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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
always .... before giving EPO
check iron levels
26
Acute interstitial nephritis - causes
1. Medications (antibiotics NSAID, PPIs) 2. Rheumatol disease (sarcoidosis) 3. infections
27
Acute interstitial nephritis - classic triad
fever, rash, eosinophils
28
Acute interstitial nephritis - diagnosis
1. clinical 2. urianalysis (WBCs + WBC casts +/- mild RBC protein 3. periphera eosinophils + urine 4. tubulointest infl in biopsy
29
Acute interstitial nephritis - management
stop the drug systemic steroids dialysis if needed
30
Acute interstitial nephritis vs Contrast associated AKI
Ca-AKI is 1-2 days after contrast, has muddy brown casts, but no pyuria. No oliguria
31
Mixed cryoglobulinemia syndrome is associated with ... and usually manifest with
chronic HCV triad of palpable purpura, fatigue and arthralgias Peripheral neuropathy, systemic symptoms and glomerulonephritis are also common
32
Mixed cryoglobulinemia - treatment
initially treated with immunosuppression and then treatment of underlying condition (eg. anti-viral for HCV)
33
refeeding hypophosphatemia can cause
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
Acute post-strept glomerulonephritis - clinical symptoms
- asymptomatic | - hematuria, edema, HTN
35
Acute post-strept glomerulonephritis - labs
high creatinine, positive streptozume test | low C3 / C4 and CH50
36
Hyper K ECG
peaked T, prolonged PR and QRS, disappearance of P and eventually Sine wave
37
Main differences IgA nephrop vs APSGN
IgA is only days after inf | Normal complement
38
SIADH - treatment
fluid restriction +/- salt tablets | hypertonic saline if severe
39
SIADH - labs
1. low Na 2. serum osm less than 275 3. urine osm more than 100 4. urine sodium more than 40
40
Absolute vs functional iron def - cause
Absolute: depletion Functional from EPO: insuf iron to accommodate accelerated eythropoiesis Functinalfrom anemia of chronic disease: iron in macrophages
41
Absolute vs functional iron def - ferritin
Absolute: low Functional from EPO: normal or high Functinal from anemia of chronic disease: normal or high
42
Absolute vs functional iron def - iron responsiveness
Absolute: high Functional from EPO: high Functional from anemia of chronic disease: low
43
HTN treatment in CKD
if proteinuria --> ACE | no proteinuria: if edema: thiazide, if no edema ace
44
Hypocalcemia after transfusion
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
allergic interstitial nephritis - treatment
just stop the agent | if no improve in 2 days --> steroids
46
ankylosing spondylitis - how to monitor progression
ESR and radiolog
47
extraarticulular manifestations of ankylosing spondilitis
- uveities - AR - Pulm fibrosis - iga nephropathy
48
gout presipitants medications
- diuretics - low aspirin - immunosuppressants
49
colchicine contraindications
- liver or renal disease | - drug interactions (like cyclosporine)
50
rotator cuff syndrome - where is the pain
letarally
51
best initial medication for RA (after pain control)
methotrexate (+FOLIC ACID)

STEP 3 Uworld (14 decks)

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