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Nephrology > MKSAP > Flashcards

MKSAP Flashcards

1
Q

What are the risk factors for development of cyst in a ESRD patient

A

Male with long standing ESRD on HD

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2
Q

Why is screening for cysts important in patients with ESRD?

A

Because of malignant transformation. Screening is based on individual risk vs life expectancy and should be performed using annual renal US.

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3
Q

Medication approved for ADPKD

A

Tolvaptan

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4
Q

Rx of myeloma kidney

A

Bortezomib based chemotherapy + high dose dexamethasone

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5
Q

Why does nephrotic syndrome increase the risk of VTE

A

Increased hepatic production of procoagulants (fibrinogen, 5, 8) and increased loss of renal Anti thrombin 3 and protein S

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6
Q

What is the surrogate marker for increased VTE risk in nephrotic syndrome and what is the cutoff

A

Albumin <2.8

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7
Q

Define BP goal for severe pre-eclampsia

A

> 160/110

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8
Q

Rx of severe pre eclampsia and HELLP

A

BO control and IV magnesium for seizure prophylaxis. Unlike TTP no role for plex and steroids

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9
Q

Preferred Rx for GERD in patients with CKD

A

H2 blockers - dose and frequency adjusted for kidney function

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10
Q

Electrolyte derangement associated with PPI use and the mechanism

A

PPI in a patient with genetic TRMP mutations in Mg channels in GI tract —> GI loss of Mg—> hypo Mag—> persistent opening of K channel in distal nephron (Mg Gaurd K channel) —> K wasting

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11
Q

How do you approach white coat HTN (screen for CV risk, progression to HTN, pharmacotherapy, lifestyle interventions)

A
  1. No evidence of CV benefit with Rx of white coat HTN
  2. Can use screening echo —> LVH warrants Rx
  3. No pharmacotherapy if BP 130-160/80-100
  4. Lifestyle modifications still recommended
  5. 1-5% progress to HTN
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12
Q

Which antacid should be avoided in CKD patients

A

Magnesium based —> increased risk of hyperMg

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13
Q

What are the effects of hyper Mg and above what level are they seen?

A

Blocks K and Ca channels —> reduced neuronal transmission leading to weakness or paralysis —> bradycardia and hypotension.

Typically above >4.8

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14
Q

What is the immidiate and definitive management of hyper Mg

A
  1. Immediate: Iv Calcium gluconate —> rapid reversal of neuronal and CV effects
  2. Definitive : HD
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15
Q

Causes and Evaluation algorithm for NAGMA

A

Causes: hyperCl-, HCO3 loss (renal or GI) and H+ retention (inability of kidney to excrete acid)

Next step: asses kidneys ability to excrete acid by measuring urinary NH3. Urinary NH3 difficult to measure due to short half life —> measure Cl instead —> calculate urinary anion gap: (Na+K) - Cl. Negative AG indicated appropriate acid generation.

If kidneys adequately excreting NH3–> look for GI loss

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16
Q

What are the causes of AIN with fever, rash, eosinophils and without and what is the timeline for development of both

A
  1. With fever, rash, peripheral eosinophilia —> antibiotics, autoimmune, and systemic illness; develops within days
  2. Without the above —> NSAID including celebrex (6-18 months) and PPI (3 months)
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17
Q

Rx of AIN

A
  1. D/C offending meds
  2. Steroids to slow progression
  3. Repeat KFT within 5-10 days after d/c meds —> should improve —> no improvement—> kidney Bx
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18
Q

Proximal RTA losses mnemonic

A

Bicarbonate GAP (glucose, amino acids, phosphorus >5%)

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19
Q

Proximal RTA also known as Fanconj syndrome drug

A

Cyclophosphamide and Ifosfamide

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20
Q

Kidney disease in a young to middle aged male who is migratory agricultural worker from Central America/Asia

A

Chronic interstitial nephritis

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21
Q

Normal osmolarity range

A

279-295

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22
Q

Normal osmolal gap

A

<10

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23
Q

Hormone that regulates osmolarity

A

ADH

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24
Q

Na correction for glucose

A

1.6-2.2 for every 100 increase in glucose

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25
Q

What is isotonic huponatremia

A

Lab artifact due to increased solid phase component of the plasma - MM and hyper TG

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26
Q

Most common drugs associated with hypo Na

A
  1. Antidepressants
  2. Thiazides
  3. Ecstasy
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27
Q

What are the two subdivisions of isovolumic hyponatremia

A
  1. SIADH: kidneys inability to concentrate urine —> resultant Na wasting
  2. Excess water intake/low solute intake
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28
Q

Goal correction of hyperNa

A

10-12

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29
Q

Rx of nephrogenic DI

A

Thiazide diuretics

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30
Q

Rx of lithium related nephrogenic DI

A

Amiloride —> reduced absorption of lithium in CT

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31
Q

EKG changes in hypoK

A

ST depression, decreased T wave amplitude, and increased u wave amplitude

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32
Q

Urine K/Cr ratio indications extra renal losses of K

A

<13

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33
Q

Barter syndrome —- diuretics

A

Loop

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34
Q

Gitlemans syndrome — diuretics

A

Thiazide

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35
Q

Middle syndrome —- excess

A

Aldosterone

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36
Q

EKG findings in hyper K

A

Peaked T and short QT —> wide QRS long PR, loss of P wave —> sone wave pattern

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37
Q

Which antibiotic and another commonly used IP med (analgesic) can cause hyper K

A

TMP and NSIAD

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38
Q

Distal RTA is a manifestation of this common disease

A

DM

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39
Q

I binder in gut

A

Patiomer

40
Q

FePO4 suggesting renal PO4 wasting

A

> 5%

41
Q

Metabolic abnormality cause hypoPO4

A

Respiratory alkalosis

42
Q

Which two electrolyte derangements can cause Carpio pedal spasm and Chvostek sign

A

Ca and Mg

43
Q

Rx of hyper Mg

A

IV CA

44
Q

Iron preparation that causes renal PO4 wasting

A

Ferric carboxymaltose

45
Q

If you check Ca, always check — too

A

Mg

46
Q

What is Mg role in PTH release

A

Supresses

47
Q

GFR cutoff for CIN prophylaxis

A
  1. <30: always
  2. 30-44: based on individual risk factors
48
Q

Therapy for nephrotic syndrome

A
  1. Albuminuria: ACE/ARB
  2. Hyperlipidemia: Statins
  3. Edema: salt restriction and loop diuretics
49
Q

Patient is on max dose of loop diuretics, initially response now failed. Explaination?

A

Loop diuretics —> increased Na delivery to the distal tubules —> hypertrophy of distal cella’s —> counteracting effect of loop diuretics

50
Q

Thee most common causes of CKD

A
  1. DM
  2. HTN
  3. Glomerular diseases
51
Q

Dose of ACE/ARB in DKD

A

Typically to maximal tolerated dose

52
Q

What is finerenone

A

Non steroidal mineralicorticoid receptor antagonist

53
Q

3 classes of Meds used in DKD

A
  1. ACE/ARB
  2. SGLT 2
  3. GLP-1
  4. Finerenone
54
Q

Recommended screening for all patients with membranous nephropathy despite PLAR2 status for ages >65

A

Age appropriate cancer screening

55
Q

Expected rise in Cr after ACE/ARB

A

25-30%

56
Q

4 differentials for Ig deposition in kidneys

A
  1. Amyloid
  2. Multiple myeloma
  3. Waldenstrom macroglobulinemia
  4. MGRS
57
Q

What is Type 1 hypoK distal RTA

A

Inability to excrete H—> compensatory increase in Cl—-> NAGMA —> hypoK—> loss of urine acidification beyond Ph 6

58
Q

What is type 4 hyperK distal RTA

A

Aldosterone deficiency or resistance

59
Q

Stage 2 HTN first line drug

A

Combination of two drugs

60
Q

HTN plus volume overload is a — retentive state

A

Na

61
Q

GFR cutoff for PICC

A

<60

62
Q

Kidney manifestation of IgG4RD

A

CIN

63
Q

Composition of structure stone

A

Magnesium ammonium phosphate

64
Q

How does low Na diet prevent kidney stone formation

A

Ca parallels the excretion of Na and therefore reducing Na will also reduce Ca excretion

65
Q

Diamond urine crystals

A

Utica acid diamonds

66
Q

Coffin shaped crystals

A

Struvite

67
Q

Rhomboid urinary crystals

A

Cal oxalate

68
Q

Mx of resistant HTN by huperaldosteronism without surgery

A

Aldosterone antagonist - spirinolactone or eplerenone

69
Q

HCO3 compensation for chronic respiratory alkalosis

A

10 fall in CO2 —> 5-6 fall in HCO3

70
Q

Urine dipstick identifies —- protein while urine protein Cr ratio identifies —-

A

Albumin only; all proteins

71
Q

Discrepancy in proteinuria on UA dipstick and protein/cr ratio

A

Protein other than albumin —> MM?

72
Q

BP goal in pregnancy

A

140/90

73
Q

Three drugs approved for HTN in pregnant

A
  1. Labetalol
  2. Methyldopa
  3. Nifedipine
74
Q

3 meds approved for HTN in pregnant

A
  1. Labetalol, metoprolol, and pindolol. Atenolol and propranolol cause adverse side effects
  2. Methydopa
  3. Nifedipine
75
Q

Med to be taken at week 12-28 or gestation in patient with HTN

A

Aspirin

76
Q

What are the two mechanisms of rise in Cr

A
  1. Decreased GFR
  2. Decreased tubular secretion with normal GFR
77
Q

Which meds reduce tubular secretion of Cr without affecting GFR

A
  1. HIV: bictegravir and dolutegravir
  2. Trimetoprim
  3. Cimetidine
78
Q

2 criteria for resistant HTN

A
  1. HTN despite three different antihypertensives
  2. BP at goal but requiring more than 4 meds
79
Q

Diuretic more effective in managing HTN

A

Chlorthalidone

80
Q

Define abdominal compartment syndrome

A

Pressure >20 with at-least one organ failure

81
Q

When to initiate HCO3 supplementation in CKD

A

<22

82
Q

Define pre-eclampsia

A

New onset HTN after 20 weeks of pregnancy with either proteinuria (>300) or evidence of end-organ dysfunction: neurological, pulm edema, liver, kidney injury, thrombocytopenia

83
Q

Define abdominal compartment syndrome

A

I yea-abdominal pressure >20 with atleast one organ dysfunction

84
Q

Serum value that is more sensitive than Cr in estimating GRF in patients with altered muscle mass

A

Serum cystatin C

85
Q

Which drug crystallizes in the tubules causing intraabdominal renal obstruction

A

Acyclovir —> needle shaped crystals

86
Q

How to manage acyclovir induced kindey stone formation

A

Aggressive fluid resuscitation during acyclovir therapy

87
Q

Immunosupression for lupus nephritis safe during pregnancy

A

Tacrolimus and cyclosporine

88
Q

Gingival Side effect of cyclosporine

A

Gingival hyperplasia

89
Q

Initial therapy for African Americans with HTN

A

CCB or thiazides

90
Q

In addition to ACE/ABR and NSAIDs, which other medication impairs renal blood flow causing pre-renal AKI

A

Calcineurin inhibitors

91
Q

Definitive Rx of HRS

A

Transplant

92
Q

Conditions associated with isosthenuria

A
  1. Sickle cell disease
  2. Iron overload
93
Q

Lab required to make a diagnosis of iron deficiency in presence of CKD

A

Transferrin saturation. Ferretin alone not diagnostic

94
Q

Fistula associated heart failure characteristic diagnostic feature

A

Elevated right heart pressure with preserved EF

95
Q

Bowel regimen in CKD patient

A

Don’t give phosphate based enema

96
Q

Up trending Cr with Bactrim use

A

Proximal tubular secretion increased

97
Q

Which laxatives to avoid in CLD

A

Magnesium based

Nephrology (1 decks)

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