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Nephro > MTB 2 > Flashcards

MTB 2 Flashcards

1
Q

Alport Syndrome
Defect in?
Presentation?
Tx?

A

Collagen - Type IV
Sensorineural hearing loss
Visual disturbance - collagen loss for lens of eye
No therapy

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2
Q

Polyarteritis Nodosa
Pathophys
Ass’d with

A

Systemic vasculitis - small and medium arteries
MC affect kidney
Spare the lung
Ass’d with Hep B

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3
Q

PAN Presentation

Organ systems involved

A

GN +
Nonspecific sx’s = fever, malaise, weight loss, myalgias, arthralgia over wks to months
GI = Abd pain, bleeding, N/V. Pain worse w eating
Neuro: Vasc damage around big peripheral nerves = neuropathy of peroneal, ulnar, radial, brachial
Mononeuritis multiplex
Stroke in young person
Skin: Purpura and petechiae; digital gangrene, livedo reticularis
Cardiac Dz = 1/3 of pts

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4
Q

Livedo Reticularis seen in

A

Atheroemboli of kidney

PAN

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5
Q

Tests for PAN

A

Anemia, leukocytosis
High ESR and CRP
ANA and RF sometimes

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6
Q

Most accurate diagnostic test PAN

A

BX of symptomatic site

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7
Q

TX for PAN

A

Cyclophosphamide + Prednisone

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8
Q

Best initial test for PAN

A

Angiograpy shows aneurysmal dilation

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9
Q

Presentation of Lupus Nephritis

A

Any degree of renal involvement
Kidneys - normal or mild, asymptomatic proteinuria
Severe = Membranous GN
Long standing scars = Glomerulosclerosis

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10
Q

Most accurate test for Lupus nephritis

A

Kidney Bx

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11
Q

TX for Lupus nephritis
Mild
Severe, proliferative

A

Mild - glucocorticoids

Severe - Glucocorticoids + Cyclophosphamide or Mycophenolate

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12
Q

MOA of Mycophenolate

A

Inhibits enyzme needed for T and B cells to grow
Immunosuppresant
Used in RA

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13
Q

DDX for large kidneys seen on sonogram and CT scan

A

PKD
Amyloid
HIV nephropathy
Diabetes

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14
Q

Amyloidosis ass’d with

A 
Abnormal protein production
Myeloma
Chronic Inflammatory Dz
Rheumatoid Arthritis 
IBD
Chronic Infxn
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15
Q

Most accurate test for Amyloidosis

A

Bx shows green birefringence with Congo Red stain

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16
Q

TX for Amyloidosis

A

Tx underlying dz

Melphalan + Prednisone

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17
Q

Massive proteinuria leads to

A

Nephrotic syndrome

  • Edema
  • Hyperlipidemia
  • Thrombosis = urinary loss of Protein C, protein S, antithrombin
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18
Q

Nephrotic syndrome ass’d with Cancer of solid organ

A

Membranous

- Breast, Lung, Colon, Prostate

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19
Q

Nephrotic syndrome ass’d with Hep B

A

Membranous

Membranoproliferative

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20
Q

Nephrotic syndrome ass’d with SLE

A

Membranous

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21
Q

Nephrotic syndrome ass’d with Hodgkins Lymphoma

A

Minimal Change

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22
Q

Nephrotic syndrome ass’d with Children

A

Minimal Change

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23
Q

Nephrotic syndrome ass’d with IVDA and AIDS

A

Focal Segmental

24
Q

Nephrotic syndrome ass’d with African Americans and Hispanics

A

Focal Segmental

25
Q

Best initial test for Nephrotic syndrome

A

UA

  • Good for amt of protein over 24 hrs
  • Albumin/Creatinine = average protein produced over 24 hrs
26
Q

Most accurate test for Nephrotic syndrome

A

Renal BX

27
Q

What are maltese crosses and when do we see them

A

Lipid deposits in sloughed off tubular cells
Fatty cast
Nephrotic syndrome

28
Q

Labs of Nephrotic syndrome

A

Hyperproteinuria
Hypoproteinemia
Hyperlipidemia = loss of lipoproteins
Edema

29
Q

Best initial TX for Nephrotic syndrome

A 
Glucocorticoids
No response after weeks = cyclophosphamide
ACE/ARBs 
Edema = salt restriction + diuretics
HyperLipidemia = statins
30
Q

Presentation of Uremia

A 
Metabolic Acidosis 
Fluid overload
Encephalopathy
Hyperkalemia
Pericarditis
31
Q

Manifestations of renal failure

A

Anemia = loss of EPO
Hypocalcemia = no 1,25-OH Vit D to absorb calcium from gut
Osteodystrophy = secondary hypoPTH from low Calcium
Bleeding = platelets do not work in uremic environment b/c can’t degranulate
Infxn = neutrophils don’t work well - can’t degranulate
Pruritis
Hyperphosphatemia
Hypermagnesemia
Atherosclerosis and HTN
Endocrinopathy - Men have low testosterone, ED. women are anovulatory

32
Q

When do we use EPO as TX

A

Anemia from ESRD is the ONLY time

33
Q

What is winter’s formula

A

pCO2 = 1.5 (HCO3) + 8

34
Q

TX for hyperphosphatemia

A 
Oral Phosphate Binders
Calcium acetate
Calcium carbonate
Sevalamer
Lanthanum
35
Q

Which phosphate binders do we never use? Why?

A

Aluminum containing

Cause dementia

36
Q

Assn’s with TTP

A

HIV
Cancer
Drugs = cyclosporine, ticlopidine, clopidogrel

37
Q

HUS ass’d with

A

Children
E.Coli 0157:H7
Shigella

38
Q

TTP/HUS Presentation

A

Intravascular hemolysis
Renal insufficiency
Thrombocytopenia

39
Q

What does TTP/HUS look like on smear?

A

Schistocytes
Helmet cells
Fragmented RBCs

40
Q

TTP ass’d with

A

Neuro sx’s

Fever

41
Q

TX for TTP/HUS

A 
HUS = resolves on own
TTP = emergent Plasmapheresis or infusion of FFP
42
Q

When do we use steroids in TTP/HUS

A

Never.

43
Q

MCC of death in PCKD

A

Renal Failure from recurrent pyelonephritis and nephrolithiasis episodes = scarring, loss of renal function

44
Q

Assn’s with PCKD

A

Liver cysts
Ovarian cysts
MVP
Diverticulosis

45
Q

Causes of hypernatremia

A 
From loss of free water
Sweating 
Burns
Fever
Pneumonia 
Diarrhea
Diuretics
46
Q

Pathophys of DI

A

High volume water loss

Insufficient/ineffective ADH

47
Q

Central v Nephrogenic DI

A

Central - production problem

Nephrogenic - Loss of ADH effect on collecting duct

48
Q

Causes of Nephrogenic DI

A 
Lithium
Demeclocycline
Chronic Kidney Dz
Hypokalemia
Hypercalcemia
49
Q

What is Urine osmolality and sodium in NDI

A

Low

50
Q

What is Urine osmolality and sodium in CDI

A

Low

51
Q

Best initial test for DI

A

Water Deprivation Test

  • Urine volume stays High
  • Urine osmolality stays Low
52
Q

Response to ADH admin

A 
CDI = sharp decrease in urine volume, increase osmolality 
NDI = No change
53
Q

Most accurate test for CDI v NDI

A

ADH Level

  • Low in CDI
  • High in NDI
54
Q

TX for DI

A 
Correct underlying cause
CDI = replace ADH
NDI = Correct K+ and Ca+ 
Stop offending drugs
HCTZ or NSAIDs
55
Q

What complication occurs when sodium levels are brought down too rapidly

A

Cerebral Edema from shift of fluids from vascular space into cells of the brain
- Worsening confusion and seizures

Nephro (6 decks)

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