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Nephro > MTB > Flashcards

MTB Flashcards

1
Q

Methods to assess total amount of protein in a day

A
  1. Single protein to creatinine ratio

2. 24 hour urine collection

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2
Q

WU for proteinuria

A
  1. UA

2. Protein to Creatinine (P/Cr)

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3
Q

What determines cause of proteinuria

A

Kidney BX

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4
Q

Diabetic pt with microalbuminuria - next step in management

A

Start ACE

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5
Q

Is Bence jones protein detectable on dipstick?

A

No

Must do immunoelectrophoresis

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6
Q

What stain is important in allergic interstitial nephritis

A

Wright and Hansel

Detect eosinophils in urine

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7
Q

DDX for Hematuria

A 
Stones in KUB
Heme disorders
Infxn
Cancer - KUB
Cyclophosphamide
Trauma
Glomerulonephritis
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8
Q

Dysmorphic RBCs indicates

A

Glomerulonephritis

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9
Q

When is cytoscopy the answer

A 
Hematuria w/out infxn
Prior trauma
AND
Renal US or CT inconclusive
Bladder sonography shows mass for possible BX
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10
Q

What is cytoscopy the most accurate test for

A

Bladder

visualizes bladder and urethra = areas that do not show up well on X ray

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11
Q

Red cell cast?

A

Glomerulonephritis

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12
Q

White cell cast?

A

Pyelonephritis

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13
Q

Eosinophil cast?

A

Allergic Interstitial Nephritis

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14
Q

Hyaline cast?

A

Dehydration

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15
Q

Broad, waxy cast?

A

Chronic Renal DZ

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16
Q

Granular muddy brown cast?

A

Acute Tubular Necrosis

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17
Q

Fatty Casts?

A

Nephrotic syndrome

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18
Q

Prerenal azotemia causes

A

Decreased perfusion

  • Hypovolemia
  • HypoTN
  • Renal Artery stenosis
  • Hypoalbuminemia
  • Cirrhosis
  • NSAIDs = constrict afferent arteriole
  • ACE I = efferent arteriole VD
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19
Q

NSAIDs effect on kidney

A

Constrict afferent arteriole = decrease GFR

PGs dilate afferent to increase GFR

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20
Q

ACE-I impact on GFR

A

Worsen GFR - but prevent progression of renal insufficiency - long term protect glomerulus

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21
Q

Postrenal Azotemia causes

A

Obstruction = blocks filtration at glomerulus

  • Prostate Hypertrophy
  • Stone in ureter
  • Cervical Cancer
  • Urethral stricture
  • Neurogenic bladder = MCC in DM and MS
  • Retroperitoneal fibrosis
22
Q

MCC of death in cervical cancer

A

postrenal azotemia - renal insufficiency b/c both ureters blocked

23
Q

What is the major force favoring filtration in kidney

A

Hydrostatic pressure in glomerular capillary

24
Q

Drugs that cause retroperitoneal fibrosis kidney

A

Bleomycin
Busulfan
Methylsergide
Radiation

25
Q

MCC of intrinsic renal dz

A

ATN - ischemia and toxins

26
Q

Presentation of AIN

A

Fever
Rash
Eosinophils

27
Q

Causes of Intrinsic renal dz

A 
AIN
Rhabdomyolysis 
Hemoglobinuria
Contrast agents
Crystals
Proteins
Post strep infxn
28
Q

Presentation of AKI

A

Asymptomatic rise in BUN and Creatinine
Sx’s - N/V, malaise, weakkness, SOB
Severe - Confusion, arrhythmia from hyperkalemia, acidosis. Pericarditis

29
Q

Presentation of Postrenal Azotemia

A

Enlargement of bladder

Massive diuresis after Foley placement

30
Q

Diagnostic test for Acute Kidney Injury

A

BUN

Creatinine

31
Q

BUN/Cr ratio > 20:1

A

Prerenal Azotemia

Postrenal Azotemia

32
Q

BUN/Cr intrinsic renal dz

A

Around 10:1

33
Q

Best imaging test for acute kidney injury

A

Renal sonogram

34
Q

Postrenal Azotemia

A

BUN/Cr > 20:1
Distended bladder, urine release w foley
BL or UL hydronephrosis on sonogram

35
Q

When do we do kidney BX

A

Rarely correct answer

Most accurate for Allergic interstitial nephritis or poststrep GN

36
Q

What is UNa and FeNa in Prerenal azotemia

A

Low UNa = < 20

Low FeNa = <1%

37
Q

What is urine Osmolality in ATN

A

Inappropriately LOW
Isosthenuria - same as blood, about 300 mOsm/L
Tubule cells damaged = urine cannot be concentrated

38
Q

Dehydration does what to osmolality (urine concentration)

A

Normally increases

39
Q

In ATN, what happens to sodium

A

Body inappropriately loses sodium and water into urine
UNa > 20
UOsm < 300

40
Q

Healthy person w fluid overload

Osmolality?

A

LOW urine Osmolality

Dilute urine

41
Q

Healthy person w dehydration

Osmolality?

A

HIGH urine osmolality

Concentrated Urine

42
Q

Sickle cell trait pts management

A

Advise avoid dehydration

Do not need other TX

43
Q

What is Uremia

A

Renal insufficiency to the degree that dialysis is needed

44
Q

What does urine specific gravity correlate to

A

Urine osmolality

45
Q

Causes of ATN

A

Ischemia

Toxins

46
Q

Renal Insufficiency with rapid onset

A

Contrast

47
Q

Renal insufficiency drugs

How long to be nephrotoxic

A 
Vanco
Gentamicin
Amphotericin
Cisplatin
Acyclovir
Cyclosporine
5 to 10 days
48
Q

Most proven benefit at preventing contrast-induced nephrotoxicity

A

Saline Hydration

49
Q

Pathophys of contrast on kidney

A

Contrast causes spasm of afferent arteriole causing renal tubule dysfunction. High reabsorption of Na and water, causing high specific gravity of urine = VERY low urine Na

50
Q

Tumor Lysis Syndrome

A

Hyperuricemia

Hyperkalemia

51
Q

Renal failure prevention in chemo pts

A

Prior to chemo to prevent tumor lysis syndrome:
Allopurinol
Hydration
Rasburicase

52
Q

Management of Hyperkalemia in tumor lysis syndrome

A
  1. Normalize cellular electrical activity with Calcium
  2. Drive K+ Intracellulary
  3. Decrease total body K+ content
    - insulin and glucose = rapidly act to drive K+ intracellular within 15-30 mins

Nephro (6 decks)

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