MKSAP Nephro I Flashcards
Guidelines recommend treatment of metabolic acidosis with alkali therapy in patients with chronic kidney disease when the serum bicarbonate is chronically less than ____.
<22 mEq/L (22 mmol/L).
Monoclonal gammopathy of RENAL significance is diagnosed in patients who would otherwise meet the criteria for MGUS but have an abnormal urinalysis and kidney insufficiency; ____confirms the diagnosis.
kidney biopsy
Antiproteinuric therapy with an ____ is the hallmark and most validated treatment strategy for IgA nephropathy.
ACEI/ARB
Isovolemic hypotonic hyponatremia associated with urine osmolality ____ indicates excessive water intake, as seen with psychogenic polydipsia or poor solute intake.
<100 mOsm/kg H2O
What is Diabetes Insipidus?
- lack of ADH for pituitary (central)
- or kidney resistance to ADH (nephrogenic)
Without antidiuretic hormone, excessive water is urinated out. Na is usually normal though can be elevated in people without access to water.
___ can be used to help prevent calcium oxalate stones in patients with chronic diarrhea and malabsorption.
Potassium citrate
A diagnosis of ____ is suggested by the constellation of anemia, hypercalcemia, normal anion gap metabolic acidosis, and acute kidney injury.
multiple myeloma (HCTZ and milk alkali syndrome both present with metabolic alkalosis)
Management of ethylene glycol toxicity in the context of organ-specific toxicity, severe acidemia, or very large ingestions includes (3)
- aggressive fluid resuscitation
- fomepizole
- hemodialysis
The initial step in the management of newly diagnosed membranous glomerulopathy is to evaluate for secondary forms of the disease, which account for approximately 25% of cases. Secondary causes include (4)
- HBV/HCV
- lupus
- syphilis
- malignancy (esp pts >65 yo)
DI is diagnosed with simultaneous laboratory evidence of inability to concentrate urine (urine osmolality ____ ) in the face of elevated serum sodium and osmolality.
<300 mOsm/kg H2O
If necessary, a water deprivation test can confirm the diagnosis. A response to exogenous ADH would support a diagnosis of central DI, whereas a lack of response is seen in nephrogenic DI.
Treatment is with desmopressin.
Hypoaldosteronism can be caused by ___ (4) can cause hyperkalemia, especially in patients with chronic kidney disease or diabetes mellitus, or in those taking an ACE inhibitor or angiotensin receptor blocker.
- heparin
- inhibitors of the renin-angiotensin system
- type 4 renal tubular acidosis
- primary adrenal disease
Start combination therapy with two first-line antihypertensive drugs of different classes for adults with stage 2 hypertension defined as BP > ______ and an average BP of _____ mmHg above BP target.
140/90 mmHg, 20/10 mmHg
What is typically characterized by a vasculitic prodrome of malaise, arthralgia, myalgia, and skin findings; hematuria, proteinuria, and acute kidney injury?
ANCA-associated glomerulonephritis (leading to RPGN)
A kidney biopsy will confirm the diagnosis.
What are the three immunofluorescence findings seen on kidney biospy?
- pauci immune staining (i.e. ANCA-associated
glomerulonephritis) - granular staining (lupus nephritis)
- linear staining (anti-glomerular basement membrane glomerulonephritis)
What causes AMS, increased anion gap in a patient receiving APAP on a chronic basis in the setting of critical illness, poor nutrition, liver disease, CKD, or a strict vegetarian diet.
Pyroglutamic acidosis
Diagnosis can be confirmed by measuring urine levels of pyroglutamic acid.
