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UWORLD ABIM > Nephro > Flashcards

Nephro Flashcards

1
Q

4 big causes of AIN

A

PPI
Nsaids
Sjogren
Sarcoid

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2
Q

still have AKI 5 days after cardiac cath, also skin rash

A

Atheroembolic dz, can have livedo reticularis and peripheral emboli. supportive care, maybe statin and consider stop anticoag

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3
Q

differentiate IgA nephropathy and Post-infectious GN

A

Both are related to immune complex. Both can happen post-infection.

IgA: will happen w/in 2-3 days. Complement will be NORMAL. its the most common primary GN. Systemic form is HSP (palpable pupura, GI, joints, kidney). Bx = glomerular IgA deposits.

PSGN: latent period, usually 7-10 days but up to 6 weeks. Complement is LOW. Cola-colored urine. Check ASO, anti-DNase for strep.

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4
Q

most common glomerulonephritis

A

IgA nephropathy (usually a few days after URI (strep pharyngitis)

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5
Q

Causes of glomerulonephritis with low complement

A

SIP in all the CoMPlements

SLE
Infective Endocarditis 
Postinfection
Cryoglobulinemia 
MembranoProliferative

Note: even though IgA nephropathy (most common GN) and HSP are immune complex mediated, it will not have low complement, HA

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6
Q

vasculitis with low C4

A

Cryoglobulinemia

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7
Q

tx for lupus nephritis

A

MMF (mycophenolate mofentil) is the main one. Can also use Cyclophosphamide. Will do this with steroids.

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8
Q

GN with low complement level and Hep C

A

either Membranoproliferative GN or Cryoglobulinemia-assocated GN

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9
Q

Who gets membranoproliferative GN?

A

Mainly Hep B and Hep C, also SLE

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10
Q

mononeuritis multiplex plus GN

A

Microscopic polyangitis

p-anca//anti-MPO. may have palpable purpura and pulmonary hemorrhage. its a vasculitis

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11
Q

associations with minimal change disease

A 
nsaid use
Hodgkin disease (so young patient with bulky LN)
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12
Q

black person or HIV or obese with nephrotic syndrome

A

FSGS

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13
Q

caucasian with nephrotic syndrome

A

membranous

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14
Q

patient with cancer and nephrotic

A

membranous (note: hodgkin associated with minimal change disease)

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15
Q

flank pain, hematuria and nephrotic syndrome

A

suspect renal vein thrombosis/renal infarction with membranous nephropathy. will have high LDH

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16
Q

nephrotic syndrome with low complement

A

MPGN

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17
Q

trace protein on dipstick but lots of protein on urine protein/cr ratio

A

multiple myeloma. light chains are not picked up on dipstick, only albumin

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18
Q

most common stone

A

calcium oxalate

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19
Q

association with calcium phosphate stone

A

distal RTA

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20
Q

biggest meds for stones

A

triamterene, indinavir, absorbic acid (vitamin C –> oxalate)

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21
Q

how to reduce hypercalciuria (and thus calcium stones)

A
  • reduce animal protein
  • reduce Sodium
  • reduce sucrose and fructose

drugs:
- thiazides to reduce calcium in the urine

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22
Q

T/F: You should reduce dietary calcium to reduce kidney stone formation

A

FALSE. actually when you reduce calcium intake, then this allows oxalate to be free and will actually make more stones.

so you want good calcium in the diet, don’t recommend supplements though

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23
Q

tx for uric acid stone

A

get urine pH above 6, by giving potassium citrate (alkalinize the urine a bit, acidic pH is a risk factor for uric acid stone)

citrate is also a stone inhibitor

can then do allopurinol if reeeallly needed

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24
Q

2 meds to remember for renal stones

A

-if hypercalciuria, give thiazides

if uric acid stones or low citrate, give potassium citrate

diet is the big thing though

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25
Q

Diet changes for renal stone management

A

-increase volume intake (3-3.5L/day)

High calcium:

  • increase dietary calcium (non supplement), fruits/veggies, citrate and fluids
  • reduce sodium, non-dairy animal protein intake, sucrose/fructose

High oxalate: avoid high oxalate foods, adequate dietary calcium, avoid vitamin C supplements (gets converted to oxalate)

High uric acid: reduce purine intake (animal protein)

low urinary citrate: increase fruit and vegetables, reduce animal protein intake

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26
Q

calcium phosphate stone associate

A

distal RTA

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27
Q

uric acid stone risk factor

A

low urine pH. they are radiolucent so will not show up. increase urine pH

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28
Q

staghorn calculi

A

recurrent UTI patient, urease splitting. usually surgical treatment

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29
Q

hexagonal crystals for stone stone

A

cystine stone (not citrate)

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30
Q

T/F: ACE-i should be avoided in bilateral renal a stenosis

A

FALSE

initial tx of bilateral renal a stenosis = ACE-I and Diuretic.

If this fails then can do stenting

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31
Q

thrombocytopenia, anemia and AKI after diarrheal illness

A

usually HUS. will have a MAHA

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32
Q

role of lasix in hypercalcemia tx

A

usually avoid as it can worsen hypovolemia and hypokalemia. it does promote urinary calcium excretion and is reserved for patients who develop volume overload

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33
Q

elevated osmolar gap

A

Measured Osm - Calculated Osm >10

Calculated: 2(Na) + BUN/2.8 + Glu/18

Toxic alcohols:

  • Alcoholic ketoacidosis
  • methanol
  • ethylene glycol (calcium oxalate stones)
  • isopropyl alcohol (no anion gap or metabolic acidosis)
34
Q

Would you expect urinary calcium levels high or low in primary/tertiary hyperPTH?

A

High

35
Q

Hypercalcemia with elevated 25 (OH) D

A

vitamin d toxicity

36
Q

Hypercalcemia with elevated 1, 25 (OH) D

A

possible granulomatous disease, cxr for possible sarcoid or lymphoma

37
Q

urinary anion gap

A

Na + K - Cl

in distal RTA (has hypokalemia) will be markedly positive: 20-40.

its also positive in type 4 (which always have hyperkalmeia an associated with diabetes)

Normal is negative (-20)

38
Q

common causes distal RTA

A
  • sjogren
  • SLE
  • rheumatoid arthritis
  • amphotericin
  • urinary obstruction
  • toxin (toluene)
39
Q

Urine sodium in prerenal AKI

A

<20

40
Q

kidney stones < _____ are likely to pass on their own

A

10mm

41
Q

dx of hepatorenal syndrome

A

no improvement in renal function after 48 hour trial of diuretic cessation and volume expansion with albumin

42
Q

tx of hepatorenal syndrome

A

midodrine (selective alpha-1 agonist) and octreotide (reduces splanchnic vasodilation)

43
Q

how can you tell clinically hepatorenal vs abdominal compartment syndrome

A

if the abdomen is soft, suspect HRS. Tense ascites leads to abdominal compartment syndrome

44
Q

T/F: PT, PTT and bleeding time are normal in a patient with CKD related bleeding

A

False. PT and PTT usually normal. Bleeding time prolonged, defect in platelet and vWB factor interaction. use ddavp

45
Q

tx hypernatremia

A

Check volume status

Euvolemic: Free water supplementation

Hypovomeic:

  • if sx: 0.9% saline until euvolemic, then D5
  • asx: D5
46
Q

2 most common causes of NAGMA

A
  • RTA

- diarrhea

47
Q

Sjogren + non anion gap metabolic acidosis

A

distal RTA. SLE also associated

48
Q

Which RTA causes stones?

A

Distal RTA (Type 1) causes calcium phosphate stones

49
Q

What is the potassium in the RTAs?

A

Distal (Type 1) RTA: Hypokalemia

Proximal (Type 2): Hypokalemia

Type 4 RTA (low renin-low aldosterone): Hyperkalemia

50
Q

T/F: Distal RTA has hyperkalemia

A

False. It has hypokalemia. Distal = type 1.

Type 4 has low renin/low aldosterone and thus has hyperkalemia

51
Q

Why does Type 4 (aka not type 1 distal) RTA have hyperkalemia?

A

it is a low renin-low aldosterone based. Aldosterone normally excretes K+ and H+ in the urine while reabsorbing Na

52
Q

Urine anion gap in distal RTA

A

Positive.

Urine Na + K - Cl. If there is no RTA, typically chloride is elevated to match the H+ and your H+ is excreted and the gap is negative.

53
Q

urine anion gap in diarrhea

A

negative

54
Q

Osmolar gap without acidosis

A

Isopropyl alcohol (rubbing alcohol)

55
Q

Osmolar gap >10 with positive AG

A

Methanol (blindness)
ethanol
ethylene glycol (oxalate crystals)

56
Q

2 main causes of metabolic alkalosis

A

Volume depletion (gastric) and primary hyperaldosteronism

57
Q

Urine chloride in metabolic alkalosis

A

low in volume (gastric) depletion

high (>10) in primary hyperaldosteronism (hypertension)

58
Q

mixed high anion gap metabolic acidosis and respiratory alkalosis

A

salicylate toxicity.

May have tinnitus, vertigo, hyperthermia, pulm edema, AMS, elevated PT, low serum uric acid, mildly elevated LFTs

Tx is supportive and = alkalization of the urine with bicarb

59
Q

T/F: Iron deficiency is the most common cause of erythropoeietin resistance in patients with ESRD

A

True. all patients getting epo should be getting iron (unless ferritin >500). Don’t be tricked by a normocytic anemia

60
Q

T/F: Cholesterol emboli presents similar to AIN

A

True. Renal failure, sterile pyuria, wbc casts. usually following percutaneous endovascular procedures. Fever and rash would be expected in AIN

61
Q

Most common nephropathy for thrombosis (especially renal vein thrombosis)

A

Membraneous nephropathy

  • this is also the most common in caucasians
  • associated with hep b, hep c, sle, nsaids and solid tumors

-tx with steroids and cyclophosphamide

62
Q

diuretic choice in CKD patients

A

CrCL>30: thiazide
CrCl<30: loops

diuretics can correct edema and increase the effectiveness of other antihypertensive meds

63
Q

common drugs that cause NAGMA

A
  • Carbonic anhydrase inhibitors (Acetazolamide, Topiramate)
  • bactrim
  • amphotericin B
  • lithium
  • fiampin
  • cisplatin chemotherapy
64
Q

features of scleroderma renal crisis

A
  • AKI
  • marked HTN
  • normal urine sediment
  • MAHA
65
Q

T/F: IgA nephropathy and other GN’s have the hallmark of both hematuria and proteinuria

A

TRUE. So if a patient had a recent illness and proteinuria without hematuria, don’t pick IgA nephropathy

66
Q

heavy proteinuria and profound hypoalbuminemia following and upper respiratory infection. no hematuria

A

minimal change disease

67
Q

malignancy and clots in nephropathy

A

membranous nephropathy

also SLE, nsaids, hep B and hep C associations. white folks.

68
Q

sxs of hypophosphatemia

A 
muscle weakness
rhabdo
hemolytic anemia 
metabolic encephalopathy 
heart failure
69
Q

recommendations for PSA levels

A

Normal DRE and PSA <3: routine f/u

Normal DRE and PSA 3-7: Repeat PSA weeks later, if >3 refer to urologist for TRUS bx

Abnormal DRE, or PSA >7: Refer to urologist for TRUST bx

70
Q

how to manage high phosphate in CKD patients

A

Step 1: restrict dietary phosphate (<900mg/day)

Step 2: Phosphate binders
(Ca <9.5 = calcium carbonate or acetate; Ca>9.5 = sevelamer or lanthanum)

If still high, Step 3: Measure PTH (tx > 300).

  • phosphate <5.5: Vitamin D analog for Ca <9.5, Cinacalcet for Ca >9.5
  • phosphate >5.5: Cinacalcet
  • can’t use cinacalcet in hypocalcemia b/c seizures and QT prolong risk
71
Q

T/F: Calcimimetics like cinacalcet decrease freq of fractures and rate of parathyroidectomy in CKD pts

A

True, when they have hyperphosphatemia and secondary hyperparathyroidism. They also reduce risk of CV disease in elderly (>65 old).

72
Q

Fluids for post-obstructive diuresis

A

Isotonic or 1/2NS at a rate <50% of urine volume/hr

73
Q

manage urge incontinence in BPH

A

Step 1: Behavior modification (bladder training, fluid mgmt)
Step 2: alpha-adrenergic antagonist (terazosin, tamsulosin)
Step 3: antimuscarinic agents (tolterodine, oxybutynin) but measure PVR first, use cautiously if >200 ml

74
Q

rhomboid crystals for stone

A

uric acid

75
Q

coffin lid crystals for stone

A

struvite (staghorn calculi)

76
Q

__________ stones commonly occur in patients with malabsorption from small bowel dz (Crohns), bariatric surgery/gastric bypass and cystic fibrosis

A

Calcium oxalate

-causes increased colonic oxalate absorption and low urinary citrate

77
Q

urine protein creatinine ratio

A

normal is <0.2 = 200mg protein day

UPC of 2.5 = 2.5g/day of total protein

78
Q

UPC ratio diagnostic of proteinuria

A

Urine protein-cr ratio >0.2mg/mg

79
Q

T/F: There are no benign causes of proteinuria

A

False. Orthostatic/positional proteinuria is benign cause of isolated proteinuria.

Obtain split daytime (standing) and nighttime (supine) urine collections

80
Q

T/F: Hematuria in patients on anticoag does not require workup

A

False

81
Q

What does sterile pyuria suggest ?

A

Aka negative culture

Suggests Interstitial Nephritis, Interstitial Cystitis or Mycobacterium Tuberculosis

82
Q

What does eosinophiliuria suggest

A 
AIN
PSGN 
Atheroembolic dz 
Septic emboli 
Small-vessel vasculitis

**absence does not rule any of these out, including AIN

UWORLD ABIM (10 decks)

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