GK Nephrology Flashcards by Garima Khanal

MCC of glomerulonephritis worldwide?

Berger’s Disease (IgA nephropathy)

affects young males within days after URI or GI infection

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MCC of glomerulonephritis in the US?

Post-infectious group A strep after a skin (impetigo) or pharyngeal infection

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UA results for acute glomerulonephritis

hematuria

RBC casts

proteinuria

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acute glomerulonephritis + hemoptysis

goodpasture’s disease

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Tx for glomerulonephritis

supportive

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CPx of Berger’s Disease (IgA Nephropathy)

gross hematuria following a URI

red/smokey/coca cola colored urine

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Berger’s Disease Tx for pts at high risk of progression to AKI (pts with HTN, low GFR, proteinuria > 1g/day)

ACE-I or ARB

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cola/tea colored urine

glomerulonephritis

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hypertension

coca colored urine

periorbiral edema

azotemia: ↑ BUN/Creatinine Ratio
oliguria: < 400ml

fever/abdominal/flank pain

glomerulonephritis

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IgA mesangial deposits

Berger’s Disease

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Tx for IgA nephropathy or proteinuria

ACE-I

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normal glomerulus

impermeable to RBC and proteins

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glomerulonephritis pathophys

immune mediated glomerular inflammation → glomerular damage →increased urinary protein + blood loss

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crescent-shaped glomerulus on biopsy

rapidly progressing glomerulonephritis

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What is the MCC of nephrotic spectrum glomerular disease in Americans?

Diabetes Mellitus

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MCC of nephrotic syndrome in children

minimal change disease

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periorbital edema worse in the AM in children

minimal change disease (nephrotic syndrome)

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sxs of nephrotic syndrome

proteinuria, hypoalbuminemia, hyperlipidemia, edema, frothy urine, DVT

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initial test for nephrotic syndrome

UA: proteinuria causing frothy urine

Microscopy: oval maltese cross-shaped fat bodies (fatty casts)

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oval shaped fat bodies

nephrotic syndrome

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gold standard test for nephrotic syndrome

24 hr urine protein > 3.5g/day

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definitive dx for nephrotic syndrome

podocyte damage on electron microscope (Minimal Change disease)

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1st line tx for minimal change diease

glucocorticoids

Others: Thiazides or loop diuretics for edema

fluid/Na restriction

Proteinuria reduction: ACE-I/ARBS

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MCC of pyelonephritis

E. Coli

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What will physical exam show for pyelonephritis?

+ CVA tenderness fever tachycardia

What will UA show for Pyelonephritis

Pyuria (WBC \> 10) + nitrites

hallmark of pyelonephritis

**WBC casts**

definitive dx of pyelonephritis

urine culture

1st line Outpatient treatment for pyelonephritis

fluoroquinolones

Inpatient treatment for pyelonephritis

3rd or 4th gen ceph: Third Generation: **Cefotaxime, Ceftazidime, CeftriaxoneCefixime, Cefdinir** Fourth Generation: **Cefepime**

tx for pyelonephritis in pregnant patients

IV ceftriaxone

Tx for Hyperkalemia

calcium gluconate: administer when there are ECG changes to stabilize the cardiac membrane and reduce risk of cardiac dysrhythmias

hallmark of intrinsic kidney injury

cellular cast formation

What medication can cause exogenous intrinsic kidney injury?

aminoglycosides: gentamicin, tobramycin etc

**epithelial cell casts & muddy brown casts** **low specific gravity (unable to concentrate urine)**

**Acute tubular necrosis**

electrolyte imbalance seen in ATN

hyperkalemis increased phosphatemia

Tx for ATN

remove offending agents, IVF

How does **acute tubulointerstitial nephritis** present?

fever, eosinophilia, maculopapular rash, arthralgias

WBC casts

acute tubulointerstitial nephritis (AIN)

most imp noninvasive test in acute kidney injury

**RBC casts** with hematuria, **dysmorphic red cells**

**acute glomerulonephritis** (AGN) or **vasculitis**

waxy/granular casts: acellular with sharp edges

**_narrow_** waxy casts: chronic ATN **_broad_** waxy casts: end stage renal disease

fatty casts: "maltese crosses", oval fat bodies

nephrotic syndrome due to HLD

Hyaline casts

nonspecific, can be seen in normal urine

normal or near normal UA results indicate which kind of AKI?

prerenal or postrenal

hematuria and pyuria w/o casts

UTI

pyuria alone

most likely due to infection

GFR for stage 5 CKD

GFR \< 15 = ESRD

MCC of ESRD

DM, HTN, gomerulonephritis

what is the best predictor for renal disease progression

proteinuria

best test for CKD

spot Ualbumin/Ucreatinine ratio ACR

broad waxy casts in UA

ESRD

what will renal US show in CKD?

small kidneys

what is a lifestyle change a pt can make when diagnosed with CKD?

restrict protein, sodium, water, potassium, phosphate

what are hematologic complications of CKD?

anemia of chronic disease renal osteodystrophy

osteitis fibrosis cystica

periosteal erosions and bony cysts on skull X ray

**"Salt & Pepper"** appearance of skull on x ray

renal osteodystrophy

typical findings in labs of renal osteodystrophy

hypocalcemia, dec. Vit D, inc Phosphate, Inc PTH

Tx for renal osteodystrophy

Vit D (calcitriol) + phosphate binders: Calcium acetate, Sevelamer (if both calcium and phosphate levels are elevated)

When is dialysis indicated?

GFR ≤ 10 and/or serum creatinine ≥8

typical presentation for adult polycystic kidney disease

abdominal pain palpable flank mass HTN, hematuria

resistant HTN and palpable abd pass

PKD

**cerebral berry aneurysms (worst HA of my life), Mitral valve prolapse,** abdominal pain, abd mass and hematuria

PKD

Prevalance of horseshoe kidneys is increased in females with what?

**turner syndrome** (amenorrhea, short-statured, delayed breast development, webbed skin b/w neck and shoulders)

Dx for horseshoe kidney

CT urography

Tx for horseshoe kidney

tx complications like UTI and kidney stones **Symphysiotomy** (older tx method)

imaging for Hydronephrosis

Ultrasound

MCC of secondary HTN

renal vascular disease

Initial Imaging for Renal Vascular Disease

Initial test = CT angio

Gold standard for renal vascular disease

**renal catheter arteriography**

def mgmt for renal vascular disease

revascularization

signs of **hypoalbuminemia**

ascites, pitting edema

Typical findings of Granulomatosis w/ Polyangiitis (GPA Wegener's)

* URI/Nose sxs: refractory sinusitis * lower resp tract sxs (hemoptysis) * glomerulonephritis (hematuria)

main lab finding in granulomatosis w/polyangitis

**+ C-ANCA**

Tx for Granulomatosis w/ polyangiitis

corticosteroids + cyclophosphamide (immunomodulator)

The most common ECG abnormality associated with hypercalcemia is

a **shortened Q-T interval**

Renal Cell Carcinoma Triad

1. hematuria 2. abdominal/flank pain 3. palpable abdominal mass HTN, hypercalcemia, normocytic normochromic anemia

Renal Cell Carcinoma Tx

radical nephrectomy

Aldosterone is released in response to what two electrolyte/volume changes?

1. **Hypovolemia:** increased aldosterone promotes sodium retention 2. **Hyperkalemia:** Aldosterone causes increased K+ excretion in exchange for Na+ reabsorption

Na+ homeostasis is determined by

aldosterone

hypovolemia stimulates both

aldosterone and ADH secretion

Hyperkalemia Tx

Calcium Gluconate

ECG changes for Hyperkalemia

Peaked T waves Dropped P waves, widened QRS complex Sine waves

Best test to diagnose Renal Artery Stenosis

**Magnetic Resonance Angiography (MRA)**

What is a serious complication of Polycystic Kidney DIsease?

cerebral aneurysm

SIgns of Polycystic Kidney Disease

**abd, flank, back pain** **hematuria** **HTN** Cerebral Aneurysms

Mgmt for PKD

**ACE-I or ARBs**

General causes of metabolic acidosis

**addition of excess acids** **impaired acid secretion** inapprorpiate **loss of alkali**

How is the anion gap calculated

Na - (Cl + HCO3) normal anion gap is 10 +/- 2 anion gap \> 12 = elevated

MUDPILES

**Causes of Elevated Anion Gap Acidosis:** **M**ethanol **U**remua **D**iabetic Ketoacidosis **P**araldehyde **I**soniazid **L**actic acidosis **E**thylene Glycol **S**alicylate Toxicity

Typical findings for wilms tumor

asymptomatic abd mass abdominal pain

A salicylate overdose results in what acid-base disturbance?

Primarily respiratory alkalosis **(hyperventilation)** Secondary **metabolic acidosis**

What **electrolyte abnormality** will be present in Multiple Myeloma?

Hypercalcemia

Common manifestations of hypomagnesemia

muscle cramping, weakness, hyperreflexia, ataxia, seizures