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STEP 3 Uworld > IM Renal > Flashcards

IM Renal Flashcards

1
Q

MCC of proteinuria in adolscents (and how to diagnose)

A

orthostatic

  • urine protein/cr ration collected by supine and standing
  • split 24 hours urine collection
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2
Q

treatment of hypoNa in decompensate Heart failure

A

water restriction

ADH2 antagonist in CHF if Na less than 120

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3
Q

EPA for anemia in CKD - when? benefits?

A

If HB less than 10

  • improve QOL / less transfusions
  • DECREASED LV HYPERTROPHY
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4
Q

ADPKD - diagnosis / symptoms

A

U/S

HTN, hematuria, proteinuria, flank pain, renal insuf

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5
Q

ADPDK - extrarenal features

A
  1. Cerebral aneurysm
  2. hepatic + pancreatic cysts
  3. MVP, aortic regurgitation
  4. ventral + inguinal hernias
  5. colonic diverticulosis
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6
Q

ADPDK - treatment

A
  1. aggressive control risk factors for CV and CKD
  2. ACE inhb
  3. Hemodyal or kidney transplant if end stage
  4. screen fam members 18 or older with u/s
    ACE INH AND STATINS
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7
Q

High phosphorus - treatment

A

low P-diet

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8
Q

How to monitor active renal involvement in SLE

A

COMPLEMENT and anti-DSDNA

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9
Q

risks for Kindey Doror

A 
gestational complications (in female)
(NO higher risk for ESRD)
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10
Q

contrast associated AKI - pathoph

A
  • prerenal vasoconstriction

- direct tubular cytotoxicity

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11
Q

contrast associated AKI - Risk factors

A
  1. CKD
  2. High contrast load
  3. hypovolemia
  4. load NSAID
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12
Q

contrast associated AKI - presentation

A

Cr elevation in 24-48 h and gradual retuern in 3-7 days

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13
Q

contrast associated AKI - prevention

A
  • fluids
  • stop NSAID
  • less contrast
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14
Q

contrast associated AKI - diagnosis

A
  • clinical
  • FeNA less than 1 (Pre renal vasoconstriction)
  • muddy brown granular casts
    USUALLY NO PYUREA
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15
Q

alcoholic ketoacidosis treatment

A

IV dextrose containing normal saline + thiamine

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16
Q

Familiar hypocalciuric hypercalcemia

A

AD, inactivation to CA2+ receptors, higher levels needed to suppress PTH
BENIGN

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17
Q

Unique supportive evidence for renovascular disease

A

unexplained rise of creatinine after ACEi

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18
Q

Albumin vs Calcium

A

calcium decreases 0.8 for every decrease of 1mg of albumin

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19
Q

hematuria - next step

A

urinalysis (unless trauma or suspected stone –> CT)

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20
Q

Obstructing urolithiasis associated with infection AKI, severe pain-management

A

percutaneous nephrostomy or ureteral stand placement

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21
Q

suspect hepatorenal syndrome - next step

A
  • volume challenge (to confirm that renal failure is not 2ry to intravascular volume depletion)
  • midodrine + octreotide + albumin
22
Q

rhabdomyolysis induced AKI - management

A

early and aggressive isotonic saline infusion

- maybe mannitol and alkalinization

23
Q

ureteral stone management

A

Ureseptsis or renal failure or complete
obstruction ?
Yes –> consult
No –> if larger than 10 mm consult. If smaller hydration, pain control alpha blockers and strain urine, if nothing in 6 wks –> consult

24
Q

best kidney test for DM patients

A

urine alb/cr ratio (yearly) (better than 24 hour albumin or spot urine albumin)

25
Q

always …. before giving EPO

A

check iron levels

26
Q

Acute interstitial nephritis - causes

A
  1. Medications (antibiotics NSAID, PPIs)
  2. Rheumatol disease (sarcoidosis)
  3. infections
27
Q

Acute interstitial nephritis - classic triad

A

fever, rash, eosinophils

28
Q

Acute interstitial nephritis - diagnosis

A
  1. clinical
  2. urianalysis (WBCs + WBC casts +/- mild RBC protein
  3. periphera eosinophils + urine
  4. tubulointest infl in biopsy
29
Q

Acute interstitial nephritis - management

A

stop the drug
systemic steroids
dialysis if needed

30
Q

Acute interstitial nephritis vs Contrast associated AKI

A

Ca-AKI is 1-2 days after contrast, has muddy brown casts, but no pyuria. No oliguria

31
Q

Mixed cryoglobulinemia syndrome is associated with … and usually manifest with

A

chronic HCV
triad of palpable purpura, fatigue and arthralgias
Peripheral neuropathy, systemic symptoms and glomerulonephritis are also common

32
Q

Mixed cryoglobulinemia - treatment

A

initially treated with immunosuppression and then treatment of underlying condition (eg. anti-viral for HCV)

33
Q

refeeding hypophosphatemia can cause

A

rhabdomyloysisi
maybe P. levels are normal but intracellular are low, so refeeding (esp if res alkalosis co-exists) shifts the P into the cells becuase of insulin

34
Q

Acute post-strept glomerulonephritis - clinical symptoms

A
  • asymptomatic

- hematuria, edema, HTN

35
Q

Acute post-strept glomerulonephritis - labs

A

high creatinine, positive streptozume test

low C3 / C4 and CH50

36
Q

Hyper K ECG

A

peaked T, prolonged PR and QRS, disappearance of P and eventually Sine wave

37
Q

Main differences IgA nephrop vs APSGN

A

IgA is only days after inf

Normal complement

38
Q

SIADH - treatment

A

fluid restriction +/- salt tablets

hypertonic saline if severe

39
Q

SIADH - labs

A
  1. low Na
  2. serum osm less than 275
  3. urine osm more than 100
  4. urine sodium more than 40
40
Q

Absolute vs functional iron def - cause

A

Absolute: depletion
Functional from EPO: insuf iron to accommodate accelerated eythropoiesis
Functinalfrom anemia of chronic disease: iron in macrophages

41
Q

Absolute vs functional iron def - ferritin

A

Absolute: low
Functional from EPO: normal or high
Functinal from anemia of chronic disease: normal or high

42
Q

Absolute vs functional iron def - iron responsiveness

A

Absolute: high
Functional from EPO: high
Functional from anemia of chronic disease: low

43
Q

HTN treatment in CKD

A

if proteinuria –> ACE

no proteinuria: if edema: thiazide, if no edema ace

44
Q

Hypocalcemia after transfusion

A

packed RBCs are preserved and anticuagulaged with sodium citrate. Patients with massive transfusions or if liver/renal disease fail to clear it. It binds Ca2+ and causes hypocalcemia symptoms (even with normal levels of Ca2+)

45
Q

allergic interstitial nephritis - treatment

A

just stop the agent

if no improve in 2 days –> steroids

46
Q

ankylosing spondylitis - how to monitor progression

A

ESR and radiolog

47
Q

extraarticulular manifestations of ankylosing spondilitis

A
  • uveities
  • AR
  • Pulm fibrosis
  • iga nephropathy
48
Q

gout presipitants medications

A
  • diuretics
  • low aspirin
  • immunosuppressants
49
Q

colchicine contraindications

A
  • liver or renal disease

- drug interactions (like cyclosporine)

50
Q

rotator cuff syndrome - where is the pain

A

letarally

51
Q

best initial medication for RA (after pain control)

A

methotrexate (+FOLIC ACID)

STEP 3 Uworld (14 decks)

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