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MOHD Keystone > Kidney > Flashcards

Kidney Flashcards

1
Q

What are the 2 most effective things you can do to slow the progression of CKD?

A

control BP and proteinuria

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2
Q

Is patient survival greater w/ a kidney transplant or dialysis?

A

transplant

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3
Q

What is the goal BP for a patient w/ CKD? Why is is lower than target BPs for other chronic dzs?

A

130/80

-because CKD is a RF for CVD

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4
Q

What are the 5 stages of CKD along w/ their corresponding GFRs? How long must kidney damage be present in order to qualify for a CKD dx?

A
  1. kidney damage s/ normal or ↑GFR (≥ 90)
  2. kidney damage w/ mildly ↓ GFR (60-89)
  3. moderately ↓GFR (30-59)
  4. severely ↓GFR (15-29)
  5. kidney failure (
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5
Q

What lab values are seen in patients w/ bone and mineral disorders (renal osteodystrophy) assoc. w/ CKD

A
  • ↓ 1,25(OH)2 D3
  • ↓ Ca2+
  • ↑ P
  • ↑ PTH
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6
Q

What are 3 of the major complications assoc. w/ CKD?

A
  • mineral and bone disorders
  • anemia
  • metabolic acidosis
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7
Q

How and who do you screen for CKD?

A

screen for proteinuria in high risk populations (DM & HTN)

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8
Q

If urine dipstick is (-) for proteinuria in a high risk patient (DM, HTN), what should you look for next?

A

microalbuminuria

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9
Q

What are the 2 dietary restrictions that change for a patient when they have CKD vs. ESRD?

A
  • protein intake (↓CKD | ↑ESRD)

- water intake (↑CKD | ↓ESRD)

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10
Q

hypo/hyper- natremia represent disorders of _____ homeostasis

A

water

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11
Q

Which ion is Plasma Osmolality mainly dependent on?

A

Na+

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12
Q

List 3 physiological stimuli for ADH release:

A
  1. ↑ Plasma osmolality (↑ serum [Na+])
  2. ↓ EABV (hypotension, hypovolemia)
  3. Endogenous stimuli (nausea pain)
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13
Q

List 4 etiologies of inappropriate stimuli for ADH release (SIADH):

A
  1. Drugs (SSRIs)
  2. Pulmonary dzs (like anything)
  3. CNS dz (tumor)
  4. malignancies
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14
Q

Would you expect urine osmolality to be high or low in SIADH? What about urine Na?

A

urine Na = urine osm (essentially)

both will be high → goal of ADH is to reabsorb water and [c] the urine

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15
Q

What lab values are consistent w/ true hypovolemic state?

A

Urine Na+

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16
Q

What is the first step in your ddx algorithm when checking for hyponatremia?

A

measure plasma osmolality

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17
Q

What is the first step in your ddx algorithm when checking for hypernatremia?

A

Check urine osmolality

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18
Q

What is the difference b/w central and nephrogenic diabetus insipidous?

A

central: complete lack of ADH
nephro: kidney not responding to ADH

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19
Q

What are the 2 necessary physiologic responses to defend against the development of hypernatremia?

A
  • ADH secretion & response

- thirst

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20
Q

Which urine indices indicate low EABV? Which disorders of sodium balance will you find this in?

A
  • ↓ Urine Na+
  • ↓ FeNa and FeUrea
  • total body sodium deficit →hypovolemic
  • total body sodium excess →2° Na+ retention (d/t low EABV)
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21
Q

Common causes of total body Na+ defecit (3)

A
  1. GI losses
  2. diuretics
  3. aldo deficiency
22
Q

Sole cause of 1° Na+ retention in hypervolemic state

A

renal failure

23
Q

Common causes of 2° Na+ retention in hypervolemic state (3)

A
  1. CHF
  2. liver cirrhosis
  3. nephrotic syndrome
24
Q

Low EABV leads to neurohumoral activation of __(3)___ and Na+ retention

A
  • RAAS
  • SNS
  • ADH
25
Q

proteinuria in nephrotic syndrome is defined as:

A

> 3.5 g

26
Q

RBC casts in the urine (dysmorphic RBCs) indicates

A

nephritic syndrome

27
Q

fatty casts/ lipid droplets in the urine indicates

A

nephrotic syndrome

28
Q

broad waxy casts in the urine indicate

A

chronic GN

29
Q

hematuria + mild proteinuria (

A

nephritic syndrome

30
Q

Hallmark of acute renal failure

A

retention of nitrogenous waste products = azotemia (↑BUN and serum creatinine)

31
Q

Define azotemia:

A

the accumulation of nitrogenous wastes in the blood (BUN and creatinine)

32
Q

Define uremia:

A

ssx renal failure + azotemia

33
Q

What is the first rule of AKI dx?

A

rule out obstruction!

34
Q

Dx eval of post-renal AKI

A

measure post-void residual volume in the bladder via bladder cath
((+) = > 100 mL)

35
Q

Key feature of this type of AKI is the ABSENCE of histological changes in the kidney

A

pre-renal AKI

36
Q

Normal renal response to ↓ perfusion (RBF)

A

maintained afferent arteriole + vasoconstriction of efferent arteriole

37
Q

Which nephritic syndrome is also accompanied by azotemia (type of intra-renal AKI)

A

acute nephritic syndrome (AIN)

38
Q

MC GN

A

IgA nephropathy

39
Q

MC nephrotic syndrome in young adults/ kids

A

minimal change dz

40
Q

MC nephrotic syndrome in black people

A

Focal segmental glomerulosclerosis

41
Q

Which urine indices help you differentiate pre-renal AKI vs AKI d/t ATN?

A
  • FENa (or FEurea if on diuretic)

- Uosm

42
Q

Urine osmolality value range for pre-renal AKI

A

> 500

43
Q

Urine osmolality value range for intrinsic AKI

A

Uosm

44
Q

FeNa (FeUrea) value range for pre-renal AKI

A
45
Q

FeNa (FeUrea) value range for intrinsic AKI

A

> 2-3% (>55%)

46
Q

WBC casts in urine w/o evidence of infx

A

AIN

47
Q

Classic triad of:

-fever, rash, eosinophilia (AKI)

A

AIN

48
Q

urgent Tx of hyperkalemia (esp. w/ EKG changes):

A

IV calcium gluconate

49
Q

How do insulin and sympathetic hormones affect internal K+ balance?

A

push K+ inside the cell –> lower serum K+

50
Q

How do acidosis and hyperglycemia affect internal balance of K+?

A

pull K+ outside the cell –> increase serum K+

MOHD Keystone (6 decks)

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