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**Old DOOS > Kidney 2 > Flashcards

Kidney 2 Flashcards

1
Q

what typically causes hypernatremia?

A

free water loss (not sodium gain)

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2
Q

what can cause hypervolemic hypernatremia?

A

administration of hypertonic saline, or hypertonic bicarb
hypertonic dialysis, feedings
cushing’s syndrome
primary hyperaldosteronism

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3
Q

what can cause euvolemic hypernatremia (most common cause)

A

diabetes insipidus
hypodipsia
insensiible dermal and skin losses

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4
Q

what typically causes hyponatremia?

A

reduced ability to excrete free water due to
reduced GFR
reduced ECV

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5
Q

what can cause hyperosmolar hypernatremia?

A

hyperglycemia

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6
Q

what can cause euvolemic hyponatremia?

A 
SIADH
glucocorticoid deficiency 
hypothyroidism
primary polydipsia
poor osmolar intake (ex- beer drinkers) 
positive pressure ventilation
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7
Q

what can cause hypovolemic hypo-osmolar hyponatremia

A

reduced total ECF
reduced effective circulating volume
severe hypokalemia

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8
Q

To dx SIADH what needs to be normal?

A

kidney function
adrenal function
thyroid function
volume status

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9
Q

what conditions cause secondary renal sodium retention?

A

heart failure
liver dz
pregnancy

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10
Q

what conditions cause primary renal sodium retention?

A

Acute and chronic renal failure
Effective mineralocortical excess
Decreased oncotic pressure
Tubular syndromes

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11
Q

what can cause pseudohyperkalemia?

A

hemolysis
thrombocytosis
leukocytosis

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12
Q

what can cause redistribution hyperkalemia?

A

acidosis
decrease in insulin
beta-adrenergic blockage

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13
Q

what can cause hyperkalemia w/ GFR >20 and low aldosterone?

A

addison’s dz
hyporeninemic hypoaldosteronism
Drugs (PG syntheses inhibition, captopril)

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14
Q

where are the afferent sensors for circulating volume circulation?

A

lungs

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15
Q

what do catecholamines cause

A

sodium retention

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16
Q

what does ANP do?

A

causes excretion of Na

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17
Q

if a person is hyponatermic, what will their urine osmols usually be?

A

increased form serum

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18
Q

what can severe hyperlipidemia cause?

A

pseudohyponatremia

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19
Q

what are causes of SIADH?

A

CNS pathology
pulmonary
drug related

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20
Q

what are renal causes of volume depletion?

A 
diuretics
post-obstruction diuresis
ATN (recovery)
Rental tubular acidosis)
salt-losing nephropathy
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21
Q

inability of kidney to handle a bicarbonate load?

A

renal tubular acidosis

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22
Q

what are extravascular sequestration causes of volume depletion?

A

intestinal obstruction
peritonitis
pancreatitis
rhabdomyolysis

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23
Q

What drugs can cause decreased renal excretion of K+ leading to hyperkalemia?

A

aldosterone antagonists (spironolactone)
ACEI, ARB
NSAIDs (prostaglandin inhibitors)

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24
Q

can you put someone who is experiencing hyperkalemia on an ACEI to an ARB?

A

No, will still have the same problem

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25
Q

What drugs can lead to hyperkalemia?

A 
spironolactone
triamterene
amiloride
captopril 
ACEIs and ARBs
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26
Q

if a patient is hypokalemic what must you assess?

A

metabolic status

renal excretion

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27
Q

what is one of the most common causes of a hypokalemic metabolic alkalosis

A

diuretics (thiazides)

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28
Q

if potassium urine is >20 mEq/L w/ hypokalemia where are is the likely problem?

A

kidney

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29
Q

what can cause metabolic acidosis w/ an increased anion gap?

A 
renal failure
acid overproduction
meds (salicylates) 
DKA
toxins (alcohol, ethylene glycol)
30
Q

how do you determine the anion gap?

A

(Na+)- (Cl- + HCO3-)

31
Q

what conditions are associated w/ a normal anion gap metabolic acidosis

A 
extrarenal bicarb loss
RTA (renal tubular acidosis)
meds
supplements
aldosterone deficiency
32
Q

what are common causes of metabolic alkalosis

A 
gastric loss
diuretics
antacids (Tums) 
volume depletion
Gitelman syndrome
Bartter syndrome
33
Q

a Na below what or above what is a medical emergency?

A

155

34
Q

A potassium above what and below what is an emergency?

A

6.5

35
Q

a pH below what and above what is a medical emergency?

A

7.55

36
Q

Bicarb levels above what and below what are a medical emergency?

A

bicarb 40

37
Q

are cultures usually done in females w/ their first UTI

A

no

38
Q

what are features of cystitis?

A 
Frequency
Dysuria
Urgency
Suprapubic pain/discomfort
Hematuria
39
Q

what are the 2 important labs on dipstick for cystitis?

A

LCE and n itrite

LCE is more sensitive

40
Q

what should you see on the microscope analysis of urine w/ cystitis?

A

WBCs

RBCs

41
Q

what are cultures used for in cystitis?

A

to ID organism

use after failure of response

42
Q

what are common causes of hematuria?

A

UTI
stones
cancer
BPH

43
Q

what is the highest hazard ratio w/ cystitis for premenopausal women?

A

frequency of intercourse

44
Q

what is the highest risk for cystitis in postmenopausal women?

A

h/o of 6 or more UTIs

insulin treated DM

45
Q

who can experience complicated cystitis?

A 
pregnant
very young or old
diabetic
immunocomprimised
GU abnormalities
recent abx therapy
obstruction
46
Q

what are the 5 main features of pyelonephritis?

A 
fever >38 degrees Celcius
flank pain
CVA tenderness
Naseau 
Vomiting
47
Q

what commonly causes pyelonephritis?

A

E. Coli (will be nitrite positive)

48
Q

on US what can you see w/ pyelonephritis

A

focal bacterial infection on a pole of the kidney

49
Q

what do clotting red blood cells indicate?

A

urological problem, occurring in the lower urinary tract

stones, tumor

50
Q

if bleeding is occurring in the upper urinary tract will there be clotting?

A

No, most of those enzymes are removed

51
Q

red cell casts are associated with what?

A

glomerulonephritis

52
Q

what is the most effective tx for cystitis?

A

bactrim for 3 days (160-800 mg BID)

53
Q

what are other treatment for cystitis?

A

ciprofloxacin
levofloxain
nitrofurantoin
trimethoprim by itself (recurrent)

54
Q

why is increasing fluids w/ cystitis controversial

A

too much fluid may dilute the abx

55
Q

what is the benefit of cranberry juice w/ cystitis?

A

appear to prevent bacterial adherence to urinary tract epithelium
have no abx activity

56
Q

what changes the pH of urine and can help prevent UTIs

A

vitamin C 500 mg at bedtime

57
Q

what is a recurrent UTI?

A

3 infections per year of >2 within 6 months

culture negative at 2 wk post treatment

58
Q

what do you use for tx of pyelonephritis?

A

ceftriaxone IV
ciprofloxacin PO or IV
levofloxacin PO
TMP-SMX PO

59
Q

Does urine production exclude urinary obstruction w/ pyelonephritis?

A

No

60
Q

what should you get if you think a patient has an obstruction or stone w/ pyelonephritis?

A

Renal US

61
Q

when can you convert a person w/ pyelonephritis to an oral regimen?

A

If afebrile for 12-24 hours

62
Q

what are some risk factors for stones?

A 
hypercalciuria
low urine output
high protein diet
high salt diet
high oxalate diet
63
Q

what is the most frequent cause of renal stones?

A

calcium oxalate/ phos

opaque, can see on x-ray

64
Q

what causes staghorn calculus?

A

magnesium NH4/ PO4

can see on x-ray, opaque

65
Q

which of the stones may be loosened and you can’t see on an x-ray

A

uric acid

66
Q

what crystals look like coffin-lids?

A

phosphate crystals

67
Q

what is a KUB

A

kidney, ureters, and bladder x-ray (flat plate)

68
Q

how do you get rid of staghorn calculi?

A

surgery

69
Q

what are the main features of renal cell carcinoma (from most to least common)

A

hematuria
abdominal mass
pain

70
Q

what other symptoms are associated w/ renal cell carcinoma?

A

weight loss
anemia (but may see polycythemia because some can produce EPO)
fever

71
Q

what are causes of urinary tract obstructions?

A

Congenital urinary tact malformation
Intraluminal obstruction
Extrinsic compression
Acquired anomalies

72
Q

if urine osmols are higher than serum osmols then what is there?

A

increased circulating levels of ADH

**Old DOOS (11 decks)

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