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DIT Level 3 > Clinical questions - Nephrology > Flashcards

Clinical questions - Nephrology Flashcards

1
Q

Medications that cause hyperkalemia

A 
ACEi/ARBs
K-sparing diuretics - Amiloride, spironolactone, eplerenone, triamterene 
B-blockers
digoxin
NSAIDs
-azole antifungals
trimethoprim (bactrim also elevated Cr)
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2
Q

Most likely cause of a patient with hematuria and vague back pain, normal PE, with CBC showing WBC 5.5, Hgb 21.8

A

Renal cell carcinoma with paraneoplastic syndrome of elevated EPO

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3
Q

Management of nephrolithiasis

A

8 mm or less - medical management
Pain: narcotics/NSAIDs
Alpha blocker - tamsulosin

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4
Q

Major causes of pre-renal AKI

A 
BUN/Cr > 20
Underperfusion of the kidney
-volume depression
-CHF
-cirrhosis
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5
Q

Major causes of intrinsic-renal AKI

A 
Glomerulonephritis
ATN
AIN
TTP-HUS
Malignant hypertension
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6
Q

Major causes of post-renal AKI

A

urinary obstruction - bilateral

-prostate disease - BPH or cancer

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7
Q

Granulomatosis with polyangiitis (Wegner’s) - presentation, dx, treatment… how do you differentiate between Wegners and Goodpasture’s?

A

Presentation: hemoptysis and recurrent sinusitis

PE: upper airway involvement - saddle nose deformity

UA with microscopic hematuria
Pulmonary lesions
+cANCA
Definitive dx with Bx

Tx:
Cyclophosphamide
Glucocorticoids

Goodpastures does not have upper respiratory involvement, just lung and kidney

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8
Q

Nephrotic syndrome - Presentation, most common cause, pathophys, treatment

A

Swelling throughout body without urinary symptoms, no cirrhosis or risk factors, hypertension

MC - focal segmental glomerulosclerosis

Proteinuria >3.5 g/day 
Low albumin leads to peripheral edema
HLD
Hypercoagulopathy
Increased risk of infection

Tx:
Glucocorticoids
ACD/ARB
Statin

Diuretics if unknown cause for edema

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9
Q

medication class to begin in a diabetic with elevated micro albumin

A

ACE/ARB

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10
Q

FENa calculation and interpretation

A

FENa = (UrineNa / SerumNa) / (UrineCr / SerumCr) * 100.

FENa > 2 % usually indicates ATN
FENa less than 1% usually indicates a prerenal state such as dehydration (holding onto water) or other forms of prerenal azotemia.

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11
Q

Medications that cause hypokalemia

A 
Beta agonists - albuterol
thiazide diuretics
loop diuretics
Chloroquin
Insulin
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12
Q

Correcting hyponatremia

A

No faster than 12 mEq/24 hours (increase by 1 every 2 hrs)

Risk central pontine myelinolysis with rapid correction

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13
Q

Fanconi syndrome

A

impaired reabsorption of phosphate, glucose, uric acid and/or amino acids
Causes proximal renal tubular acidosis type 2

Labs:
Low phos
Glucosuria with normal serum glucose
low urea
\+/- aa in urine
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14
Q

SIADH - presentation, lab findings, treatment

A

Presentation: fatigue, anorexia, myalgia
Labs: low serum sodium, high Uosm (concentrated)

Tx:
Treat underlying cause
Fluid restriction
Sodium supplementation
Loop diuretic to get rid of extra fluid
Vasopressin receptor antagonists - conivaptan, tolvaptan
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15
Q

RTA 1 - causes, lab findings, treatment

A 
Distal tubule injury
Causes:
Autoimmune with hypergammaglobulinemia (Sjogren's, RA)
Renal transplant
Nephrocalcinosis
Medullary sponge kidney
Chronic obstructive uropathy
Drugs: amphotericin B, ifosfamide, lithium
Cirrhosis
Sickle cell

Present with low potassium, NAGMA - elevated Cl, low serum pH, uric pH >5.5, low bicarb, high Ca, low citrate excretion, low urine ammonium

Tx:
Bicarb
K
Diuretics

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16
Q

RTA 2 causes, labs, treatment

A

Proximal tubule injury

Causes:
Multiple myeloma
primary hyperparathyroidism
Sjogrens
Wilson's dz
Vit D deficiency
Elevated cysteine
Drugs: ifosfamide, tetracycline, acetazolamide
Fanconi Sn
Inherited fructose intolerance

Like RTA1 Present with low potassium, NAGMA - elevated Cl, low serum pH, uric pH >5.5, low bicarb, high Ca, low citrate excretion - except normal urine ammonium

Tx:
Bicarb
K
diuretics

17
Q

Distinguishing between RTA 1 and 2

A

When giving IV bicarb, urine bicarb will increase in RTA2, it will not in RTA1

bicarb is reabsorbed in the proximal tubules and in RTA2 the proximal tubule is injured and unable to reabsorb the bicarb

18
Q

RTA 4

A

potassium is elevated

Caused by hypoaldosteronism

Tx with fludrocortisone and dietary K restriction

19
Q

Causes of metabolic acidosis with elevated anion gap

A 
Methanol
Uremia (renal failure)
DKA
Propylene glycol, paraldehyde, pyroglutamate
Iron tabs, isoniazid
Lactic acid
Ethylene glycol, ethanol (due to lactic acidosis)
Salicylates
20
Q

Definition of AKI

A

at least one:
increase Cr of >0.3 within 48 hrs
increase Cr >50% within 7 days
UOP less than 0.5 ml/kg/hr for 6 hrs

21
Q

Definition of CKD

A 
at least 1 for 3 or more months
eGFR less than 60
Urinary abnormalities:
-proteinuria
-microscopic hematuria
-WBC/RBC casts
22
Q

Aspirin overdose - presentation, lab findings, treatment

A

Presentation:
nonspecific GI symptoms
tinnitus
tachypnea - stimulates medullary respiratory center
Hyperpyrexia - uncouples mitochondrial oxidative phosphorylation -> hyperthermia

labs:
Mixed respiratory alkalosis with HAGMA

Tx:
Within 1-2 hrs of ingestion - activated charcoal
IV bicarb to alkalinize urine
If severe - dialysis

23
Q

Pyelonephritis - presentation and treatment

A

Presentation: dysuria, fever, suprapubic pain
Exam: CVA tenderness

Tx:
Ceftriaxone
Cefepime
Cipro
Levaquin
24
Q

Diuretic useful in acute pulmonary edema

A

loop diuretics

25
Q

Diuretic useful in idiopathic hypercalciuria causing calcium stones

A

Thiazide diuretics - reduce urine calcium secretion by 50%

26
Q

Diuretic useful in glaucoma

A

acetazolamide or mannitol

27
Q

Diuretic useful in mild to moderate CHF and expanded extracellular volume

A

loop diuretic

needs aldosterone antagonist to reduce mortality

28
Q

Diuretic used in conjunction with loop or thiazide diuretics to retain potassium

A

K sparing diuretics

29
Q

Diuretic useful in edema associated with nephrotic syndrome

A

loop diuretic

30
Q

Diuretic useful in increased intracranial pressure

31
Q

Diuretic useful in hypercalcemia

A

loop diuretic to increase urine calcium secretion

-Loops lose calcium

32
Q

Diuretic useful in altitude sickness

A

acetazolamide

33
Q

Diuretic useful in hyperaldosteronism

A

spironolactone or eplerenone

34
Q

Treatments of hypercalcemia

A

No treatment indicated if asymptomatic

Significantly elevated Ca leads to dehydration
-IVF with NS
Calcitonin - increased renal calcium excretion, decreases bone reabsorption by osteoclasts
Bisphosphates (long term) - inhibits osteoclasts
Glucocorticoids in lymphoma, sarcoidosis, granulomatosis

35
Q

What are the most common causes of interstitial nephritis? Meds, diseases, infections

A 
MC - Meds
B-lactams - PCN, cephalosporins
Sulfonamides - bactrim
aminoglycosides
NSAIDS
Rifampin
Loop diuretics
Cimetidine
Allopurinol
PPIs - omeprazole, lansoprazole
Indinavir
Megalamine

Systemic diseases/autoimmune:
SLE, Sjogrens
Sarcoid

Infections:
Legionella
Leptospirosis
Strep
CMV
TB
Coryne diphtheriae
EBV
Yersina
Enterococcus
Ecoli
36
Q

Hypokalemia - presentation, causes, treatment

A

Presentation: body stiffness, muscle spasms
Can have seizures, QTc prolongation, tetany, decreased cardiac function these necessitate IV calcium

Parasthesias - PO calcium

In addition to calcium, give vit D

For permanent hypoparathyroid (i.e. removal of parathyroid glands)

  • Calcitriol
  • rhPTH

DIT Level 3 (32 decks)

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