Final Review Flashcards by Francisco Miranda

Proteinuria, azotemia, hypertension (sometimes)

Azotemia (elevated BUN, SCr & CyC)

early chronic kidney disease (CKD)

How well did you know this?

Not at all

Perfectly

Hyperkalemia, hyponatremia, hyperaldosterone, edema, HTN
Anemia, dyslipidemia, hypocalcemia, high phos, high iPTH
Neuropathy, fatigue, acidosis, dementia, nausea

signs & symptoms of late CKD

How well did you know this?

Not at all

Perfectly

Hematuria (micro or macro), oliguria, migratory edema, HTN, fever, constitutional (N/V, HA, anorexia, pallor)

Acute glomerulonephritis (AGN)

How well did you know this?

Not at all

Perfectly

Start in eyelids &amp; face usually
Always pitting
Progress downward  arm &amp; leg edema
Migratory (face in AM, clear in afternoon, legs PM)
type III hypersensitivity

edema of AGN

How well did you know this?

Not at all

Perfectly

Bloody sputum, chest pain, cough, dyspnea (come first)

Next will have hematuria

Anti-glomerular basement membrane (GBM)

Goodpasture’s s/d

How well did you know this?

Not at all

Perfectly

Proteinuria, hypoalbuminemia, dyslipidemia
NO azotemia or HTN
24 hour protein urine >3g

nephrotic syndrome

How well did you know this?

Not at all

Perfectly

Check SCr or SCyC, BUN, electrolytes, blood pressure
Rule out diabetes
Repeat urine protein, SCr, BUN, electrolytes, BP in 1 month
Can refer to nephrologist after 2 elevated readings

asymptomatic proteinuria work up

How well did you know this?

Not at all

Perfectly

HTN, HA, Inc. Urination
HypoKalemia, Dec. Vision,
Plasma aldosterone:plasma renin activity ratio greater than >30.

Conn’s syndrome (Primary Hyperaldosteronism)

How well did you know this?

Not at all

Perfectly

Intermittent, severe pain in low back or flank or abdomen
May have nausea
Move around a lot
Gross or microscopic hematuria, proteinuria

ureteral colic

Dx: Imaging (renal US or CT scan)

How well did you know this?

Not at all

Perfectly

Edema, oliguria or anuria, HA, fatigue, anorexia, N/V, arrhythmias

acute kidney injury (AKI)

Send to hospital immediately
May need surgery or dialysis
Diuretics do not improve outcomes in absence of volume overload

How well did you know this?

Not at all

Perfectly

Hematuria, Oliguria, Azotemia (elevation of (BUN) & serum creatinine levels, HTN, proteinuria, Edema in kids

Nephritic s/d

How well did you know this?

Not at all

Perfectly

Most common, especially in SE Asia, Mediterranean
Cause: dysglycosylation of IGA1  immune complexes  glomerular deposition  inflammation  hematuria, proteinuria, renal failure

IGA Nephropathy

How well did you know this?

Not at all

Perfectly

Herbs: aloe vera gel, Artemisia absinthium, astragalus, codonopsis, cordyceps, Centella

IGA Nephropathy

How well did you know this?

Not at all

Perfectly

Immune complex & complement mediated, more common in women & African American.
Labs: ANA sensitive, anti-Sm specific

Lupus nephritis

How well did you know this?

Not at all

Perfectly

Herbs: astragalus, flax, turmeric

Lupus nephritis

How well did you know this?

Not at all

Perfectly

Delay 10-20 days after infection (unlike IgAN)
Rapid onset edema, HTN, oliguria, heavy proteinuria, hematuria, low urine sodium
Labs: elevated ASO titers, reduced complement

Post-Infectious GN

Nephrotic syndrome w/ peak incidence 24-36 months
Electron microscopy: foot processes swollen & fused. Biopsy normal
Clinical: look for allergies, intestinal permeability, probiotics, restrict sodium

Minimal change GN

Herbs: lespedeza cuneata, angelica sinensis, astragalus membranaceus, codonopsis pilosula

TX: corticosteroids

Minimal change GN

S/SX: nephrotic syndrome, acute nephritis, asymptomatic proteinuria, recurrent painless gross hematuria

Membranous & Membranoproliferative GN

associated w/ Hep BV

Membranous GN

associated w/ Hep CV

Membranoproliferative GN

Herbs: croton draco, pueraria montana, petasites hybridus, alisma orientale, ephedra, ulex europaeus

Membranous & Membranoproliferative GN Herbal complement inhibitors:

PRA < 0.65 ng/ml/hr
Direct Renin <5
More common in elderly, blacks and Hispanics
Contraindicated = Glycyrrhiza

Volume Hypertension

Elevated morning (0800-1000) plasma aldosterone concentration to PRA ratio is main clue, followed by oral salt challenge followed by urine aldosterone concentration.

Hyperaldosteronism*

PRA > >0.65 ng/ml/hr Direct Renin >5 Renin-angiotensin-induced vasoconstriction/inflammation Contraindicated = diuretics

Renin Hypertension

Most common in children <6, absence of HTN, absence of hematuria, normal complement, normal renal function S/SX: Foamy urine, wt. gain->edema (periorbital (eyes) first then abdomen, feet, ankles), inciting event (URI/Bug bite), tachycardia, peripheral vasoconstriction, oliguria, decreased GFR, increased renin, aldosterone, NE,

Minimal Change Disease TX: empiric steroid therapy Nephroprotective herbs, renal adaptogens, high dose fish oil, curcumin

massive proteinuria, hypoalbuminemia, edema (URI/Bug bite), hyperlipidemia, hyperlipiduria Indicate glomerular damage, systemic T cell activation Diagnosis: urinary protein >50 mg/kg/d & hypoalbumineia

Nephrosis: (Pediatric Nephrotic Syndromes)

hematuria, oliguria, azotemia, HTN Inflammation of kidneys, more common in childhood & adolescence Types: post infectious glomerulonephritis, IgA nephropathy

Nephritic: (Pediatric Nephritic Syndromes)

Caused by prior infection GAS. Immune complexes to GAS deposit in GBM leading to autoimmunity S/SX: antecedent illness, most children asymptomatic PE: edema, gross hematuria, HTN Labs: hematuria, skin culture, stretozyme test

Post-Streptococcal Glomerulonephritis (PSGN)

Pathophysiology: chronic hyperglycemia, AGE  deposit in mesangial cells, glomerular capillary damage, AGE antibodies (Advanced Glycated End-products). All of this will cause glomerular sclerosis, protein leakage, blood sludging leading to tubular destruction, loss of charge barrier, increased capillary pressure. (Kimmelstiel-Wilson lesions) Blacks, asians, Native Americans Early: Isolate proteinuria, Dec. GFR, HTN Dx: Urine albumin >300 mg/d

Diabetic Nephropathy **Retinopathy Inc. chances of Nephropathy w/Albumineria.**

Treat acute ureteral colic, what agents (herbs, drugs, minerals, hydrotherapy,) would you use?

Primary action is spasmolytic (will give pain control) Herbs: amni visnaga, Piscidia piscipula, gelsemium sempervirens, hyoscyamus Drugs: Alpha blockers (tamsulosin) Minerals: magnesium Hydrotherapy: hot compress to back, hot bath

``` Can be dissolved pH 6.5-7 Vegetarian diet, w/ high fluid intake Potassium citrate Combine w/ spasmolytics & diuretics if ureteral colic ```

Acute uric stones

Generally require surgical removal & antibiotics Urine acidification helpful Cranberry to prevent UTIs Urea-splitting organisms (proteus, providencia or pseudomonas)

Struvite stones

Radiolucent stones, precipitate from an acidic urine Related to conditions (leukemia, diabetics etc.) High does enzymes, ketogenic diet & thiazide diuretics increase risk Dehydration risk factor Orange to red diapers can be clues about uric acid stones in infants

Uric acid stones

Magnesium ammonium phosphate stones Precipitate from alkaline urine Associated w/ chronic UTI (gram negative rods) Treat the infection, image quickly (frequently impact & need surgery)

Struvite stones

Low methionine diet may be useful, but hard to do (legume based protein sources, potassium rich foods) D/t metabolic defect of tubular reabsorption of cysteine

Cysteine stones

Limit Potassium and Sodium Inc. Carb base diet Anemia->Dec. nephrons=Endocrine dysfxn= dec EPO

CKD stage 4-5

Calcium Wasting Inc. Phosphorus absorption Inc. PTH levels

CKD stage 3