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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
Diet changes for renal stone management
-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
26
calcium phosphate stone associate
distal RTA
27
uric acid stone risk factor
low urine pH. they are radiolucent so will not show up. increase urine pH
28
staghorn calculi
recurrent UTI patient, urease splitting. usually surgical treatment
29
hexagonal crystals for stone stone
cystine stone (not citrate)
30
T/F: ACE-i should be avoided in bilateral renal a stenosis
FALSE initial tx of bilateral renal a stenosis = ACE-I and Diuretic. If this fails then can do stenting
31
thrombocytopenia, anemia and AKI after diarrheal illness
usually HUS. will have a MAHA
32
role of lasix in hypercalcemia tx
usually avoid as it can worsen hypovolemia and hypokalemia. it does promote urinary calcium excretion and is reserved for patients who develop volume overload
33
elevated osmolar gap
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
Would you expect urinary calcium levels high or low in primary/tertiary hyperPTH?
High
35
Hypercalcemia with elevated 25 (OH) D
vitamin d toxicity
36
Hypercalcemia with elevated 1, 25 (OH) D
possible granulomatous disease, cxr for possible sarcoid or lymphoma
37
urinary anion gap
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
common causes distal RTA
- sjogren - SLE - rheumatoid arthritis - amphotericin - urinary obstruction - toxin (toluene)
39
Urine sodium in prerenal AKI
<20
40
kidney stones < _____ are likely to pass on their own
10mm
41
dx of hepatorenal syndrome
no improvement in renal function after 48 hour trial of diuretic cessation and volume expansion with albumin
42
tx of hepatorenal syndrome
midodrine (selective alpha-1 agonist) and octreotide (reduces splanchnic vasodilation)
43
how can you tell clinically hepatorenal vs abdominal compartment syndrome
if the abdomen is soft, suspect HRS. Tense ascites leads to abdominal compartment syndrome
44
T/F: PT, PTT and bleeding time are normal in a patient with CKD related bleeding
False. PT and PTT usually normal. Bleeding time prolonged, defect in platelet and vWB factor interaction. use ddavp
45
tx hypernatremia
Check volume status Euvolemic: Free water supplementation Hypovomeic: - if sx: 0.9% saline until euvolemic, then D5 - asx: D5
46
2 most common causes of NAGMA
- RTA | - diarrhea
47
Sjogren + non anion gap metabolic acidosis
distal RTA. SLE also associated
48
Which RTA causes stones?
Distal RTA (Type 1) causes calcium phosphate stones
49
What is the potassium in the RTAs?
Distal (Type 1) RTA: Hypokalemia Proximal (Type 2): Hypokalemia Type 4 RTA (low renin-low aldosterone): Hyperkalemia
50
T/F: Distal RTA has hyperkalemia
False. It has hypokalemia. Distal = type 1. Type 4 has low renin/low aldosterone and thus has hyperkalemia
51
Why does Type 4 (aka not type 1 distal) RTA have hyperkalemia?
it is a low renin-low aldosterone based. Aldosterone normally excretes K+ and H+ in the urine while reabsorbing Na
52
Urine anion gap in distal RTA
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
urine anion gap in diarrhea
negative
54
Osmolar gap without acidosis
Isopropyl alcohol (rubbing alcohol)
55
Osmolar gap >10 with positive AG
Methanol (blindness) ethanol ethylene glycol (oxalate crystals)
56
2 main causes of metabolic alkalosis
Volume depletion (gastric) and primary hyperaldosteronism
57
Urine chloride in metabolic alkalosis
low in volume (gastric) depletion high (>10) in primary hyperaldosteronism (hypertension)
58
mixed high anion gap metabolic acidosis and respiratory alkalosis
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
T/F: Iron deficiency is the most common cause of erythropoeietin resistance in patients with ESRD
True. all patients getting epo should be getting iron (unless ferritin >500). Don't be tricked by a normocytic anemia
60
T/F: Cholesterol emboli presents similar to AIN
True. Renal failure, sterile pyuria, wbc casts. usually following percutaneous endovascular procedures. Fever and rash would be expected in AIN
61
Most common nephropathy for thrombosis (especially renal vein thrombosis)
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
diuretic choice in CKD patients
CrCL>30: thiazide CrCl<30: loops diuretics can correct edema and increase the effectiveness of other antihypertensive meds
63
common drugs that cause NAGMA
- Carbonic anhydrase inhibitors (Acetazolamide, Topiramate) - bactrim - amphotericin B - lithium - fiampin - cisplatin chemotherapy
64
features of scleroderma renal crisis
- AKI - marked HTN - normal urine sediment - MAHA
65
T/F: IgA nephropathy and other GN's have the hallmark of both hematuria and proteinuria
TRUE. So if a patient had a recent illness and proteinuria without hematuria, don't pick IgA nephropathy
66
heavy proteinuria and profound hypoalbuminemia following and upper respiratory infection. no hematuria
minimal change disease
67
malignancy and clots in nephropathy
membranous nephropathy also SLE, nsaids, hep B and hep C associations. white folks.
68
sxs of hypophosphatemia
``` muscle weakness rhabdo hemolytic anemia metabolic encephalopathy heart failure ```
69
recommendations for PSA levels
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
how to manage high phosphate in CKD patients
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
T/F: Calcimimetics like cinacalcet decrease freq of fractures and rate of parathyroidectomy in CKD pts
True, when they have hyperphosphatemia and secondary hyperparathyroidism. They also reduce risk of CV disease in elderly (>65 old).
72
Fluids for post-obstructive diuresis
Isotonic or 1/2NS at a rate <50% of urine volume/hr
73
manage urge incontinence in BPH
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
rhomboid crystals for stone
uric acid
75
coffin lid crystals for stone
struvite (staghorn calculi)
76
__________ stones commonly occur in patients with malabsorption from small bowel dz (Crohns), bariatric surgery/gastric bypass and cystic fibrosis
Calcium oxalate | -causes increased colonic oxalate absorption and low urinary citrate
77
urine protein creatinine ratio
normal is <0.2 = 200mg protein day UPC of 2.5 = 2.5g/day of total protein
78
UPC ratio diagnostic of proteinuria
Urine protein-cr ratio >0.2mg/mg
79
T/F: There are no benign causes of proteinuria
False. Orthostatic/positional proteinuria is benign cause of isolated proteinuria. Obtain split daytime (standing) and nighttime (supine) urine collections
80
T/F: Hematuria in patients on anticoag does not require workup
False
81
What does sterile pyuria suggest ?
Aka negative culture Suggests Interstitial Nephritis, Interstitial Cystitis or Mycobacterium Tuberculosis
82
What does eosinophiliuria suggest
``` 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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