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Renal II Final > Harrisons > Flashcards

Harrisons Flashcards

1
Q

Type II RTA characteristics

A

defect in bicarb reabsorption
features of Fanconi syndrome, including glycosuria, aminoaciduria, phosphaturia, and uricosuria (all indicate proximal tubular dysfunction)

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2
Q

Type II RTA inheritiance

A

Isolated proximal RTA = hereditary dysfunction of the basolateral Na-HCO3 cotransporter

Fanconi syndrome = inherited or acquired due to myeloma, chronic IN, or drugs

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3
Q

Type II RTA treatment

A

treatment requires large doses of bicarb (may make hypokalemia worse)

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4
Q

Type IV RTA characteristics

A

May be due to hyporeninemic hypoaldosteronism or to resistance of the distal nephron to aldosterone

Associated with volume expansion and most commonly seen in elderly and/or diabetic patients with CKD.

hyperkalemic, ,may have mild NAGMA with urine pH < 5.5 and a positive urinary anion gap.

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5
Q

Type IV RTA associated disorders

A

forms of distal tubular injury and tubulointerstitial disease (interstitial nephritis)

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6
Q

Type IV RTA treatment

A

Reduce serum K, treat with oral bicarb or citrate

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7
Q

Risk factors for acute cystitis

A 
Women > men
recent use of a diaphragm with spermicide
frequent sexual intercourse
a history of UTI
DM
incontinence
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8
Q

Causes of cystitis

A

E. coli (75-90%)
S. sparophyticus (5-15%)
Klebsiella spp., Proteus spp., Enterococcus spp. Citrobacter spp. (5-10%)

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9
Q

In what patients can papillary necrosis occur?

A

Patients with obstruction, DM, sickle cell, and analgesic nephropathy

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10
Q

What is and who gets emphysematous pyelonephritis?

A

It is associated with the production of gas int renal and perinephric tissues and occurs almost exclusively in diabetic patients.

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11
Q

What is xanthogranulomatous pyelonephritis?

A

It occurs when chronic urinary obstruction (often by staghorn caliculi), together with chronic infection, leads to suppurative destruction of renal tissue.

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12
Q

What confirms diagnosis of uncomplicated cystitis?

A

urine dipstick positive for nitrite or leukocyte esterase

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13
Q

What three factors determine the initial rate of spread of any STI within a population?

A
  1. rate of exposure of susceptible to infectious people
  2. efficiency of transmission per exposure
  3. duration of infectivity of those infected
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14
Q

What are the four C’s of control of STI treatment?

A
  1. contact tracing
  2. ensuring compliance with treatment
  3. counseling risk reduction
  4. condom promotion and provision
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15
Q

What are common causes of STIs?

A 
N. gonorrhoeae
C. trachomatis
Mycoplasma genitalium
Ureaplasma urealyticum
Trichomonas vaginalis
HSV
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16
Q

N. gonorrhea Dx and Tx

A

N. gonorrhoeae can be presumptively identified if intracellular gram-negative diplococci are present in Gram-stained samples

Treat with single dose of ceftriaxone plus azithromycin

17
Q

Chlamydia treatment

A

azithromycin or doxycycline (azithromycin may be more effective for M. genitalium)

18
Q

Symptoms of septic shock (2+ for Dx)

A 
fever ( >38 C/100.4 F)
hypothermia ( <36 C/96.8 F)
Tachypnea ( >24 breaths/min)
Tachycardia ( >90 beats/min)
(Leukocytosis, leukopenia, or > 10% bands may have a noninfectious etiology)
19
Q

What is the major mechanism for multi organ dysfunction in septic shock?

A

widespread vascular endothelial injury

20
Q

Clinical Features of Septic Shock

A

hypoventilation leading to respiratory alkalosis
encephalopathy
acrocyanosis and ischemic necrosis of peripheral tissues due to hypotension and DIC
Skin: hemorrhagic lesions, bull, cellulitis, pustules
GI: N/V, diarrhea, ileus, cholestatic jaundice

21
Q

What do petechiae and purpura with septic shock suggest?

A

N. meningitidis infection

22
Q

What does ecthyma gangrenosum with septic shock suggest?

A

P. aeruginosa infection

23
Q

What are the cardiopulmonary complications of septic shock?

A 
- ARDS caused by:
ventilation-perfusion mismatch
increased alveolar capillary permeability
increased pulmonary water content
decreased pulmonary compliance
  • Hypotension: normal/increased cardiac output and decreased systemic vascular resistance
  • Decreased ejection fraction (ventricular dilation allows for normal stroke volume)
24
Q

Adrenal and renal major complications of septic shock?

A

Adrenal insufficiency

Renal: oliguria or polyuria, azotemia, proteinuria, renal failure due to acute tubular necrosis

25
Q

Neurologic major complications of septic shock?

A

delirium in the acute phase, polyneuropathy with distal motor weakness in prolonged sepsis

May have long-term cognitive impairment

26
Q

Lab Findings in Septic Shock

A

CBC: leukocytosis with left shift, thrombocytopenia
Coagulation: prolonged thrombin time, decreased fibrinogen, evidence of DIC
Chemistries: HAGMA, elevated lactate levels
LFTs: transaminitis, hyperbilirubinemia, azotemia, hypoalbuminemia

27
Q

What disorders can be associated with nephrogenic diabetes insipidus?

A

Tubulointerstitial diseases, lithium therapy, resolving acute tubular necrosis, and urinary tract obstruction

Also can be caused rarely by mutations in the V2 ANP receptor, aquaporin-1 channel in descending thin limb of LOH, and the ANP-regulated water channel in principal cells, aquaporin 2

28
Q

What pharmacological actions can be taken to reduce proteinuria?

A

ACE inhibitors or Angiotensin II blockers (ARBs)

29
Q

Definition of acute renal failure (ARF) or acute kidney injury (AKI)

A

defined as a measurable increase in the serum creatinine (Cr) concentration

30
Q

Causes of prerenal failure

A

volume depletion (diarrhea, vomiting, GI or other hemorrhage) or reduced renal perfusion in the setting of adequate or excess blood volume (CHF, hepatic cirrhosis, severe hypoproteinemia)

31
Q

Most common cause of intrinsic renal failure?

A

Acute tubular necrosis (ATN)

ATN can be caused by an ischemic event, toxic exposure (aminoglycosides0, rhabdomyolysis

32
Q

What are predisposing factors to rhabdomyolysis?

A

Alcoholism, hypokalemia, various drugs (statins)

33
Q

What disorders are associated with TTP?

A

HIV, bone marrow transplantation, SLE, antiphospholipid syndrome

34
Q

Lab findings of prerenal azotemia

A

BUN:Cr > 20:1, uric acid elevation, low urine [Na+], fractional excretion of sodium <1% (FEN)

35
Q

urinary sediment of pts with ischemic or toxic ATN

A

muddy-brown granular casts and casts containing tubular epithelial cells

FEN is typically >1%

36
Q

What are absolute indications for dialysis?

A

severe volume overload refractory to diuretic agents
severe hyperkalemia and/or acidosis
severe encephalopathy not otherwise explained
pericarditis or other serositis

Renal II Final (1 decks)

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