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[2b] A- step 2 CK > Medicine-Renal > Flashcards

Medicine-Renal Flashcards

1
Q

Classic Presentation for [Renal Cell Carcinoma] (4)

A

RCC looks like HAWF!

[Hematuria PAINLESS (most common)] / [Abd palpable Mass] / [Wt loss] / [Flank Pain]

Scrotal varicoceles are in 10% of pts

L RCC in image

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2
Q

Normal range for PCO2

A

33 - 44 (40 = standard)

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3
Q

List the indications for HemoDialysis - 5

A

AEIOU

Acidosis (HCO3 <10, pH<7.1)

Electrolytes (⇪K>6.5 / Mg / P) or (⬇︎ Ca+)

Intoxication (Alcohols/ASA/Lithium/Anticonvulsants)

Overloaded BADLY with Fluid

Uremia (⇪ NH3-BUN)

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4
Q

What causes Sundowning?-3

Describe Sundowning

Tx?

A

[Alzheimers vs. EtOH withdrawal vs. Delirium] –> Circadian Rhythm dysfunction –> [⬆︎confusion & agitation at Sundown]

Tx = Melatonin

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5
Q

It takes Lungs minutes to compensate for acidosis/alkalosis

How long does it take Kidneys to compensate for respiratory acid-base

A

2 days

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6
Q

What are the 2 main electrolyte SE of Furosemide? ; how do they affect the heart?

A
  1. hypOkalemia which can –>VTach!
  2. hypOmagnesemia which can –>VTach!

High doses of Loop diuretics also cause reversible or permanent hearing loss and/or tinnitus

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7
Q

ADPKD - [Autosomal Dominant Polycystic Kidney Dz]

Describe the Disease - 7

A

ADPKD

Aneurysm (Berry)

Doomed [HTN and MVP]

[PrOteinuria AND Hematuria]

Kidney Failure (Early vs. Late onset) - Hepatomegaly occurs if cystic involvement

Differentation problem = Etx

Image: Renal Ultrasound which = Dx

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8
Q

BUN Normal range

A

7- 18

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9
Q

5 main serum electrolyte changes due to Chronic Kidney Dz

A
  1. ⬆︎ K+
  2. ⬆︎Phosphate
  3. ⬆︎H+
  4. ⬆︎ Mg
  5. DEC Ca+
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10
Q

How does Ethylene Glycol affect Kidneys?

A

EG is converted into oxalate by liver –> binds to Ca+ = retangular envelope shaped Ca+Oxalate crystals –> Tubular damage

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11
Q

Fomepizole MOA and indication

A

Inhibits [Hepatic Alcohol Dehydrogenase] from converting Ethylene Glycol into oxalate ; EG poisoning

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12
Q

What agents induce Renal dysfunction via Afferent Arteriole vasoconstriction-5

A
  1. NSAIDs
  2. Amphotericin B
  3. Cyclosporine
  4. Tacrolimus
  5. Radiocontrast (also causes oxidant injury)
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13
Q

Identify the type of cast and associated Disease

A

Muddy Brown Granular Cast = Acute Tubular Necrosis

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14
Q

Identify the type of cast and associated Disease

A

RBC Cast = Acute Glomerulonephritis

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15
Q

Identify the type of cast ; what 2 Disease is it associated with?

A

WBC Cast = ATiiN (Acute Tubular interstitial nephritis) or Pyelonephritis

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16
Q

Name 4 classes of drugs to cause Fever

A
  1. Anticonvulsants (via Hypersensitivity syndrome)
  2. Abx
  3. Anticholinergics
  4. Sympathomimetic
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17
Q

Hepatorenal syndrome Etx

A

Portal HTN from liver failure –> MASSIVE Splenic ARTERIAL Vasodilation –> ⬇︎BP –> PreRenal AKI that’s NOT RESPONSIVE TO IVF

Type 1 = Rapid / Type 2 = slow

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18
Q

General beta blockers (propranolol) is used to tx what complication of cirrhosis?

A

⬇︎ GastroEsophageal variceal bleeding

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19
Q

List Causes of Anion Gap Metabolic Acidosis-9

A
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20
Q

List Causes of NORMAL-Anion Gap Metabolic Acidosis (NAHA)-7

A
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21
Q

BUN/Cr Ratio values in

Pre

Intrinsic

Post Renal Failure

A
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22
Q

UNa values in

Pre

Intrinsic

Post Renal Failure

A
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23
Q

In a pt w/hematuria, what also in the urine would indicate Glomerular etx specifically?

A

Protein (On Urine Dipstick)

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24
Q

How is Uremia associated w/GI px?

A

Uremia can –> Glanzmann Thromboasthenia (dysfunction of Platelet 2b3a Fibrinogen binding R) –> Bleeding! GI px and ASA avoidance is necessary to prevent GI bleeds

Dx = ⬆︎Bleeding Time // Tx = DDaVP (⬆︎release of vWF)

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25
Q

List Risk Factors for Contrast induced nephropathy; What are the 2 most important?

A

Ctx: SCr > 1.5 or GFR <60

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26
Q

How do you address Contrast induced neprhopathy At-Risk pts, who needs contrast imaging?-4

A
  1. avoid high-concentraton radiocontrast
  2. DC NSAIDs
  3. [0.9% NS IVF] prior to imaging
  4. NAC (N-AcetylCysteine) prior to imaging
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27
Q

MAJOR signs/symptoms of Uremia -6

A
  1. AMS (FATIGUE)
  2. Pericardial Rub
  3. Pruritus
  4. Nausea
  5. Hiccups
  6. Asterixis
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28
Q

List causes of PseudohypOnatremia -2

A
  1. ⬆︎ Lipids (TAG/Chylomicrons)
  2. ⬆︎ Ig
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29
Q

Major causes of [HypOtonic Euvolemic hypOnatremia] -7

A
  1. SIADH (SOLC, Brain CA, Pancreatic CA, Drugs)
  2. Psychogenic
  3. PostOp
  4. hypOthyroid
  5. sick cell reset osmostat (occurs near death)
  6. Beer Potomania (Beer is low in Na, high in free water)
  7. Tea & Toast syndrome
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30
Q

How should you evaluate hypOnatremia?

A
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31
Q

How should you evaluate HYPERNatremia?

A
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32
Q

Normal GFR range

A

90 - 120 mL/min but most labs report > 60

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33
Q

Normal Creatinine Clearance for Men vs Women

A

Men = 97-137

Women = 88-128

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34
Q

Describe the 2 types of Hepatorenal syndrome

A

Type 1: Rapid & Fatal Renal failure triggered by Spontaneous bacterial peritonitis = poor pgn

Type 2:slow renal decline see in refractory ascities

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35
Q

Hepatorenal Syndrome tx -4

A

⬆︎volume to kidneys

1st: Stop Diuretics (Spironolactone, Lasix)
2nd: IV Albumin
3rd: Alternative: Add Octreotide to vasoconstrict splanchnics
4th: Liver transplant

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36
Q

What are the 2 most common causes of Chronic Kidney Disease

A

DM and HTN

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37
Q

Why is a Lipid Panel ordered in CKD pts?

A

Prevent Cardio dz by controlling lipids since CV dz is most common cause of Death in CKD pts

Because of this, also order EKG

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38
Q

What is the significance of Proteinuria in CKD -2

A
  1. Protein filtration worsens Kidney dz
  2. Proteinuria is an indicator of early heart dz in CKD pts
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39
Q

Why is it important to prevent Hyperphosphatemia in CKD pts

A

Elevated Phosphate 2/2 CKD –> ⬆︎ PTH release (2° HyperParathyroid) –> [Renal Osteodystrophy] and Mortality

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40
Q

List causes of Hypertonic hypOnatremia -3

A

Too much OSMOTICALLY ACTIVE substances in extracellular fluid

  1. ⬆︎ Glucose
  2. ⬆︎ Glycerol
  3. Mannitol
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41
Q

Wilms tumor etx

A

proliferation of metanephric blastema –>

HAWF (Hematuria painless/HTN, Abd mass, Wt loss, Fever, Flank Pain)

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42
Q

What are the renal complications of sickle cell TRAIT - 5

A
  1. Painless Hematuria 2/2 papillary necrosis
  2. Inability to concentrate urine (due to vasa recta damage)
  3. Distal Renal Tubular Acidosis
  4. UTI
  5. Renal Medullary CA

Sickle cell trait is a benign condition with Hgb AS that can cause fleeting papillary necrosis

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43
Q

UA for Acute Tubular Necrosis - 3

A
  1. Granular cast
  2. Hematuria
  3. Tubular epithelial cells
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44
Q

UA for Acute interstitial nephritis

A

MANY Eosinophilic WBC Cast!

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45
Q

UA for Acute Glomerulonephritis

A
  1. RBC cast with dysmorphic RBCs
  2. Proteinuria

These pts will also have HTN

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46
Q

What is the earliest renal abnormality in pts diagnosed with DM?

A

Glomerular Hyperfiltration

  • this is also the major pathophys mechanism for gluemrular injury in DM. Hint the reason ACE inhibitors help*
  • Glomerular Hyperfiltration–>Basement membrane thickening –>mesangial expansion –> Kimmelsteil Wilson nodular sclerosis*

⬆︎ urine microalbumin:creatinine is the earliest sign of NEPHROPATHY

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47
Q

What are the 5 different types of renal stones

A
  1. Ca+ stones (oxalate or phosphate)
  2. Uric acid radiolucent stone
  3. Xanthine radiolucent stone
  4. Ammonium Mg phosphate struvite
  5. Cystine hexagonal stones - inherited
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48
Q

Tx for Uric acid radiolucent stone - 3

A
  1. Alkalinize urine with [PO K+ Citrate] or NaHCO3 to > 6.5pH
  2. low purine diet
  3. +/- Allopurinol

You may see uric acid radiolucent stones in tumor lysis syndrome

49
Q

Tx for Ca+ renal stone - 4

A
  1. Hydration ≥2L / day
  2. HCTZ
  3. Na+ dietary ⬇︎
  4. Vit C dietary⬇︎

**Normal Ca+ dietary intake **

50
Q

cp of Alports X-linked Syndrome - 3

A

Can’t Pee, Can’t See, Can’t Hear a buzzing bee

  1. isolated Hematuria AND proteinuria
  2. ocular defects
  3. sensorineural hearing loss

EM = SPLITTING of Glomerular basement membrane with thinning

51
Q

Electron microscopy findings for Alports X-linked Syndrome

A

Can’t Pee, Can’t See, Can’t Hear a buzzing bee

SPLITTING of Glomerular basement membrane with thinning

52
Q

What type of renal effects does IV Acyclovir have? ; Tx?

A

Collecting Duct Crystalline nephropathy with renal tubular obstruction; AGGRESSIVE IVF before and after tx

53
Q

How is Allopurinol used to prevent kidney damage during CA tx?

A

Allopurinol prevents tumor lysis-associated urate crystal nephropathy in pts receiving tx for lymphoma/leukemia

54
Q

Needle shaped crystals on UA indicate what dx?

A

Uric Acid radiolucent stone

55
Q

Normal Post Void Residual for Women

A

< 150 cc

56
Q

Normal Post Void Residual for Men

A

< 50 cc

57
Q

List the differentiating factors for a renal cyst to be classified as Simple? - 6 ; What is mngmt for Simple Renal cyst?

A
58
Q

What type of cast are seen in Nephrotic Syndrome?

A

Fatty

59
Q

What type of cast are seen in Chronic Renal Failure?

A

Waxy broad cast

60
Q

Normal range for Ca+ is 8.4-10.4

What is the mngmt for Asymptomatic Hypercalcemia 10.4 - 14

A

NOTHING. Just avoid worsening factors like dehydration

ALWAYS BE PREPARED TO GIVE IVF FOR HYPERCALCEMIA

61
Q

Normal range for Ca+ is 8.4-10.4

What is the mngmt for Symptomatic OR Hypercalcemia >14 - 3

A
  1. IVF +/- calcitonin
  2. Bisphosphonates for long term
  3. Avoid loop diuretics UNLESS HF is present

Remember that Lung SQC can secrete PTH-related protein and cause Hypercalcemia

ALWAYS BE PREPARED TO GIVE IVF FOR HYPERCALCEMIA

62
Q

What are lab values that diagnose SIADH - 5

A
  1. hypOnatremia
  2. Serum Osmo <275
  3. Urine Osmo >100
  4. Urine Na+ >40
  5. low serum Uric acid
63
Q

Causes of SIADH - 4

A
  1. Intracranial process
  2. SSRIs
  3. NSAIDs
  4. Lung disease in general (especially SOLC) - along with ACTH secretion
64
Q

If renal obstruction is present, what does elevated Creatinine tell you about its laterality?

A

Must be BILATERAL - uL obstruction (i.e. from stone) does not bump creatinine since other Kidney will compensate

65
Q

Major causes of Rhabdomyolysis - 4

A
  1. Immobilization prolonged (direct damage)
  2. Cocaine (direct damage)
  3. Physical restraints
  4. Dehydration

Muscle breakdown –> ⬆︎CPK, ⬆︎K, ⬆︎myoglobin(which causes renal damage when filtered)

66
Q

Which drugs cause renal tubular obstruction from Crystalline nephropathy Acute Tubular Necrosis? - 5

A

These crystals are like SPAMe!

  1. Sulfonamides
  2. Protease inhbitors
  3. Acyclovir IV
  4. Methotrexate
  5. Ethylene Glycol
67
Q

Why is it dangerous to give Nitroprusside to a renal failure pt? ; Tx for this?

A

Nitroprusside’s byproduct, thiocyanate, is renal excreted, especially if infusion is > 24 hours.

Tx = Sodium Thiosulfate

68
Q

cp for Acute Urinary Retention-3 ; What are the risk factors for AUR?-6 ; Dx?

A

urinary retention a/w suprapubic tenderness and agitation

  1. Male
  2. >80 yo
  3. BPH
  4. Cognitive impairment
  5. Surgery
  6. Meds (opioids, anticholinergics)

Dx = Bladder US ≥300cc

69
Q

Pt has Dense Intramembranous C3 deposits in their glomerulus

Diagnosis? ; etx?

A

Membranoproliferative GN type 2 (dense deposit disease); caused by IgG Ab constantly activating the alternative complement pathway

70
Q

What are the 2 major examples of Immune complex-mediated Glomeronephritis

A
  1. SLE
  2. PSGN-PiG
71
Q

Pt has Anti-Glomerular Basement Membrane (GBM) IgG

Diagnosis?

A

GoodPasture syndrome

Glomerulonephritis and Pulmonary hemoptysis

72
Q

pt has Hepatitis C

What renal pathology should you be concerned for? ; cp?-3

A

Cryoglobulinemia

  1. Palpable Purpura
  2. ⬇︎complement
  3. hematuria and proteinuria

HepC is also associated with Porphyria Cutanea Tarda

73
Q

Dx criteria for Nephrotic syndrome -3

A

>3g protein/24 hr + hypOalbumin + edema

74
Q

Minimal change disease is more common in kids

When is it associated with adults? - 2

A
  1. NSAID use
  2. Hodgkin Lymphoma
75
Q

Name the 2 most common Nephrotic syndromes in adults

A

FSGS > Membranous nephropathy(subEpithelial spikes)

76
Q

What are complement levels for IgA Nephropathy?

A

NML

77
Q

Major side effects of Loop Diuretics - 4

A
  1. ⬇︎K+ which –>
  2. metabolic alkalosis
  3. Prerenal AKI
  4. Tinnitus and hearing loss at high doses
78
Q

Tx for uncomplicated cystitis - 3

A

PO abx WITHOUT waiting for cx

  1. Macrobid x 5
  2. Bactrim x 3
  3. Fosfomycin x 1
79
Q

Tx for complicated cystitis

complicated: DM, CKD, Immunocompro, obstruction, failed initial therapy, hospital acquired, indwelling item

A

Urine CX FIRST –> tailored abx (or Levofloxacin PO or CefTriaxone IM while waiting for cx)

80
Q

Which two renal pathologies is analgesic nephrophathy associated with?

A
  1. Tubulointerstitial nephritis
  2. Papillary necrosis
81
Q

Causes of Papillary Necrosis - 5

A

NSAID

  1. NSAIDs
  2. Sickle Cell
  3. Analgesic abuse
  4. Infection from PYELO
  5. DM
82
Q

Why is Succinylcholine contraindicated in conditions like burns or skeletal muscle trauma?

A

Succinylcholine already causes HYPERKalemia

These conditions –> ⬆︎PostSynpatic ACh R –> More Succinylcholiine activity –> FATAL HYPERKalemia

83
Q

In a pt with pyelonephritis, cx are given before empiric abx

When is urological imaging indicated?-4

A
  1. persistent sx after 3 days
  2. hx of nephrolithiasis/obstruction
  3. complicated pyelo
  4. gross hematuria
84
Q

Urine cytology is mostly helpful in diagnosing _____

A

Bladder CA

85
Q

How is chronic constipation related to UTIs?

A

Chronic constipation can –> rectal distension –> compresses bladder –> incomoplete voiding and urinary stasis –> RECURRENT UTIs

86
Q

What is a cystocele? ; cp?-3

A

bladder prlapse into the ANT vaginal wall –>

  1. dyspareunia
  2. urinary sx
  3. vaginal pressure
87
Q

Interstitial Cystitis is also known as ______. Etx?

A

Painful Bladder Syndrome ; idiopathic chronic bladder pain relieved with voiding

can also include dyspareunia and urinary sx. do NOT confuse with a cystocele

88
Q

What condition should you suspect in a PreRenal AKI that does NOT respond to IVF

A

HepatoRenal Syndrome

89
Q

What are the 4 major complications of any NephrOtic syndrome

A

CLag

  1. ⬆︎Coagulation from loss of AT3 (MOST COMMON WITH MEMBRANOUS NEPHROPATHY)
  2. ⬆︎Lipidemia –> Fat oval bodies Maltese crosses in urine
  3. ⬇︎albumin
  4. ⬇︎gammaglobins –> infection
90
Q

Renal Vein Thrombosis is most commonly associated with which nephrOtic syndrome?

A

Membranous nephropathy

Membranous nephropathy is also the most a/w general carcinoma

91
Q

Why do you see abnormal hemostasis in pts with chronic renal failure? ; Tx-3

A

CRF –> UREMIA –> Qualitative PLATELET DYSFUNCTION –> ⬆︎Bleeding Time

Tx = DESMOPRESSIN > Cryoprecipitate or Conjugated Estrogens

92
Q

Why should you not give Platelet transfusion to a pt with uremic-induced abnormal hemostasis

A

THOSE platets will ALSO become dysfunctional and inactivated. Tx of choice = DESMOPRESSIN

93
Q

What is the most common cause of death in Dialysis pts?

A

Cardiovascular disease

This is also the most common COD in Renal Transplant pts

94
Q

Which demographic of pts are at the highest risk of Contrast induced neprhopathy? ; Px if these HAVE to be given Contrast?-2

A

DM pts with elevated baseline creatinine ;

  1. IVF (NS or isotonic HCO3) +
  2. Acetylcysteine

This resolves in 1 week

95
Q

In a pt who has hypovolemic hypernatremia, which fluids should be given for resuscitation?

A

NORMAL saline first and then –> hypOtonic saline once pt is euvolemic

96
Q

How fast can serum sodium be corrected

A

0.5 mEq/dL/hr AND NO MORE THAN 12 mEq/dL/hr

97
Q

DM pts are also at risk for NORMAL anion gap metabolic acidosis

What condition is this from?

A

Type 4 RTA

definitely suspect this if pt has persistent hyperkalemia

98
Q

What type of electrolyte abnormalities are seen in chronic alcoholics? - 3

A

⬇︎MPK

  1. ⬇︎Mg (which can –> ⬆︎renal K+ excretion actually)
  2. ⬇︎K+ (in part from the ⬇︎Mg)
  3. ⬇︎Phosphorous
99
Q

Renal stones of which size require surgical intervention?

A

≥5mm

determined by NC upper abd helical CT

100
Q

Dx? ; etx?

A

Cystine hexagonal renal stones ; inherited amino acid transport impairment –> COAL dibasic amino acids (Cysteine/Ornithine/Arginine/Lysine) accumulation

will have positive urine cyanide nitroprusside test

101
Q

Why are pts with nephrotic syndrome at increased risk for acceleterated Atherosclerosis

A

CLag

⬆︎Lipidemia from loss of lipoproteins

102
Q

What are the risk factors for Focal Segmental Glomerular Sclerosis nephrotic syndrome - 7

A

HASH BPH

  1. HIV
  2. African american
  3. Sickle cell
  4. Heroin
  5. Body builder
  6. ParvoB19
  7. Hispanic
103
Q

What infections are most commonly associated with Membranoproliferative Glomerulonephritis Type 1 - 2

A

Hepatitis B and Hepatitis C

104
Q

tx for Minimal Change Disease

A

CTS

105
Q

What are the effects of Angiotensin II - 3

A
  1. vasoconstrcition
  2. ⬆︎Aldosterone
  3. ⬆︎Na+ reabsorption DIRECTLY
106
Q

Renal transplant dysfunction in the early post operative period has many etiologies

Name them - 5

A
  1. Ureteral obstruction
  2. Vascular obstruction
  3. acute rejection (treat with IV CTS)
  4. cyclosporine toxicity
  5. ATN
107
Q

What type of acid base abnormality is seen in seizure patients?

A

Postictal Lactic Acidosis after a GTC

this is transient and resolves within 90 min

108
Q

When is it ok to use hypertonic 3% saline?

A

symptomatic hypOnatremia ONLY

HA, NV, seizures, weakness

109
Q

What are the side effects of the Thiazide family - 4

A

HyperGLUC

  1. Glucose
  2. Lipids
  3. Uric acid
  4. Calcium
110
Q

Pt has a serum K+ of 5.7

When is it appropriate to start acute therapy (CaGluconate, Insulin with Glucose) for HyperKalemia? - 3

A
  1. EKG changes
  2. K+ ≥7
  3. rapidly rising K+ from tissue breakdown

ONLY give K+ lowering therapy if these are present, otherwise just fix underlying cause

111
Q

Normal range for Serum Osmolality

A

275-295

112
Q

List the EKG changes seen in Hyperkalemia - 3

A
113
Q

In which immune mediated vasculitis disorder are pts at risk for intussuception?

A

Bergers IgA Nephropathy Henoch Scholein Purpura

114
Q

Which glomerular disease (nephrotic or nephritic) is most commonly associated with carcinoma?

A

Membranous Nephropathy

BUT NOTE: MINIMAL CHANGE DISEASE IN ADULTS IS MOST ASSOCIATED WITH HODGKIN LYMPHOMA AND NSAIDS

115
Q

Explain Winter’s Formula

A

COMPENSATED arterial pCO2 should be within +/- 2 of [1.5 x HCO3 + 8]

If not, there is a mixed picture

116
Q

What type of acid base disturbance does TB cause? Why?

A

TB is a common cause of Addison’s primary adrenal insufficiency which –> ⬇︎Aldosterone –> Normal Anion Gap Metabolic Acidosis

117
Q

Explain how determining Tetanus prophylaxis works?

A
118
Q

Active Hepatitis B is a huge risk factor for which glomerular disease?

A

Membranous Nephropathy

119
Q

Hyalinosis of both the afferent and efferent renal arterioles indicates which disease?

A

Diabetic nephropathy

This process happens in mostly the efferent which is why DM pts first develop Glomerular Hyperfiltration

[2b] A- step 2 CK (16 decks)

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