Kidney Flashcards
1
Q
azotemia
A
retention of creatinine
2
Q
first step in urine formation
A
glomerular filtration
3
Q
How are casts shaped?
A
in the form of the nephron they originate in
4
Q
Heavy protein and lipiduria
A
nephrotic syndrome
5
Q
hematuria and proteinuria
A
glomerulonephritis
6
Q
pigmented casts and renal tubular cells
A
acute tubular necrosis
7
Q
WBCs, RBCs, and protein
A
interstitial nehritis or pyelonephritis
8
Q
how much protein in the urine indicated glomerular origin of disease?
A
> 1g
9
Q
Functional proteinuria
A
<1g
10
Q
examples of overload proteinuria
A
bence jones protein, myoglobinuria, hemoglobinuria
11
Q
increased filtration of proteins, effacement of epithelial cell foot processes
A
glomerular proteinuria
12
Q
faulty reabsorption in the proximal tubule
A
tubular proteinuria
13
Q
how much protein indicates nephrotic range?
A
> 3.5g
14
Q
dx of hematuria
A
3 red cells per HPF on 2 occasions
15
Q
normal GFR
A
150-250 (worry when it hits 60)
16
Q
What can cause normal or increased GFR?
A
hyperfiltration, disease at a different site in the nephron, interstitium, or vascular supply
17
Q
GFR estimation equation
A
C = (UxV)/P
18
Q
True or false: creatinine production and excretion are equal in normal states
A
true
19
Q
Cockcroft Gault formula
A
((140-age) x weight)/(Pcr x 72)
20
Q
What should CrCl be multiplied by in women?
A
0.85
21
Q
when is GFR overestimated?
A
obese, edematous pts
22
Q
CrCl is most accurate with a BSA of _____
A
1.73
23
Q
Where is BUN synthesized?
A
liver
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
25
Normal BUN:creat
10:1
26
BUN:creat in someone volume depleted
20:1
27
What is an accurate depiction of GFR?
avg of the creatinine clearance and urea clearance
28
absolute contraindications to kidney biopsy
bleeding disorder not corrected, uncontrolled HTN, renal infection, renal neoplasm, hydronephrosis, uncooperative pt
29
when will creatinine respond to acute renal failure?
when 50% of kidney function is lost
30
Risk category
Creatinine increased 1.5 times, 0.5 ml of urine for 6 hours
31
Injury category
Creatinine increase 2 times, 0.5 ml or urine for 12 hours
32
Failure category
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
33
Loss category
loss of kidney function for 4 wks
34
ESRD category
need for renal transplant therapy for 3 months
35
MCC of CA-acute renal failure
prerenal
36
MCC of HA-acute renal failure
ATN
37
what type of ARF has a higher mortality rate?
Hospital acquired
38
MCC of death due to ARF
sepsis and cardiopulmonary failure
39
describe prerenal ARF
volume depletion, vasodilation, tubular and glomerular function are maintained
40
describe intrinsic ARF
vasoconstriction, decreased renal perfusion
41
MCC of intrinsic ARF
ATN/AKI
42
True or false: pstrenal ARF must be bilateral
true
43
how much CO do the kidneys receive?
25%
44
causes of prerenal ARF
pancreatitis, CHF, hepatic failure, the usual
45
Treatment of prerenal ARF
fluids +/- dopamine
46
causes of intrinsic ARF
Cardiac arrest, sepsis, systemic HOTN or ischemia, rhabdomyolysis, glomerulonephritis, interstitial nephritis, renal artery occlusion, pulmonary-renal syndromes
47
treatment of intrinsic ARF
furosemide or mannitol (not if anuric) + dopamine
48
how to dx postrenal ARF
US with doppler
49
what will a BMP of ARF show?
acidosis and hyperkalemia
50
How is intrinsic ARF confirmed?
renal biopsy
51
What type of imaging is used to evaluate ARF
non contrast CT
52
urine sodium <40, high urine Cr: serum Cr ratio and Serum urea: Serum Cr ratio
prerenal ARF
53
urine sodium >40
instrinsic ARF
54
what artery and vein are used for an AV fistula for hemodialysis?
brachiocephalic and radiocephalic
55
when are AV grafts useful?
when vessels can't tolerate high flows
56
What is used for semi-emergent dialysis or when the fistula is maturing?
Hickman tunneled catheter
57
True or false: a bruit SHOULD be heard over an AV fistula
true
58
Tx of thrombosis of AV fistula
angioplasty
59
steal syndrome
shunting of blood flow from the artery to the vein
60
more than 20% of CO is diverted through an access
high output heart failure
61
blood-dialysate interface
peritoneal membrane
62
when to refer ARF to nephrologist?
s/sxs of AKI that have not reversed over 1-2 weeks, no signs of uremia
63
MCC of ATN
ischemia, nephrotoxin expsoure
64
exogenous nephrotoxins
aminoglycosides, contrast media, cyclosporine and tacrolimus (calcineurin inhibitors)
65
name some aminoglycosides
gentamycin, streptomycin, neomycin, amphoteracin B
66
prevention of damage from contrast media
hydration, NAC
67
where do cyclosporine and tacrolimus cause damage in the kidney?
distal tubule
68
dark brown urine without RBCs
rhabodomyolysis
69
endogenous nephrotoxins
myoglobin, Hgb, uric acid, bence jones protein
70
transfusion reactions
hemoglobinuria
71
chemotheray
hyperuricemia
72
bence jones protein
MM
73
True or false: non-oliguria ATN portends a better outcome
true
74
True or false: any pt with ATN should be referred to nephrology
true
75
MCC of interstitial nephritis
drugs (PCN, cephalosporins, sulfa, NSAIDs, rifampin, phenytoin, allopurinol, PPIs)
76
other causes of interstitial nephritis
ID, immunologic disorders
77
Fever, rash, arthralgias, eosinophilia, WBCs, proteinuria
intersitital nephritis
78
NSAIDs cause...
proteinuria
79
Treatment of interstitial nephritis
corticosteroids
80
hypercellular gomerulus and poorly defined capillary loops
glomerulonephritis
81
increased mesangial cellularity
immune complex ATN
82
causes of immune complex ATN
IgA nephropathy, PSGN, endocarditis, lupus, MPGN
83
MCC of late-stage ESRD
DM or HTN/vascular disease
84
true or false: in stage 1 CKD the GFR will be normal or increase
true
85
MC exam finding in CKD
HTN
86
other sxs associated with CKD
volume overload, ill appearing, decreased MS, asterixis, myoclonus, seizures
87
what lab abnormailites are associated with CKD?
hypocalcemia, hyperphosphatemia, hyperkalemia, metabolic acidosis
88
true or false: most CKD pts will die of CV complications before beginning dialysis
true
89
treatment/management of CKD
diuretics, ACE/ARB - watch K levels!, CCBs, BBs, low salt diet
90
name the cardiac complications of CKD
CAD, HF, pericarditis, pericardial effusion
91
name the hematological complications of CKD
anemia, coagulopathy, hyperkalemia (give loop diuretics)
92
treatment of acid base disorders related to CKD
oral sodium bicarb?
93
what meds should be avoided in CKD?
phosphorus and Mg, NSAIDs, contrast dye
94
Most progressive form of nephritic disease
RPGN
95
wire loop lesion of glomerulus
lupus nephritis (i)
96
Signs and sxs of nephritic disease
edema, HTN, hematuria, proteinuria <3g, cola colored urine
97
how are nephritic spectrum diseases dx?
biopsy
98
treatment of nephritic spectrum diseases
ACE/ARB, corticosteroids
99
Name the nephritic spectrum diseases
postinfectious GN, Berger disease, antiglomerular basement membrane GN and goodpasture syndrome, MPGN
100
MCC of postinfectious GN
GABHS
101
Lab findings of postinfectious GN
ASO titers are high, high serum Cr, RBC casts, low serum complement
102
treatment of postinfectious GN
anti-hypertensives, Na restriction, diuretics
103
Pathophys of berger disease
IgA deposited in glomerular mesangium
104
MC primary glomerular disease worldwide
berger disease
105
demographics for berger disease
young males
106
clinical findings of berger disease
same as nephritic spectrum + normal complement
107
treatment of berger disease
monitor annually, ACE/ARB, corticosteroids
108
GN and pulmonary hemorrhage
anti-glomerula basement membrane GN and goodpasture syndrome
109
lab findings in anti-glomerular basement membrane GN and goodpasture syndrome
lung findings, anti-GBM antibodies, high ANCA, crescent formation on light microscopy
110
treatment of antiGBM GN and goodpasture syndrome
plasma exchange, steroids, cyclophosphamide monthly
111
name the 2 types of MPGN
type 1: immune, MC, children - can be caused by infection. Type 2: C3 deposition, problems with complement pathway
112
treatment of MPGN
cyclophosphamide + steroids
113
which type of MPGN recurs more frequently?
Type II - required plasma exchange after transplant
114
MCC of proteinuric renal disease in children
minimal change disease
115
name the nephrotic specturm disorders
+/- MPGN, minimal change disease, focal segmental glomerulosclerosis
116
true or false: children with MCD are treated without bx
true
117
effacement of podocyte foot processes
MCD
118
treatment of MCD
prednisone, cyclophosphamide or cyclosporine
119
what can cause focal segmental glomerulosclerosis
heroin, morbid obesity, chronic urinary reflux, HIV
120
dx of focal segmental glomerulosclerosis
biopsy
121
treatment of focal segmental glomeruloscloerosis
diuretics, ACE/ARB, cyclosporine/mycophenolate mofetil, plasmapheresis prior to transplantation
122
true or false: focal segmental glomerulosclerosis has a high rate of relapse after transplantation
true
123
IgM and C3 seen in sclerotic lesions
FSGS
124
MCC of ESRD in the US
Diabetic nephropathy
125
diabetic pts should be screened for what yeary?
microalbuminuria
126
Tx of diabetic nephropathy
BP goal of 130/80 or 120/75 in pts with extreme proteinuria, may choose to do a transplant
127
True or false: renal cysts can cause ESRD
true
128
cysts that develop in these pts have a higher chance of developing renalmalignancy
dialysis
129
Best imaging to montior cyst size
US
130
what genes are associated with autosomal dominant PCKD
ADPKD1 and ADPKD2
131
signs and sxs of ADPCKD
abdominal or flank pain with hematuria, history of UTI and stones, large, palpable kidneys, abdominal mass and HTN, hepatic and pancreatic cysts
132
how is ADPCKD diagnosed?
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
how is ADPCKD evaluated?
US then CT if unclear
134
tx of infection d/t ADPCKD
quinolones/bactrim
135
what type of stones are seen in ADPCKD?
calcium oxalate
136
where do arterial aneurysms occur d/t ADPCKD?
circle of willis
137
Tx of ADPCKD
renal transplant (not from family member)
138
cardiac complications from ADPCKD
MVP, AA, aortic valve abnormalities
139
What is fanconi syndrome?
early tubular damage (type II proximal RTA)
140
lab abnormalities seen with MM/fanconi syndrome?
hypercalcemia, hyperuricemia
141
Tx of MM/fanconi syndrome
fluids, chemo, correct hypercalcemia, +/- plasmaphoresis
142
Isothenuria and hematuria
sickle cell disease
143
Microscopic pyuria with sterile urine
TB
144
Gold standard for TB nephropathy
urine cx
145
where does gout cause damage to the kidney?
proximal tubule
146
treatment of gout and kidney involvement
allopurinol, febuxostat
