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Nephro > MTB 3 > Flashcards

MTB 3 Flashcards

1
Q

Causes of Hyponatremia

A

HYPERvolemia
HYPOvolemia
Addison Dz
Euvolemia

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2
Q

Pathophys of Hypervolemia Hyponatremia

Examples

A

Intravascular volume depletion leads to increased ADH. Pressure receptors in atria and carotids sense decrease in volume, stimulate ADH

  • CHF
  • Cirrhosis
  • Nephrotic Sydnrome
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3
Q

Pathophys of Hypovolemia Hyponatremia

Examples

A

Sweating, burns, fever, pneumonia, diarrhea, diuretics

- When chronic replacement with water

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4
Q

Pathophys of Euvolemia Hyponatremia

Examples

A 
Pseudohyponatremia
Psychogenic Polydipsia
Hypothyroidism
SIADH
Hypothyroidism
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5
Q

Hyperglycemia pathophys in Hyponatremia

A

Very high glucose levels lead to decrease in sodium levels.
Every 100mg/dL of glucose above normal, there is 1.6 mEq/L decrease in sodium

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6
Q

Psychogenic Polydipsia Pathophys

A

Massive water ingestion above 12 to 24 liters/day

Hx of Bipolar

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7
Q

SIADH pathophys

Examples

A

Lung or Brain Dz

Drugs: SSRIs, sulfonylureas, vincristine, cyclophosphamide, TCAs

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8
Q

Presentation of Hyponatremia

A 
Confusion
Lethargy
Disorientation 
Seizures
Coma
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9
Q

What is Urine osmolality in SIADH

A

High - inappropriately concentrated urine
Uric Acid - Low
BUN - Low

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10
Q

Most accurate test in SIADH

A

High ADH level

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11
Q

TX for SIADH

A

Severe, symptomatic
- ADH Antagonists: Tolvapatan, Conivaptan
Chronic
- Demeclocycline blocks ADH at collecting duct

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12
Q

Correction of low sodium too rapidly?

A

Central Pontine Myelinolysis

Osmotic demyelinization

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13
Q

How fast do we correct low sodium

A

0.5-1 mEq per hour OR

12 to 24 mEq per day

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14
Q

Causes of pseudohyperkalemia

A

Hemolysis
Repeated fist clenching
Thrombocytosis or leukocytosis

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15
Q

Drugs that cause hyperkalemia

A 
Non-selective beta blockers
ACE, ARBs
Spironolactone
Digitalis
Cyclosporine
Heparin
NSAIDs
Succinylcholine
Trimethoprim (esp HIV)
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16
Q

Hyperkalemia - causes of decreased excretion

A 
Renal Failure
Aldosterone decreases
- ACE/ARBs
- Type IV renal tubular acidosis 
- Spironolactone/Eplerenone
- Triameterene and amiloride
- Addison Dz
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17
Q

Hyperkalemia from increased release by tissues

A

Tissue destruction
-Rhabdomyolysis
- Tumor lysis syndrome
Decreased insulin
Acidosis - cells pick up hydrogen and release potassium in exchange
Beta blockers/Digoxin - inhibit Na/K ATPase
Heparin

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18
Q

Role of insulin and potassium

A

Inusulin drives potassium INTO cells

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19
Q

K+ is intra or extracellular

A

95% Intracellular

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20
Q

Presentation of hyperkalemia

A 
Muscle contraction and cardiac conduction
Weakness
Paralysis
Ileus
Cardiac rhythm disorders
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21
Q

Most urgent test in severe hyperkalemia

A

EKG

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22
Q

EKG findings in hyperkalemia

A

Peaked T waves
Wide QRS
PR interval prolongation

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23
Q

TX for Hyperkalemia w abnormal EKG

A
  1. Calcium chloride or calcium gluconate
  2. Insulin and glucose drive K+ back into cells
  3. Bicarbonate - drives K+ into cells
    - used most when acidosis causes hyperkalemia
24
Q

TX for removing K+ from the body

A
  1. Kayexalate - sodium polystyrene sulfonate - removes thru bowel over several hours by binding K+ in gut
25
Q

How to lower K+ Levels

A
  1. Insulin and Bicarb redistribute into cells
  2. Inhaled beta agonist - albuterol
  3. Dialysis
26
Q

When is calcium used in hyperkalemia

A

Only when EKG is abnormal to protect the heart

27
Q

Causes of hypokalemia

A

Shifting into cells
Decreasing intake
Renal loss
GI Loss

28
Q

Renal loss of K+ hypokalemia Causes

A 
Loops
Increased aldosterone
Primary hyperaldosteronism = Conn's
Cushing syndrome
Bartter syndrome = Salt loss at LOH
Licorice
Volume depletion
Hypomagnesemia
RTA = types I and II
29
Q

Presentation of hypokalemia

A

Muscular contraction and cardiac conduction
Weakness
Paralysis
Loss of reflexes

30
Q

EKG of Hypokalemia

A

U waves

PVCs (ventricular ectopy), flattened T waves, ST depression

31
Q

TX for Hypokalemia

A

Oral K+ replacement

32
Q

AE of IV K+ replacement

A

Fatal arrhythmia if done too fast

33
Q

How long do bicarb and insulin take to work in hypokalemia

A

15 - 20 mins

34
Q

RTA = what kind of acidosis

A

Metabolic Acidosis with normal AG

35
Q

How to calculate Anion Gap

Normal range

A

Na - (Cl + HCO3)

6-12

36
Q

Two most important causes of Metabolic Acidosis with normal AG
Why normal AG

A
  1. RTA
  2. Diarrhea
    BC both are hyperchloremic = Cl rises
37
Q

Type I RTA
Pathophys
Causes

A

Distal tubule damage where HCO3 cannot be generated, so acid cannot be excreted into tubule which raises pH of urine
Nephrocalcinosis = Calcifies renal parenchyma
Drugs - Ampho B
AI - SLE, Sjogren

38
Q

What is role of Distal tubule

A

Generates new bicarb under Aldosterone influence

39
Q

What kind of urine (acidic/alkaline) do we see increased formation of kidney stones

A

Alkaline - from calcium oxalate

40
Q

Best initial test for RTA type I

A

UA - abnormally high pH > 5.5

41
Q

Most accurate test for RTA type I

A

Infuse acid into blood w ammonium chloride

42
Q

TX for RTA type I

A

Replace bicarbonate that will be absorbed at proximal tubule

43
Q

RTA Type II
Location
Causes

A

Proximal
-90% of filtered HCO3 reabsorbed at proximal tubule
Damage causes decreased ability to reabsorb HCO3, and is lost in urine

44
Q

What damages proximal tubule

A

Damage by

  • Amyloidosis
  • Myeloma
  • Fanconi syndrome
  • Acetozolamide
  • Heavy metals
45
Q

What effect does chronic metabolic acidosis have on calcium

A

Leaches calcium out of bones - softens them

Osteomalacia

46
Q

Most accurate test for Type II RTA

A

Evaluate HCO3 malabsorption in kidney

  • give HCO3 and test urine pH
  • urine pH rises b/c kidney can’t absorb
47
Q

K+ in Type I RTA

A

Hypokalemic

48
Q

K+ in Type II RTA

A

Hypokalemic

49
Q

TX for Type II RTA

A

Volume depletion enhances HCO3 reabsorption

- Thiazides

50
Q

Type IV RTA
pathophys
MC in which population

A 
Hyporeninemia, Hypoaldosteronism
Decreased amt or effect of aldosterone at kidney tubule
- Na Loss
- K+ and H+ retention 
MC in Diabetes
51
Q

Testing for Type IV RTA

A

Persistently high urine Na despite Na-depleted diet

Hyperkalemia

52
Q

Which RTA do we see nephrolithiasis

A

Type I - Distal

53
Q

RTA with Variable urine pH

A

Type II - Proximal

54
Q

RTA with high urine pH

A

Type I - Distal

55
Q

TX for Type IV RTA

A

Fludrocortisone

- highest aldosteronelike effect

56
Q

RTA with Hyperkalemia

A

Type IV

Nephro (6 decks)

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