unremarkable findings on abdominal exam has
obstructive ureterolithiasis
perferred modality for diagnosing ureteral stone are
ultrasonography or noncontrast spiral CT of abdomen
what does tuberculosis causing chronic primary adrenal insufficiency cause in the body
Addisions: Aldosterone deficiency
- non-anion gap
- hyperkalemic and hyponatremic metabolic acidosis
Aminioglycosides coveres what
serious gram-negative infections
toxicity of aminoglycosides
nephrotoxic
amikacin is what type of drug
aminoglycoside abs
type of drug: Levofloxacin
fluoroquinolone
Asymptomatic hypercalcemia
elevated or inappropriately normal PTH
low urinary calcium excretion
Familial hypocalciuric hypercaclemia
how is primary hyperparathyroidism different from familial hypocalciuric hypercalcemia
primary hypeparathyroidism has increase urinary calcium excretion ( urine calcium/creatinine clearance ratio)
treatment for hyperkalemia with significant ECG changes
calcium gluconate
how do beta adrenergic impact potassium
shifts potassium intracellular
- watch out in COPD patients
acidosis impact on potassium
hyperkalemia
3 ways K enters a cell
- insulin, beta-adrenergic, hematopoiesis
- GI loss
- hyperaldosteronism, diuretics
what 2 values are needed for best picture of acid-base status
pH
CO2
contrast-induced nephropathy
- transient spike in creatinine within 24 hours of contrast
- return to normal within 5-7 days
what can be given to minimize the risk of contrast-induced nephropathy
- IV hydration with isotonic bicarbonate or normal saline
- acetylcysteine
what should you suspect with large amounts of blood on urinalysis with relative absence of RBCs on urine microscopy
Myoglobinuria caused by rhabdomyolysis
when is anion gap calculated
metabolic acidosis
what is normal anion gap
6-12
when is osmolar gap calculated
ethanol, methanol or ethylene glycol toxicity
risk of correcting hyponatremia too quickly
CNS osmotic demyelination syndrome
triad for renal cell carcinoma
flank pain
hematuria
palpable abdominal renal mass
Unilateral varicoceles that fail to empty when a patient is recumbent raise suspicion for?
underlying mass pathology, such as renal cell carcinoma
characterize diabetic nephropathy
proteinuria
progressive decline in GFR
pathologic hallmark of diabetic nephropathy
nodular glomerulosclerosis
- diffuse glomerulosclerosis is more common
aspirin causes what acid base disturbance
respiratory alkalosis
metabolic acidosis
what is low urine sodium
less than 10
membranoproliferative glomerulonephritis is associated with what
hep C
hepatorenal syndrome is seen in patients with
severe liver cirrhosis secondary to system and renal hypoperfusion
does renal function improve with acute renal failure
no
typical findings for acute renal failure
- creatinine greater than 1.5
- low urine sodium
- no blood, casts, protein in urine,
Recurrent stones since childhood, positive family history, typical hexagonal crystals on urinalysis, and positive cyanide nitroprusside test
cystinuria
when should a person not get metformin
- ill patients with acute renal failure
- liver failure
- sepsis
common medications that cause hyperkalemia
- nonselective bet-adrenergic blockers
- potassium-sparing diuretics
- ACE inhibitors
- ARBS
- NSAID
what type of drug is amiloride?
potassium sparing diuretic
renal vein thrombosis is a complication of what nephrotic syndrome
membranous glomerulopathy
metabolic changes with vomiting
hypochloremic metabolic alkalosis
hypokalemia
increase bicarbonate
treatment for vomiting induced metabolic alkalosis
isotonic sodium chloride
potassium
patient with headache, sunburns, thrombocytopenia, glomerulonephritis, low C3 and C4 levels has
SLE
what causes membranoproliferative glomerulonephritis
persistent activation of the alternative complement pathway
microscopic finding for membranoproliferative glomerulonephritis
dense intramembranous deposits that stain C3
nephrotic-range proteinuria and hematuria, diagnosis
membranoproliferative glomerulonephritis
side effect of rifampin
red urine
after taking TCA, have abdominal pain and fullness/tenderness along the midline below the umbilicus ?
urinary retention
- prevent destrusor contraction and sphincter relaxation
- urinary cath and discontinue meds
when do you see asterixis
- hepatic encephalopathy
- uremic encephalopathy
- CO2 retention
AEIOU
acidosis electrolytes (K) ingestion overload uremia
electrolyte problems in alcoholics ? how
hypomagnesemia that causes hypokalemia
- intracellular Mg, inhibit K secretion by renal outer medullary potassium channels into urine
- No Mg, no K
hypertension, palpable bilateral abdominal masses and microhematuria
ADPCKD
Dysuria, urinary frequency, suprapubic tenderness suggests
uncomplicated cystitis
treatment for complicated cystitis
oral fluroquinolones
treatment for uncomplicated cystitis
- Trimethoprim-sulfamethoxazole
- nirtofurantion
- fofomycin
men with what have an higher increase of anticholinergic problems when they have what
benign prostatic hyperplasia
most common renal vascular lesions seen in hypertension are
arteriosclerotic lesions of afferent and efferent arterioles and glomerular capillary tufts
characterize diabetes mellitus nephropathy
- increased extracellular matrix
- basement membrane thickening
- mesangial expansion
- fibrosis
patients with nephrotic syndrome has increased risk for what
- atheroscloerosis ( due to hyperlipidemia)
2. arteriovenous thrombosis ( loss of antithrombin III)
Saline-responsive metabolic alkalosis is associated with
low urinary chloride excretion
volume contraction
saline-unresponsive metabolic alkalosis associated
urinary chloride greater than 20
what is used to treat severe metabolic acidosis
IV sodium bicarbonate
