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Kidney Flashcards

1
Q

azotemia

A

retention of creatinine

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2
Q

first step in urine formation

A

glomerular filtration

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3
Q

How are casts shaped?

A

in the form of the nephron they originate in

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4
Q

Heavy protein and lipiduria

A

nephrotic syndrome

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5
Q

hematuria and proteinuria

A

glomerulonephritis

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6
Q

pigmented casts and renal tubular cells

A

acute tubular necrosis

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7
Q

WBCs, RBCs, and protein

A

interstitial nehritis or pyelonephritis

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8
Q

how much protein in the urine indicated glomerular origin of disease?

A

> 1g

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9
Q

Functional proteinuria

A

<1g

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10
Q

examples of overload proteinuria

A

bence jones protein, myoglobinuria, hemoglobinuria

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11
Q

increased filtration of proteins, effacement of epithelial cell foot processes

A

glomerular proteinuria

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12
Q

faulty reabsorption in the proximal tubule

A

tubular proteinuria

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13
Q

how much protein indicates nephrotic range?

A

> 3.5g

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14
Q

dx of hematuria

A

3 red cells per HPF on 2 occasions

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15
Q

normal GFR

A

150-250 (worry when it hits 60)

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16
Q

What can cause normal or increased GFR?

A

hyperfiltration, disease at a different site in the nephron, interstitium, or vascular supply

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17
Q

GFR estimation equation

A

C = (UxV)/P

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18
Q

True or false: creatinine production and excretion are equal in normal states

A

true

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19
Q

Cockcroft Gault formula

A

((140-age) x weight)/(Pcr x 72)

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20
Q

What should CrCl be multiplied by in women?

A

0.85

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21
Q

when is GFR overestimated?

A

obese, edematous pts

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22
Q

CrCl is most accurate with a BSA of _____

A

1.73

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23
Q

Where is BUN synthesized?

A

liver

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24
Q

What underestimates GFR causing an increased BUN?

A

urea clearance, dehydrated, volume depleted, GI bleed, cell lysis, steroids, increased protein, decreased renal perfusion, renal artery stenosis

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25
Q

Normal BUN:creat

A

10:1

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26
Q

BUN:creat in someone volume depleted

A

20:1

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27
Q

What is an accurate depiction of GFR?

A

avg of the creatinine clearance and urea clearance

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28
Q

absolute contraindications to kidney biopsy

A

bleeding disorder not corrected, uncontrolled HTN, renal infection, renal neoplasm, hydronephrosis, uncooperative pt

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29
Q

when will creatinine respond to acute renal failure?

A

when 50% of kidney function is lost

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30
Q

Risk category

A

Creatinine increased 1.5 times, 0.5 ml of urine for 6 hours

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31
Q

Injury category

A

Creatinine increase 2 times, 0.5 ml or urine for 12 hours

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32
Q

Failure category

A

Creatinine increased 3 times or >4mg with an acute increased of 0.5, 0.3ml of urine in 24 hours or anuria for 12 hours

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33
Q

Loss category

A

loss of kidney function for 4 wks

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34
Q

ESRD category

A

need for renal transplant therapy for 3 months

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35
Q

MCC of CA-acute renal failure

A

prerenal

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36
Q

MCC of HA-acute renal failure

A

ATN

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37
Q

what type of ARF has a higher mortality rate?

A

Hospital acquired

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38
Q

MCC of death due to ARF

A

sepsis and cardiopulmonary failure

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39
Q

describe prerenal ARF

A

volume depletion, vasodilation, tubular and glomerular function are maintained

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40
Q

describe intrinsic ARF

A

vasoconstriction, decreased renal perfusion

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41
Q

MCC of intrinsic ARF

A

ATN/AKI

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42
Q

True or false: pstrenal ARF must be bilateral

A

true

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43
Q

how much CO do the kidneys receive?

A

25%

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44
Q

causes of prerenal ARF

A

pancreatitis, CHF, hepatic failure, the usual

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45
Q

Treatment of prerenal ARF

A

fluids +/- dopamine

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46
Q

causes of intrinsic ARF

A

Cardiac arrest, sepsis, systemic HOTN or ischemia, rhabdomyolysis, glomerulonephritis, interstitial nephritis, renal artery occlusion, pulmonary-renal syndromes

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47
Q

treatment of intrinsic ARF

A

furosemide or mannitol (not if anuric) + dopamine

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48
Q

how to dx postrenal ARF

A

US with doppler

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49
Q

what will a BMP of ARF show?

A

acidosis and hyperkalemia

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50
Q

How is intrinsic ARF confirmed?

A

renal biopsy

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51
Q

What type of imaging is used to evaluate ARF

A

non contrast CT

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52
Q

urine sodium <40, high urine Cr: serum Cr ratio and Serum urea: Serum Cr ratio

A

prerenal ARF

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53
Q

urine sodium >40

A

instrinsic ARF

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54
Q

what artery and vein are used for an AV fistula for hemodialysis?

A

brachiocephalic and radiocephalic

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55
Q

when are AV grafts useful?

A

when vessels can’t tolerate high flows

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56
Q

What is used for semi-emergent dialysis or when the fistula is maturing?

A

Hickman tunneled catheter

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57
Q

True or false: a bruit SHOULD be heard over an AV fistula

A

true

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58
Q

Tx of thrombosis of AV fistula

A

angioplasty

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59
Q

steal syndrome

A

shunting of blood flow from the artery to the vein

60
Q

more than 20% of CO is diverted through an access

A

high output heart failure

61
Q

blood-dialysate interface

A

peritoneal membrane

62
Q

when to refer ARF to nephrologist?

A

s/sxs of AKI that have not reversed over 1-2 weeks, no signs of uremia

63
Q

MCC of ATN

A

ischemia, nephrotoxin expsoure

64
Q

exogenous nephrotoxins

A

aminoglycosides, contrast media, cyclosporine and tacrolimus (calcineurin inhibitors)

65
Q

name some aminoglycosides

A

gentamycin, streptomycin, neomycin, amphoteracin B

66
Q

prevention of damage from contrast media

A

hydration, NAC

67
Q

where do cyclosporine and tacrolimus cause damage in the kidney?

A

distal tubule

68
Q

dark brown urine without RBCs

A

rhabodomyolysis

69
Q

endogenous nephrotoxins

A

myoglobin, Hgb, uric acid, bence jones protein

70
Q

transfusion reactions

A

hemoglobinuria

71
Q

chemotheray

A

hyperuricemia

72
Q

bence jones protein

73
Q

True or false: non-oliguria ATN portends a better outcome

74
Q

True or false: any pt with ATN should be referred to nephrology

75
Q

MCC of interstitial nephritis

A

drugs (PCN, cephalosporins, sulfa, NSAIDs, rifampin, phenytoin, allopurinol, PPIs)

76
Q

other causes of interstitial nephritis

A

ID, immunologic disorders

77
Q

Fever, rash, arthralgias, eosinophilia, WBCs, proteinuria

A

intersitital nephritis

78
Q

NSAIDs cause…

A

proteinuria

79
Q

Treatment of interstitial nephritis

A

corticosteroids

80
Q

hypercellular gomerulus and poorly defined capillary loops

A

glomerulonephritis

81
Q

increased mesangial cellularity

A

immune complex ATN

82
Q

causes of immune complex ATN

A

IgA nephropathy, PSGN, endocarditis, lupus, MPGN

83
Q

MCC of late-stage ESRD

A

DM or HTN/vascular disease

84
Q

true or false: in stage 1 CKD the GFR will be normal or increase

85
Q

MC exam finding in CKD

86
Q

other sxs associated with CKD

A

volume overload, ill appearing, decreased MS, asterixis, myoclonus, seizures

87
Q

what lab abnormailites are associated with CKD?

A

hypocalcemia, hyperphosphatemia, hyperkalemia, metabolic acidosis

88
Q

true or false: most CKD pts will die of CV complications before beginning dialysis

89
Q

treatment/management of CKD

A

diuretics, ACE/ARB - watch K levels!, CCBs, BBs, low salt diet

90
Q

name the cardiac complications of CKD

A

CAD, HF, pericarditis, pericardial effusion

91
Q

name the hematological complications of CKD

A

anemia, coagulopathy, hyperkalemia (give loop diuretics)

92
Q

treatment of acid base disorders related to CKD

A

oral sodium bicarb?

93
Q

what meds should be avoided in CKD?

A

phosphorus and Mg, NSAIDs, contrast dye

94
Q

Most progressive form of nephritic disease

95
Q

wire loop lesion of glomerulus

A

lupus nephritis (i)

96
Q

Signs and sxs of nephritic disease

A

edema, HTN, hematuria, proteinuria <3g, cola colored urine

97
Q

how are nephritic spectrum diseases dx?

98
Q

treatment of nephritic spectrum diseases

A

ACE/ARB, corticosteroids

99
Q

Name the nephritic spectrum diseases

A

postinfectious GN, Berger disease, antiglomerular basement membrane GN and goodpasture syndrome, MPGN

100
Q

MCC of postinfectious GN

101
Q

Lab findings of postinfectious GN

A

ASO titers are high, high serum Cr, RBC casts, low serum complement

102
Q

treatment of postinfectious GN

A

anti-hypertensives, Na restriction, diuretics

103
Q

Pathophys of berger disease

A

IgA deposited in glomerular mesangium

104
Q

MC primary glomerular disease worldwide

A

berger disease

105
Q

demographics for berger disease

A

young males

106
Q

clinical findings of berger disease

A

same as nephritic spectrum + normal complement

107
Q

treatment of berger disease

A

monitor annually, ACE/ARB, corticosteroids

108
Q

GN and pulmonary hemorrhage

A

anti-glomerula basement membrane GN and goodpasture syndrome

109
Q

lab findings in anti-glomerular basement membrane GN and goodpasture syndrome

A

lung findings, anti-GBM antibodies, high ANCA, crescent formation on light microscopy

110
Q

treatment of antiGBM GN and goodpasture syndrome

A

plasma exchange, steroids, cyclophosphamide monthly

111
Q

name the 2 types of MPGN

A

type 1: immune, MC, children - can be caused by infection. Type 2: C3 deposition, problems with complement pathway

112
Q

treatment of MPGN

A

cyclophosphamide + steroids

113
Q

which type of MPGN recurs more frequently?

A

Type II - required plasma exchange after transplant

114
Q

MCC of proteinuric renal disease in children

A

minimal change disease

115
Q

name the nephrotic specturm disorders

A

+/- MPGN, minimal change disease, focal segmental glomerulosclerosis

116
Q

true or false: children with MCD are treated without bx

117
Q

effacement of podocyte foot processes

118
Q

treatment of MCD

A

prednisone, cyclophosphamide or cyclosporine

119
Q

what can cause focal segmental glomerulosclerosis

A

heroin, morbid obesity, chronic urinary reflux, HIV

120
Q

dx of focal segmental glomerulosclerosis

121
Q

treatment of focal segmental glomeruloscloerosis

A

diuretics, ACE/ARB, cyclosporine/mycophenolate mofetil, plasmapheresis prior to transplantation

122
Q

true or false: focal segmental glomerulosclerosis has a high rate of relapse after transplantation

123
Q

IgM and C3 seen in sclerotic lesions

124
Q

MCC of ESRD in the US

A

Diabetic nephropathy

125
Q

diabetic pts should be screened for what yeary?

A

microalbuminuria

126
Q

Tx of diabetic nephropathy

A

BP goal of 130/80 or 120/75 in pts with extreme proteinuria, may choose to do a transplant

127
Q

True or false: renal cysts can cause ESRD

128
Q

cysts that develop in these pts have a higher chance of developing renalmalignancy

129
Q

Best imaging to montior cyst size

130
Q

what genes are associated with autosomal dominant PCKD

A

ADPKD1 and ADPKD2

131
Q

signs and sxs of ADPCKD

A

abdominal or flank pain with hematuria, history of UTI and stones, large, palpable kidneys, abdominal mass and HTN, hepatic and pancreatic cysts

132
Q

how is ADPCKD diagnosed?

A

2 or more cysts in pts less than 30, 2 or more in each kidney and 30-59y/o, 4 or more in each kidney in those 60 and older

133
Q

how is ADPCKD evaluated?

A

US then CT if unclear

134
Q

tx of infection d/t ADPCKD

A

quinolones/bactrim

135
Q

what type of stones are seen in ADPCKD?

A

calcium oxalate

136
Q

where do arterial aneurysms occur d/t ADPCKD?

A

circle of willis

137
Q

Tx of ADPCKD

A

renal transplant (not from family member)

138
Q

cardiac complications from ADPCKD

A

MVP, AA, aortic valve abnormalities

139
Q

What is fanconi syndrome?

A

early tubular damage (type II proximal RTA)

140
Q

lab abnormalities seen with MM/fanconi syndrome?

A

hypercalcemia, hyperuricemia

141
Q

Tx of MM/fanconi syndrome

A

fluids, chemo, correct hypercalcemia, +/- plasmaphoresis

142
Q

Isothenuria and hematuria

A

sickle cell disease

143
Q

Microscopic pyuria with sterile urine

144
Q

Gold standard for TB nephropathy

145
Q

where does gout cause damage to the kidney?

A

proximal tubule

146
Q

treatment of gout and kidney involvement

A

allopurinol, febuxostat

The Kidney (1 decks)

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