Exam 3 Important stuff I need to remember Flashcards
Dx of acute kidney injury
increased of 0.3 serum creatinine (days to wks)
Causes of decreased serum creatinine
pregnancy
cirrhosis
Cause of falsely low creatinine assay
jaundice
Cause of falsely high creatinine assay
DKA
2 Drugs causing increased serum creatinine
trimethoprim
cimetidine
Med contraindicated in AKI
NSAIDs, they decrease PGE which cause afferent vasodilation
FENA value and meanings
2% for ATN/diuresis
if FENA decreased with diuretic=ineffective diuresis
FEurea value and meanings
50% for ATN/CKD
used with diuretics because they do no impact FEurea
Suggestion of isothenuria
ATN with no response to ADH
Urine lab values for Pre-renal azotemia (Na/Osm/gravity/FENA/BUN:Cr)
Na500
specific gravity>1.015
FENA 20:1
Urine lab values for ATN (Na/Osm/gravity/FENA/BUN:Cr)
Na>40 Osm=280 specific gravity=1.010 FENA>2% BUN/Cr =15:1
Casts with ATN
granular casts with muddy brown (RBC)
Casts with CKD
waxy casts
Hyperkalemia cardio sx
peaked T waves
widened QRS
Med tx for hyperkalemia
Ca (increases threshold)
insulin/beta2 stimulants (K into cells)
kayexalate (K/Na exchange in colon)
UTI prophylaxis for recurrent infections
TMP-SMX
Viral cystitis cause
adenovirus 11, 21
seen seasonally
Neonate UTI
from hematogenous spread
Infatn UTI
from ascending route
Med choice for ped HTN
HCT for no end organ damage
ACEI/ARB for CKD or DM with HTN
Cause of urge incontinence
detrusor overactivity
Cause of stress incontinence
increased intra-abd pressure, with no bladder contraction
Exacerbation of stress incontinence
estrogen
Risks for UT maligancy
smoking hx
analgesic abuse
pelvic irradation
Use of intravesical therapy
stages Ta, T1, Cis bladder cancer
noninvasive cancers
When do you do a radical cystectomy
non-met, muscle invasive bladder cancer
Meds causing kidney stone formation
Vit C/D triamterene protease inhibitors lasix acetazolamide
Stones soluble in alkaline urine
uric acid
cystine
Drug for uric acid stones
allopurinol
Drug for struvite stones
lithostat
Drugs for cystine stones
thiola
D-penicillamine
Urosepsis pathogen factors
LPS and Lipid A
type 1 and P-fimbriae
Early goal tx for urosepsis
hemodynamic stability
Crashing uroseptic tx
nephrostomy
Testicular detorsion tx timeframe and ultrasound finding
6 hrs
no flow on echo (heterogenous)
Testicular rupture tx timeframe
72 hrs for surgery
Epididymitis ultrasound finding
increased flow to epididymis
Penile fracture rupture
albuginea and tumescent corpora cavernosa
Fournier’s gangrene
pain in penis/scrotum out of proportion to exam
increased with DM/EtOH/immunosuppressed
E coli causes commonly
Arterial vs ischemic priapism
arterial has no pain, from cavernous a. damage
ischemic has blood stasis
Causes of priapism
Sickle-cell
leukemia infiltration
trazodone/phenothiazines/cocaine
Tx for priapism
for Sickel Cell, transfuse Hb
aspiration/irrigation of corpora
phenylephrine injection
shunt if not tx w/in 1 hour
Kidney decline with age
increased decline over the age of 40 (from 0.1 to 0.8cc/min/yr)
CKD consequences of adapations
intraglomerular HTN/glomerular hypertrophy cause glomerulus scarring
increased ammoniagensis causes scarring of intersitium
CKD adaptations
increased renal afferent vasodilation increased renal efferent vasoconstriction hypertrophy of tubule above cause increased GFR increased ammonia for H+ removal
BP control with CKD pts
ACEI/ARBS- slow progression of damage
CCB’s for transplant pts
Side effect of ACEI/ARBs with CKD
increased creatinine levels
stabilize after a time
Cause of anemia with CKD
erythropoietin deficiency
seen at Stage 4 of CKD
normocytic normochromic anemia
Tx of CKD anemia
with EPO
get Hb over 10mg/dL
Serum level changes in CKD
increased PTH and FGF-23
decreased Ca2+ and 1,25 Vit D
Primary vs secondary hyperparathyroidism
primary-adenoma causes increased Ca/decreased phosphate
secondary-from hyperplasia responding to decreased Ca/increased phosphate
Types of renal osteodystrophy with CKD
osteitis fibrosa cystica (increased PTH)
osteomalacia (decreased bone vol)
mineralization (decreased 1,25 Vit D)
Bone disease prevention with CKD goal
keep phosphate below 5.5mg/dL
Major cause of death from CKD
medial calcification (arteriosclerosis)
Tx for excess volume in CKD
thiazides up to stage 3
loop diuretics at stage 4 and 5
due to thiazide dependence on GFR
Pain mgt meds for kidney stones
morphine sulfate (narcotic) ketorolac (NSAID)
Meds for kidney stone passing
nifedipine (CCB)-decreased ureteral contraction
tamsulosin/teraosin (alpha1-anatagonists)-decreased peristalsis
Ca2+ stone prevention
fluids (over 2 L/day)
thiazides + amiloride
NOT triamterene (causes stones)
Tx for primary hyperoxaluria
pyridoxine
Tx for secondary hyperoxaluria
cholestryamine (binds oxalate)
Meds for cystine stones
tipronin/d-penicillamine
break disulfide bonds b/t cysteines
Struvite stone tx without surgery
urease inhibitor
acetohydroxamic acid
Tx for nephrogenic diabetes insipidus
thiazides or indomethacin
goal to decrease urine flow
Tx for Li+ induced diabetes insipidus
amiloride-decreases Li+ absorption
