Kirila - DSA

Question 1

3 classes of RTA

Answer 1

Proximal (TYPE 2) = HCO3- reabs. defect
Distal (TYPE 1) = H+ secretion defect
Type 4 = NH3 secretion defect (hyperkalemia, low RAAS, DM, glomerulosclerosis, CKD)

Question 2

High steroid use can cause what?

Answer 2

Cushing’s –> hyperglycemia, immunocompromised, edema

Question 3

Acute kidney injury

Answer 3

Decline in GFR –> electrolyte issues, etc

Question 4

Effective volume depletion

Answer 4

Decreased kidney perfusion for any reason

Question 5

Examples of “effective” volume depletion

Answer 5

• Heart failure –> perfusion decreased

- Vascular dilation (sepsis, etc.) –> perfusion decreased

Question 6

Treatment for PRE-RENAL kidney injury

Answer 6

• Fluid replacement + treat underlying cause

Question 7

BMP vs. CMP

Answer 7

BMP = Na, K, Cl + BUN, Cr
CMP = BMP + liver enzymes, Ca, protein

Question 8

If electolytes or kidney function is altered, what else should be ordered besides a CMP?

Answer 8

Magnesium + CBC

Question 9

Imaging for suspected renal lithiasis

Answer 9

X-ray, Ultrasound (NOT CT)

Question 10

Main complications of acute renal failure (decreased GFR)

Answer 10

• Vascular volume overload
• Hyponatremia, hyperkalemia, hyperMg
• Metabolic acidosis (can’t secrete H+)

Question 11

What to avoid in context of acute renal failure (decreased GFR)?

Answer 11

Magnesium-containing compounds (antacids, etc.)

Question 12

Encephalopathy in acute renal failure

Answer 12

Production of ammonia –> toxic to brain

Question 13

Causes of intrinsic renal failure

Answer 13

• Vascular obstruction
• Glomeruli or microvascular disease
• Acute tubular necrosis (contrast dyes, etc.)
• Tubular nephritis (pyelo, NSAIDs, dyes, drugs)
• Tubular deposition (myeloma)
• Renal graft rejection

Question 14

Calculating GFR (male)

Answer 14

(140 - age) x Wt (kg) / (SCr x 72)

Question 15

Calculating GFR (female)

Answer 15

Male GFR x 0.85

Question 16

Molecular effects of uremia

Answer 16

Decreased transmembrane voltage –> increased cellular Na+ and decreased cellular K+, inhibition of Ca++ influx

Question 17

Whole body effects of uremia

Answer 17

Overhydration of cells, increased vascular volume, malaise, anorexia, N/V/D, hypothermia (less ATP-mediated Na+ transport), K+ deficits in cells, metabolic acidosis

Question 18

How to treat (modestly) uremia?

Answer 18

H2O and NaCl restriction

Question 19

When does potassium become an issue in uremia?

Answer 19

Later - early on, aldosterone can cause K+ secretion

Hyperkalemia –> cardiac arrhythmias, etc.

Question 20

Drugs that can increase serum potassium (to be avoided in uremia)

Answer 20

• Spironolactone, Amiloride

- ACE-inhibitors, Beta-blockers

Question 21

Most common complication of ESRD?

Answer 21

Hypertension - due to renal pathology (primary or systemic)

Question 22

ESRD w/o hypertension…

Think _____

Answer 22

• Salt-wasting renal disease (tubulointerstitial disease)
• Chronic volume depletion
• Currently on anti-HTN medication

Question 23

Associated conditions/symptoms w/ ESRD-HTN

Answer 23

• Pulmonary congestion/edema (increased cap. pressure)
• Pericarditis (metabolic toxins)
• Anemia (decreased EPO, hemolysis in uremia (burst))
• Impaired blood clotting
• Increased infection susceptibility
• Bone weakening

Question 24

High labs in uremia

Answer 24

Potassium, phosphate, uric acid

Question 25

Low labs in uremia

Answer 25

Calcium, albumin, hemoglobin

Question 26

How to treat uremic ESRD / HTN?

Answer 26

- Anti-HTN treatment - Eliminate volume overload (diuretics, intake restriction) - EPO - Phosphate binders (Ca carbonate or acetate) - Restrict K, Kayexalate (K+ binder) - Protein restriction