IM- Nephro Flashcards
Causes for primary adrenal insufficiency (4)
- Autoimmune
- Infections (HIV, TB, disseminated fungal)
- Hemorrhagic infarction (meningococcemia, anticoagulants)
- Metastatic cancer (lung)
Clinical presentation for acute adrenal insufficiency (4)
- Shock
- Abd tenderness with deep palpation
- Unexplained fever
- N/V, weight loss and anorexia
Lab findings for acute adrenal insufficiency (4)
- Hyponatremia, hyperkalemia, hypercalcemia and eosinophilia
Clinical presentation for chronic adrenal insufficiency (5)
- Fatigue, weakness and anorexia
- GI (N/V, abd pain)
- Weight loss
- Hyper pigmentation or vitiligo
- Hypotension
Lab findings for chronic adrenal insufficiency (5)
-Hyponatremia, hyperkalemia, hypercalcemia, eosinophilia & anemia
How to diagnose adrenal insufficiency
- measure ACTH and Serum cortisol with high-dose (250microgram) ACTH stimulation test
What do you expect to see in primary adrenal insufficiency during ACTH stimulation test
low cortisol
high ACTH
What do you expect to see in secondary adrenal insufficiency during ACTH stimulation test
low cortisol
low ACTH
what acid-base imbalance is seen in Primary adrenal insufficiency (Addison disease)?
normal anion gap metabolic acidosis
Causes of Hyponatremia with
<290 serum osmolarity and
<100 urine osmolality (2)
- Primary polydipsia
- Malnutrition (beer drinker’s potomania)
Causes of Hyponatremia with
>290 serum osmolarity (2)
- Marked hyperglycemia
- Advanced renal failure
Causes of Hyponatremia with
<290 serum osmolarity
>100 urine osmolality &
Urine sodium <25 (3)
- Volume depletion
- CHF
- Cirrhosis
Causes of Hyponatremia with
<290 serum osmolarity
>100 urine osmolality &
Urine sodium >25 (3)
- SIADH
- Adrenal insufficiency
- Hypothyroidism
- 5 days of URI
- Young adult men (20-30)
- Recurrent gross hematuria
IgA nephropathy
- 10-21 days after URI
- Children (6-10)
- gross hematuria
- Adults can be asymptomatic or develop an acute nephritic syndrome
Post-infectious glomerulonephritis
- Normal Complement
- Mesangial IgA deposits on kidney biopsy
IgA nephropathy
- Low C3 complement
- Elevated anti-streptolysin O &/or anti-DNAse B
- Kidney biopsy with subepithelial humps consisting of C3 complement
Post-infectious glomerulonephritis
What lab value differentiates Familial hypocalciuric hypercalcemia (FHH) with primary hyperparathyroidism?
Urinary calcium level
High serum Calcium
High serum PTH
Low urinary calcium
Familial hypocalciuric hypercalcemia (FHH)- AD mutation of calcium-sensing receptor (CaSR)
High serum Calcium
High serum PTH
High urinary calcium
Primary Hyperparathyroidism
What are the 4 types of urinary incontinence
Stress
Urgency
Mixed
Overflow
Constanct involuntary dribbling and incomplete emptying? Dx? Tx(3)?
Overflow urinary incontinence
- Correct underlying cause
- Cholinergic agonists
- Intermittent self-catheterization
Leakage with Valsalva (coughing, sneezing, laughing). Dx? Tx(4)?
Stress urinary incontinence
- Lifestyle modification
- Pelvic floor exercises
- Pessary
- Pelvic floor surgery
Sudden, overwhelming, or frequent need to void. Dx? Tx (3)?
Urgency urinary incontinence
- Lifestyle modifications
- Bladder training
- Antimuscarinic drugs (Oxybutynin therapy)
24F, worsening headache, fatigue, sunburn on the face, bilateral pitting ankle edema, UA- protein+, RBC+, RBC casts+
-SLE
- Gradula symptom onset
- Joint, renal, serosal &/or neurologic involvement
- Rash
SLE
Dx for SLE
- Anemia. leukopenia, thrombocytopenia
- ANA, Anti-double-stranded DNA, anti-smith
- Low complement levels, increased immune complexes
The onset of Acute interstitial nephritis (AIN) caused by meds like beta lactams and PPI
7-10days after exposure
AKI = 7 days of starting drug, WA with hematuria, pyuria and crystals, increased risk with volume depletion and CKD
Crystal-induced AKI
Drugs that can cause Crystal-induced AKI (6)
Acyclovir Sulfonamides Methotrexate Ethylene glycol protease inhibitors Uric acid (tumor lysis syndrome)
Hypochloremia
hypokalemia
elevated bicarbonate level
GI losses due to vomiting
Causes of metabolic alkalosis that are saline-responsive (5)
- Vomiting
- Gastric suctioning
- Diuretics
- Laxative abuse
- Decreased oral fluid intake (volume depletion)
Causes of metabolic alkalosis that are saline-resistant (3)
- Primary hyperaldosteronism
- Cushing’s syndrome
- Severe hypokalemia
easy fatigability, postural dizziness, muscle cramps
volume depletion
Muscle weakness and arrhythmias
Hypokalemia
Hypernatremic- hypovolemic and symptomatic. Tx?
0.9%NS until euvolemic and the 5% dextrose
Hypernatremic- hypovolemic and Asymptomatic. Tx?
5% dextrose (preferred hypotonic fluid than 0.45%)
Hypernatremic- Euvolemic. Tx?
Free water preferred
The most common electrolyte abnormality in Chronic alcoholism? Cause (3)
Hypomagnesemia
- Poor nutritional intake, alcohol-induced renal losses, diarrhea)
Hypokalemia that cannot be corrected with potassium replacement is called? Caused by?
refractory hypokalemia
- Intracellular magnesium
(inhibit potassium secretion by renal outer medullary potassium (ROMK) channels - causing excessive renal potassium loss )
Organ systems affected by diabetic autonomic neuropathy (4)?
Cardiovascular
Peripheral nerves
GI
GU
The most common cause of chronic primary adrenal insufficiency (Addison disease) in endemic areas is
TB
Aldosterone deficiency that presents with a non-anion gap and hyperkalemic and hyponatremic metabolic acidosis
Addison’s disease
The metabolic acidosis caused by aspirin intoxication is due to (2)
increased production
decreased renal elimination of organic acids (lactic acid, ketoacids)
Drugs that cause Acute interstitial nephritis (4)
NSAIDS
PCN
TMP-SMX
cephalosporines
Drugs that cause hyperkalemia (8)
TMX(trimethoprim) Nonselective beta-adrenergic blockers ACE inhibitors, ARB, K sparing diuretics Digitalis Cyclosporine Heparin NSAIDS Succinylcholine
Three conditions that predisposes to the formation of calcium oxalate stones ?
- Small bowel disease
- Surgical resection
- Chronic diarrhea
leading to malabsorption of fatty acids and bile salts
What kind of hypernatremia is caused by diabetes insipidus (DI)?
Euvolemic
4 causes of nephrogenic DI resulting from renal ADH resistance
- Hypercalcemia
- Sever hypokalemia
- Tubulointerstitial renal disease
- mediation
Flushing (Cherry-red color), cyanosis, headache, altered mental status, seizures, coma, arrthymia, tachypnea followed by respiratory depression, pulmonary edema, abd pain, N/V, metabolic acidosis (from lactic acidosis), renal failure
Cyanide accumulation and toxicity
what can cause cyanide toxicity (3)
- Wool, silk
- Metal extraction in mining
- sodium nitroprusside
2 risk factors for Hepatorenal syndrome
- Advanced cirrhosis with portal HTN
- Edema
No RBC, Protein, or granular casts in urine
No improvement in renal function with fluids
Absence of tubular injury
FeNa <1% (or Urine Na < 10mEQ/L)
Renal hypo perfusion
Hepatorenal syndrome
splanchnic vasoconstrictors (3)
- Midodrine
- Octreotide
- NE
Renal transplant dysfunction early post-operative period can have 5 causes
- Ureteral obstruction
- Acute rejection
- Cyclosporine toxicity
- Acute tubular necrosis
how is acute renal transplant rejection treated?
IV steroids
Tinnitus
Fever
Tachypnea
Salicylate intoxication
Acid-base imbalance in aspirin intoxication
Mixed respiratory alkalosis
anion gap metabolic acidosis
What is the type of hematuria in patient with
Glomerular hematuria vs nonglomerular hematuria
G; Microscopic>gross
Non-G; Gross >microscopic
common disease that cause glomerular hematuria (3)
Poststreptococcal
IgA nephropathy
Alport syndrome
common disease that cause non-glomerular hematuria (5)
Nephrolithiasis Cancer Polycystic kidney disease infection (cystitis) papillary necrosis
UA finding in Glomerular hematuria (4)
Blood
Protein
RBC casts
dysmorphic RBCs
UA finding in Nonglomerula hematuria (2)
Blood
Normal-appearing RBCs
