MKSAP STOCK4 Flashcards
What is the pneumococcal immunization strategy in patients with chronic kidney disease
Vaccination with both the 13-valent pneumococcal conjugate AND the 23-valent pneumococcal polysaccharide vaccines
What is the diagnosis for abdominal pain, palpable purpura, athralgia, and glomerulonephritis with NORMAL complement levels
IgA vasculitis
What is the cancer risk in Balkan Endemic Nephropathy
Increased risk of transitional cell (urothelial) carcinoma of the renal pelvis, ureters, and bladders
This is the preferred drug class for CKD with proteinuria
ACE inhibitor or ARB
What is the syndrome involving fluid and electrolyte shifts resulting from nutritional rehabilitation of severely malnourished patients?
Refeeding Syndrome
Dx test of choice for evaluating suspected nephrolithiasis in pregnant pt
US
What is a cause of hypokalemia associated with hypovolemia, metabolic alkalosis, increased urine potassium excretion and DECREASED urine chloride excretion
Vomiting (losing Cl via gut so want to preserve in urine)
What are two imaging options for suspected nephrolithiasis?
Ultrasound; Non contrast CT
What are two metabolic complications commonly associated with immunosuppressive medications used in kidney transplantation?
Diabetes Mellitus; Dyslipidemia
What are the two most common causes of death in patients with ESRD?
Cardiovascular Dz, infection
What is the supposed chronic kidney disease associated with PPIs?
Chronic Tubulointerstitial Kidney Dz
What is the recommended monitoring of patients with isolated hematuria and a family history of hematuria?
Periodic measurement of kidney function and urine protein
What are two recommended mgmt interventions for DM nephropathy?
Adequate control of BP; Use of an ACE inhibitor or angiotensin receptor blocker
What are two distinguishing clinical features of membranous glomerulopathy?
Nephrotic Syndrome; Thromboembolic events (renal vein thrombosis)
What is the primary mgmt of drug-induced acute interstitial nephritis
Stop the offending medication
What is the clinical presentation, urine findings, and FENA associated with aminoglycoside-induced nephrotoxicity?
Nonoliguric acute tubular necrosis; granular casts in the urine sediment; and FENA >1
What acid base disorder is associated with opioid overdose
Primary Respiratory Acidosis
What are two characteristics of urine microscopic findings that are associated with glomerular hematuria?
Dysmprphic erythrocytes; erythrocyte casts
What is the initial fluid mgmt of chronic asymptomatic hyponatremia due to SIADH?
Fluid restriction without sodium restriction (liberalize salt in diet)
What is the mechanism of injury associated with anti-glomerular basement membrane disease?
Antibodies directed against the noncollagenous domain of type IV collagen
What is the diagnosis associated with hyperkalemia, a normal anion gap metabolic acidosis, and a urine pH <5.5
Type IV (Hyperkalemic Distal) renal tubular acidosis
What is the treatment for class III and class IV lupus nephritis?
Combination immunosuppression therapy (glucocorticoids and cyclophosphamide)
What obesity drug is associated with acute oxalate nephropathy?
Orlistat
What condition is associated with hypovolemia, metabolic alkalosis, and increased concentrations of urine sodium and chloride?
Diuretic Use
What is the characteristic urinalysis finding in renal amyloidosis?
Proteinuria; often nephrotic range (>5 g)
What are two screening tests for patients with risk for CKD?
Obtain eGFR (BMP); urine testing for protein/cr ratio or albumin/cr ratio
What is the recommended treatment approach for elderly patients with ESRD and a high burden of comorbid conditions and poor functional status
Nondialytic therapy (palliative care)
What is the BP goal for patients under 60 according to JNC 8?
BP <140/90
What is the renal syndrome associated with abnormal tubular handling of glucose, amino acids, uric acid, phosphate, and bicarbonate?
Fanconi Syndrome
What are two vascular endothelial growth factor inhibitors linked to thrombotic microangiopathy?
Bevacizumab and Sunitinib
What is the condition associated with bone pain, hypophosphatemia, low 1,25 vitamin D and normal 25 vitamin D
Oncogenic Osteomalacia
Name 3 conditions that may cause abdominal compartment syndrome
Abdominal surgery, massive fluid resuscitation, liver or pancreatic disease with large volume ascites
What is a common cause of decreased serum creatinine in the elderly in the absence of any change in kidney function
Low muscle mass
What are the two highest cancer risks in kidney transplant patients?
Squamous Cell Carcinoma of the skin; Post-Transplant Lymphoproliferative Disorder (PTLD)
What is the mechanism of serum creatinine elevation in patients taking trimethoprim?
Decreasd creatinine secretion (NO CHANGE IN GLOMERULAR FILTRATION RATE)
What is the UA finding that distinguishes hemoglobinuria from hematuria?
Absence of erythrocytes (seen in myoglobinuria)
What is the diuretic choice for resistent HTN in patients with stage >4 CKD?
Loop Diuretic
What is the initial step in the mgmt of infection-related glomerulonephritis?
Treat the underlying infection
What are THREE indications for mechanical kidney stone removal?
Large Stone >10 mm; Failed medical mgmt; or complicated nephrolithiasis (i.e. urosepsis, acute kidney injury, anuria, refractory pain)
What is the ESSENTIAL drug class in the treatment of resistant hypertension?
Diuretics
What makes a diagnosis of chronic HTN in a pregnant patient?
Development of HTN prior to the 20th week of gestation
What is the JNC 8 HTN goal for HTN in CKD
BP <140/90 with an ACE or ARB
What is the glomerular disease characteristically associated with HIV infection
Focal Segmental Glomerulosclerosis (Collapsing Variant)
What condition is characterized by persistent hematuria, normal kidney function, and positive family history of hematuria WITHOUT renal failure?
Thin Glomerular Basement Membrane Disease
What are three findings associated with infection-related glomerulonephritis?
Nephritic Syndrome; Low C3 levels; Normal C4 levels
What is the reduction of serum sodium for every 100 mg/dL increase in plasma glucose above 100?
1.6 (So if glucose is 300, the Na is actually about 3 higher)
What is the condition characterized by impaired excretion of hydrogen ions in the DCT
Type I (Hypokalemic Distal) Renal Tubular Acidosis
What are three interventions for chronic mgmt of uric acid nephrolithiasis?
Increase urine output (fluids); Alkalinization of urine; Xanthine oxidase inhibitors (allopurinol)
What is the necessary study to diagnose type of glomerulonephritis?
Kidney Bx
Cause of diarrhea, MAHA, thrombocytopenia, and kidney failure
Shiga Toxin related HUS
What are three conditions that predispose to alcoholic ketoacidosis
Chronic Alcohol abuse, liver disease, and acute intoxication
What are two drug classes that are recommended by JNC 8 for treating HTN in patients with CKD and DM
Either an ACE inhibitor or an ARB
What are two electrolyte changes associated with NSAID use?
Sodium Retention, Hyperkalemia
What Acid-Base abnormality may occur in patients with short-bowel syndrome?
D-lactic acidosis
This is the management of prehypertension
Lifestyle modification and annual blood pressure determinations
What is the recommended kidney imaging modality in patients with CKD
Ultrasound
What is the strongest nonmodifiable predictor of the development of acute kidney injury after cardiac surgery?
Pre-existing chronic kidney disease
What are two types of kidney disease associated with elevated IgG4 levels
IgG4 related interstitial nephritis; Retroperitoneal fibrosis
Tx for patients with enteric hyperoxaluria and calcium oxalate stones?
Bile Salt Binders
What ambulatory blood pressure threshold for initiating pharmacologic therapy?
>135/85
What is the mgmt of struvite nephrolithiasis
Stone removal
What are 4 diagnostic criteria for SIADH
Hypo-osmolar hyponatremia, Euvolemia, Urine osmolality inappropriately greater than plasma osmolality, no other obvious cause (Addision, Hypothyroid)
Intervention that reduces the risk for contrast-induced nephropathy
IV NS
What is the acid-base disorder associated with laxative abuse?
Normal Anion Gap Metabolic Acidosis
What is the renal replacement modality preferred for critically ill, unstable patients in acute kidney injury
Continuous Renal Replacement Therapy
What is the cancer risk associated with acquired cystic kidney disease?
RCC
What are two drug classes that are recommended by JNC 8 for treating HTN in patients with CKD but WITHOUT DM
Same as if they had DM; ACE inhibitor or ARB
What are two treatment goals for cardiorenal syndrome?
Improve cardiac function and fluid balance
What fractional excretion test diagnosis prerenal AKI in patients taking diuretics?
FeUrea
At what CKD stage is referral to a nephrologist appropriate?
Stage G4 or G5
