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Renal > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is hematuria?

A

3 RBC seen on >2 occasions

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2
Q

Bence Jones proteins?

A

Plasma Cell Myeloma

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3
Q

Glomerular protein- albumin?

A

diabetic nephropathy

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4
Q

What causes urinary casts?

A

Tamm- Horsfall protein in tubules

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5
Q

What cast is seen with concentrated urine, fever, exercise, diuretics?

A

Hyaline casts

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6
Q

RBC casts?

A

GN

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7
Q

WBC casts?

A

Pyelo, interstitial nephritis

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8
Q

Pigemented/muddy brown casts?

A

acute tubular necrosis (ATN)

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9
Q

Waxy casts

A

late CKD

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10
Q

Granular casts

A

ATN

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11
Q

Normal BUN?

A

7-30 mg/dL

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12
Q

Normal Creatinine?

A

0.7-1.2 mg/dL

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13
Q

Normal BUN/ Creatinine ratio?

A

10:1

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14
Q

Abnormal BUN/ Creatinine ratio?

A

20:1

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15
Q

What are 6 absolute contraindications for renal biopsy?

A
  1. Uncorrected bleeding disorder
  2. Severe uncontrolled HTN
  3. Renal infection
  4. Neoplasm
  5. Hydronephrosis
  6. Uncooperative pt
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16
Q

What are 5 relative contraindications for renal biopsy?

A
  1. Solitary or ectopic kidney
  2. Horseshoe
  3. ESRD
  4. Congenital anomalies
  5. PCKD
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17
Q

What are 5 relative contraindications for renal biopsy?

A
  1. Solitary or ectopic kidney
  2. Horseshoe
  3. ESRD
  4. Congenital anomalies
  5. PCKD
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18
Q

What are the 3 criteria for AKI?

A
  1. Rise in SCr at least > 0.3 over 48hrs OR
  2. 1.5x baseline within 7dys
  3. Urine volume < 0.5 ml/kg per 6hrs
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19
Q

3 types of AKI?

A

Pre-renal
Intrinsic/Renal
Post-renal

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20
Q

Most common AKI form?

A

Pre-renal (hypoperfusion)

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21
Q

Criteria used for AKI?

A

RIFLE

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22
Q

RIFLE?

A 
Risk
Injury
Failure
Loss
Endstage
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23
Q

What is activated and released during hypotension?

A

SNS and RAAS, Vasopressin/ ADH

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24
Q

Once vasopressin and ADH is released what happens?

A

vasocontriction of AFFERENT ARTERIOLE and decrease in urine—- leads to HTN

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25
Q

Risk factors for pre-renal AKI?

A

Advanced age, male, black

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26
Q

Pre-renal w/ hypovolemia?

A

dizziness, thirst, Orthostatic Hypo, poor skin turgor

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27
Q

Pre-renal w/ low cardiac output?

A

Rales, third/ fourth heart sounds, JVD, peripheral edema

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28
Q

Pre-renal w/ sepsis?

A

Fever, elevated WBC, Orthostatic Hypo

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29
Q

FEna in prerenal AKI?

A

<1%

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30
Q

Imaging for pre-renal AKI?

A

Ultrasound

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31
Q

Urine osmolality in pre-renal AKI?

A

> 500

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32
Q

Txt for Pre-renal AKI?

A

Txt cause
Txt HTN
Furosemide for overload
Consult nephrology for RRT

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33
Q

The least common cause of AKI?

A

Post-renal

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34
Q

Anuria, oliguria, or polyuria?

A

Post-renal

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35
Q

FEna in post-renal AKI?

A

> 2 or varies

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36
Q

Urine Osmolality in post-renal AKI?

A

<400

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37
Q

Urine sediment in Post renal AKI?

A

normal, RBC, WBC, or cystals

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38
Q

Imaging for post-renal AKI?

A

Ultrasound or CT

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39
Q

Txt for post-renal AKI?

A

Relieve obstruction- bladder cath, stent, surgery

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40
Q

85% of all intrinsic/renal AKI?

A

Acute tubular necrosis (ATN)

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41
Q

Caused by renal ischemia or exposure to toxins?

A

Acute tubular necrosis (ATN)

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42
Q

3rd leading cause of new onset AKI in hospitalized patients?

A

radiographic contrast dye

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43
Q

S/S of ATN?

A

Uremic state

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44
Q

Urine sediment for ATN?

A

Granular, MUDDY BROWN CASTS, epithelial cell casts, free renal tubular epi cells

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45
Q

FEna for ATN?

A

> 1% usually >2

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46
Q

Txt for ATN?

A

Treat cause
loop diuretics ONLY for overload
IV thiazide diuretics (chlorothiazide or metolazone)
RRT

47
Q

Prognosis for ATN?

A

70% ICU, inpatient 20-50%

48
Q

AKA Tubulointerstitial nephritis?

A

Acute Interstitial nephritis (AIN)

49
Q

What mainly causes Acute Interstitial Nephritis?

A

Drugs (70%)

50
Q

AIN classic triad?

A

fever, rash, arthralgia post infection or medication

51
Q

Dx of AIN?

A

serum eosinophilia (allergic) , eosinophiluria

52
Q

Definitive dx for AIN?

A

Biopsy

53
Q

Med txt for AIN?

A

Methylprednisolone 500-1000MG daily for 3 days followed by oral prednisone 2wks

54
Q

If can’t tolerate steroids, what can be given?

A

mycophenolate mofetil

55
Q

Complex relationship between cardiac and renal dysfunction?

A

cardiorenal syndrome

56
Q

Type 1 Cardiorenal syndrome?

A

Acute HF results in AKI

57
Q

Type 2 Cardiorenal syndrome?

A

Chronic cardiac dysfunction causes progressive CKD

58
Q

Type 3 Cardiorenal syndrome?

A

Abrupt AKI causes actue cardiac dysfunction HF

59
Q

Type 4 Cardiorenal syndrome?

A

CKD contributes to cardiac dysfunction

60
Q

Type 5 Cardiorenal syndrome?

A

Heart and kidney dysfunction due to other acute or chronic systemic diseases (sepsis, DM)

61
Q

Txt cardiorenal syndrome?

A

no medical txt

treating HF has improved eGFR in Type 1 and 2

62
Q

Rapid loss of renal function in pts w/ cirrhosis and fulminant liver failure?

A

Hepatorenal

63
Q

Type 1 Hepatorenal syndrome?

A

rapid decline in renal function

64
Q

Type 2 Hepatorenal syndrome?

A

unrelenting ascites that does not improve with diuresis

65
Q

Txt Hepatorenal syndrome?

A

Liver transplant (no renal before liver)

66
Q

Prognosis for Hepatorenal?

A

risk of death is high

67
Q

Most common Nephrotic syndrome?

A

Primary

68
Q

Where is minimal change disease seen?

A

children

69
Q

Where is Focal segmental glomerulosclerosis seen?

A

adults

70
Q

What s/s is seen in nephrotic syndrome?

A

severe albuminuria/ proteinuria > 3.5 g/day***
Hypoalbuminemia < 2.5g
Edema (localized or generalized)
Hyperlipemia and Lipiduria
Hypercoagulability (urine loss of antithrombin)
Susceptibility to infections (loss of complement and immunoglobulins)

71
Q

Frothy urine?

A

nephrotic disease

72
Q

Urine sediment for nephrotic ?

A

Fatty casts

73
Q

Maltese cross

A

nephrotic

74
Q

Txt for proteinuria?

A

ACEI or ARBs (monitor potassium)

75
Q

Txt for edema?

A

Loop diuretics

76
Q

Most common cause of nephrotic syndrome in children?

A

MCD

77
Q

Third most common form of primary nephrotic syndrome in adults?

A

MCD

78
Q

Dx of MCD?

A

EM shows classical widespread effacement of foot processes of the podocytes

79
Q

Txt for MCD?

A

Prednisone 60 mg 4-8 wks

80
Q

Txt for relapsed MCD?

A

chemo meds: cyclophosphamide, tacrolimus, cyclosporine, or rituximab

81
Q

Most common cause of nephrosis in adults?

A

Focal segmental glomerulosclerosis

82
Q

Occurs in 50% of African Americans and approx 80% of children?

A

Focal segmental glomerulosclerosis

83
Q

Dx of FSGS?

A

BIOSPY

84
Q

Txt for FSGS?

A

Predisone

85
Q

“Spike and dome” pattern

A

Membranous glomerulonephritis (MGN)

86
Q

Initial presentation of MGN?

A

DVT or renal vein thrombosis

87
Q

Dx of MGN?

A

Silver methenamine showing spike

88
Q

Most common cause of ESRD in the US

A

Diabetic Nephropathy

89
Q

DM type most common in DN?

A

Type 1

90
Q

DN classic triad?

A

HTN, heavy proteinuria, and retinopathy

91
Q

obstructs blood flow out of the glomerulus?

A

efferent arteriole

92
Q

dilates allow blood flow into the glomerulus?

A

afferent arteriole

93
Q

What is the 1st stage of diabetic nephropathy?

A

hyperfiltration

94
Q

What does excess matrix form?

A

Kimmelstiel Wilson nodules- protien balls

95
Q

Protein balls?

A

DN

96
Q

What secretes more structural matrix?

A

Mesangial cells

97
Q

Nodular GS (Kimmelstiel Wilson)

A

DN

98
Q

Txt for DN?

A

ACEI or ARB

99
Q

Most common form of renal amyloid?

A

Primary amyloidosis

100
Q

S/S of swelling in the face, ankles, and legs?

A

RA

101
Q

Dx of choice for RA?

A

abdominal fat pad

102
Q

LM appears apple green?

A

RA

103
Q

Lm appears pink

A

RA

104
Q

what does a congo red stain show?

A

pink amyloid

105
Q

Txt for RA?

A

Melphanan w/ high dose dexamethasone

106
Q

Most common cause of asymptomatic hematuria?

A

Thin basement membrane disease

107
Q

S/S of asymptomatic hematuria incidental finding?

A

TBMD

108
Q

Txt for TMBD?

A

Reassurance

109
Q

Triad of Alport syndrome?

A

GN, ESRD, hearing loss, and eye problems

110
Q

Inherited defect in type IV collagen?

A

Alport Syndrome

111
Q

What type of genetic disorder is Alport Syndrome?

A

85% x linked pattern

112
Q

Dx for Alport?

A

woven basket or basket weave apperance

113
Q

Txt for Alport?

A

ACEI or ARBS
Hearing aids
Contacts or corneal replacement

Renal (9 decks)

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