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Internal Medicine > Deja - Internal - Nephrology COPY > Flashcards

Deja - Internal - Nephrology COPY Flashcards

1
Q

ARF - Signs and symptoms NOT 2o to uremia:

A
  1. Metabolic acidosis.
  2. Hyperkalemia –> Arrhythmias.
  3. Fluid overload –> Pulm. edema, CHF, HTN.
  4. Hyperphosphatemia.
  5. HTN 2o to excess renin secretion.
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2
Q

Oliguria - Definition:

A

Less than 400cc/24h.

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3
Q

What tests would you initially order to evaluate for ARF?

A
  1. Urine/serum electrolytes.
  2. Urine/serum BUN/Cr.
  3. Urinalysis including urine osmolarity.
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4
Q

What is FENa?

A

Stands for fractionals sodium excretion and is the best diagnostic test to help discriminate between the different types of ARF.

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5
Q

FENa in Prerenal, renal, and post renal?

A

Pre –> >2%.

Postrenal –> >4%.

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6
Q

Name the type of ARF associated with the following urinary sediment findings: Red cell casts, urine eosinophils, WBCs, granular casts.

A

Red cell casts –> GN.
Urine eosinophils –> AIN.
WBC casts –> AIN.
Granular casts –> ATN.

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7
Q

What medications classically cause ATN?

A

CLAAP

Contrast
Lithium
Aminoglycosides
Amphotericin
Pentamine
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8
Q

What are the causes of AIN?

A

Inflammation of the renal parenchyma caused by:

  1. Medications: diuretics, NSAIDs, penicillin.
  2. Infection: CMV, EBV, Toxo, Syphilis.
  3. Systemic diseases: Sarco, Sjögren.
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9
Q

Uremic syndrome - Cardiovascular:

A
  1. HTN

2. Pericarditis

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10
Q

Uremic syndrome - Pulmonary:

A
  1. Pleural effusions

2. Pulm. edema.

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11
Q

Uremic syndrome - CNS:

A
  1. Asterixis

2. Clonus

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12
Q

Uremic syndrome - Hematology:

A
  1. Anemia due to low erythropoietin.

2. Incr. bleeding time due to platelet dysfunction.

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13
Q

Uremic syndrome - GI:

A
  1. Nausea

2. Vomiting

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14
Q

Uremic syndrome - Metabolic:

A
  1. Acidosis.
  2. Electrolyte imbalances (especially hyperkalemia).
  3. Hypocalcemia (lack of vitD).
  4. Azotemia.
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15
Q

What can be used to measure the severity of CRF?

A

GFR.

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16
Q

In CRF, there is decreased synthesis of what 2 entities?

A
  1. VitD

2. EPO

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17
Q

Electrolyte abnormalities seen in CRF:

A
  1. Hyperkalemia
  2. Hypocalcemia
  3. Hyperphosphatemia
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18
Q

Indications for dialysis:

A

AEIOU

Acidosis
Electrolyte abnormalities
Ingestion of toxins
Overload of fluid
Uremic symptoms
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19
Q

How can urinary cholesterol be identified?

A

If urine is seen under polarized light, there will be “MALTESE CROSSES”.

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20
Q

Other names for minimal change disease?

A

Nil disease or lipoid nephrosis.

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21
Q

Nephrotic syndrome - MC primary cause in adults:

A

FSGS or membranous glomerulonephritis.

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22
Q

Nephrotic syndrome - 2 forms, type I is slowly progressive and type II has autoantibodies against C3 and is more rapidly progressive.

A

Membranoproliferative glomerulonephritis.

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23
Q

Nephrotic syndrome - Associated with refractory HTN:

A

FSGS

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24
Q

Nephrotic syndrome - Frequently recurs:

A

Minimal change disease

25
Q

Nephrotic syndrome - Granular deposits of IgG and C3:

A

Membranous glomerulonephritis.

26
Q

Nephrotic syndrome - Present in young, black men with refractory HTN:

A

FSGS

27
Q

Nephrotic syndrome - Associated with HIV, IVDA, SCA:

A

FSGS.

28
Q

Nephrotic syndrome - “Spike and dome” on histology due to excess basement membrane:

A

Membranous glomerulonephritis.

29
Q

Nephrotic syndrome - Slowly progressive with minimal response to steroids:

A

Membranous GN

30
Q

Nephrotic syndrome - Associated with hep, SLE, syphilis, malaria, penicillamine, gold, CA:

A

Membranous GN.

31
Q

Main treatment for FSGS:

A

Steroids with cyclophosphamide - Poor prognosis.

32
Q

Main treatment for membranous GN:

A

Steroids, can add cyclophosphamide in refractory cases.

33
Q

Main treatment for membranoproliferative GN:

A

Steroids. Plasmapheresis can be added.

34
Q

Name the systemic diseases that can lead to nephritic syndrome.

A
  1. SLE
  2. SCA
  3. HIV
  4. Diabetes
  5. Myeloma
35
Q

Name the 5 types of GN?

A
  1. Post-strep GN (PSGN)
  2. RPGN
  3. Mesangial proliferative GN
  4. Membranoproliferative GN
  5. IgA nephropathy
36
Q

Nephritic syndrome - Self-limiting disease:

A
  1. PSGN

2. Henoch-Schonlein

37
Q

Nephritic syndrome - Buerger disease:

A

IgA nephropathy

38
Q

Nephritic syndrome - Coarse, granular IgG or C3 deposits:

A

PSGN

39
Q

What is the MC glomerulonephropathy:

A

Buerger disease

40
Q

What is the MC type of kidney stone?

A

Calcium pyrophosphate

41
Q

What is the 2nd MC type of kidney stone?

A

Ammonium Mg Ph

42
Q

What are the underlying bacterial etiologies of ammonium Mg Ph stones?

A
  1. Proteus
  2. Pseudomonas
  3. Providencia
  4. Staphylococcus sapro
43
Q

How is nephrolithiasis diagnosed?

A

Plain films can identify radiopaque stones.
Renal US can visualize hydronephrosis.
IV pyelogram is another option.
–> Non contrast CT can visualize small stones and is the GOLD standard for diagnosis.

44
Q

What is the mnemonic for common pathogens causing UTIs?

A

KEEPS:

Klebsiella
E.coli
Enterobacter
Proteus
S.saprophyticus
45
Q

What is the indication of a contaminated urinalysis?

A

Many epithelial cells or many types of bacteria present.

46
Q

Other than urinalysis, what test should be ordered in a patient suspected to have a UTI?

A
  1. Urine culture

2. Gram stain and sensitivity

47
Q

What is the 1st-line treatment for UTI?

A

3-day course of TMP-SMX.

In areas with resistance, ciprofloxacin is first choice.

48
Q

In what patient should fluoroquinolones be avoided?

A

Pregnant patients.

49
Q

How is anion gap calculated and what is a normal range?

A

Na - (Cl + HCO3). Normal range is 9-14.

50
Q

What is Winter’s formula?

A

It determines if there was appropriate compensation in the setting of metabolic acidosis:
1.5x(HCO3) +8 +/-2=Pco2.

51
Q

What are the causes of anion gap metabolic acidosis?

A

MUD PILES

Methanol, Metformin
Uremia
DKA
Paraldehyde 
INH, iron tablets
Lactic acidosis
Ethanol
Salicylates
52
Q

How is the etiology of the anion gap metabolic acidosis determined?

A

Check for ketonuria.

53
Q

Anion gap metabolic acidosis - Ketonuria present:

A
  1. DKA
  2. Paraldehyde
  3. Isopropyl alcohol ingestion
  4. Starvation
54
Q

Anion gap metabolic acidosis - Ketonuria Absent:

A
  1. Lactic acidosis
  2. Methanol
  3. Ethylene glycol
  4. Salicylate poisoning
55
Q

What are the causes of normal anion gap metabolic acidosis?

A
  1. Renal tubular acidosis
  2. Diarrhea
  3. Colostomy
  4. Ileostomy
  5. Ingestion of Mg sulfate
  6. Calcium chloride
  7. Acetazolamide
  8. Hyperparathyroidism
56
Q

What is in the DDX when a patient has the classic finding of HTN with HYPOkalemia?

A

Conn vs 2o hyperaldosteronism due to renal artery stenosis.

57
Q

How is RAS diagnosed?

A

Imaging via renal arteriogram, MRA, or Doppler US.

58
Q

How is RAS treated?

A

Angioplasty and in some cases surgery.

59
Q

ARF - Signs and symptoms 2o to uremia:

A
  1. Asterixis
  2. Nausea
  3. Vomiting
  4. Anemia
  5. Pericarditis
  6. Pruritus
  7. Urea crystals on the skin (“uremic frost”).
  8. Fatigue
  9. Oliguria

Internal Medicine (107 decks)

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