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Step 2 > Nephro > Flashcards

Nephro Flashcards

1
Q

Red cell casts

A

Glomerulonephritis

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2
Q

White cell casts

A

Pyelonephritis

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3
Q

Eosinophil casts

A

Acute/allergic interstitial nephritis

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4
Q

Hyaline casts

A

Dehydration concentrates the urine and normal Tamm-Horsfall proteins precipitate into casts

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5
Q

Broad, waxy casts

A

Chronic renal disease

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6
Q

Granular muddy-brown casts

A

ATN-collection of dead tubular cells

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7
Q

Most common meds causing ATN

A 
Contrast agents 
Aminoglycosides 
Cisplatin
Amphotericin
Cyclosporine 
NSAIDs
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8
Q

Most common meds causing AIN/drug rash/SJS/hemolysis?

A 
Penicillin 
Cephalosporin 
Sulfa drugs 
Phenytoin
Rifampin 
Quinolones
Allopurinol
PPI
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9
Q

Most accurate test for AIN

A

Hansel or Wright stain

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10
Q

Possible kidney damage from NSAIDs

A 
ATN from direct tubule toxicity 
AIN 
Membranous glomerulonephritis
Vascular insufficiency from vasoconstriction of afferent arteriole 
Papillary necrosis
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11
Q

Goodpasture Syndrome

A

Glomerulonephritis
Lung involvement- hemoptysis
NO OTHER SIGNS!

Best initial test: antiglomerular basement membrane Ab
Most accurate test: kidney biopsy showing linear immunoflouresence

Tx: plasmapheresis and steroids

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12
Q

IgA nephropathy (Berger’s disease)

A

Glomerulonephritis
Asian population
Gross hematuria 1-2 days after a URI

IgA level only increased 50% of the time

Kidney biopsy: mesengial deposits and C3 seen on EM

Tx: None

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13
Q

Post-infectous GN

A

1-3 weeks following throat or skin infection with group A beta-hemolytic strep

Sx: 
Dark urine
Periorbital edema
HTN 
Oliguria

Dx: Low complement
ASO and anti-DNAse Ab

Biopsy rarely done

Tx: self limited, use supportive measures such as antibiotics and diuretics to control fluid overload

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14
Q

Alport Syndrome

A

Congenital defect of IV collagen
glomerulonephritis plus:
High frequency hearing loss
Visual disturbances- loss of collagen that holds lens of eye together

No treatment

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15
Q

Polyarteritis Nodosa

A

Systemic vasculitis of small and medium vessels- SPARES THE LUNGS

Glomerulonephritis 
Fever, weight loss, myalgias/arthralgias 
GI symptoms and pain worse with eating 
Peripheral mononeuropathies 
Stroke 
Purpura, petichiae 
Cardiac disease

Dx:
Anemia, leukocytosis
Elevated ESR and CRP
p-ANCA (not usually)

Angiography showing aneurysmal dilatation of renal, mesenteric, or hepatic artery

Most accurate test: biopsy

Treat: prednisone and cyclophosphamide, Check HBV

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16
Q

GN associated with lupus

A

Membranous glomerulonephritis

17
Q

Amyloidosis

A 
Abnormal protein produced in:
Multiple Myeloma
Chronic inflammatory diseases 
RA 
IBD
Chronic infections

Bx: green birefringence with Congo red staining with polarizing light

Treatment: mephalan and prednisone

18
Q

Nephrotic syndrome associated with solid organ cancer

A

Membranous

19
Q

Nephrotic syndrome associated with children

A

Minimal change

20
Q

Nephrotic syndrome associated with drug use and AIDS

A

FSGS

21
Q

Nephrotic syndrome associated with NSAID use

A

Minimal change or membranous

22
Q

Nephrotic syndrome definition

A

Hyperproteinuria >3.5g in 24 hours
Hypoproteinemia- decreased immunity, increased clotting
Hyperlipidemia
Edema

23
Q

Distal RTA (Type I)

A

Amphotericin or autoimmune damage to distal tubule preventing it from making new bicarb and prohibiting H+ to be secreted from tubule. Hypokalemic acidosis
Increased formation of kidney stones

Dx:
Best initial test: UA with pH > 5.5 Most accurate test: infuse acid into blood with ammonium chloride- pH in urine remains basic = positive test

Tx: Replace bicarb

24
Q

Proximal RTA (Type II)

A

Amyloidosis, myeloma, Fanconi, acetazolamide, or heavy metals decrease the ability of kidney to reabsorb bicarb.
Hypokalemic metabolic acidosis
Acidosis steals calcium from bones- osteomalacia

Dx:
Urine pH is variable: basic until most bicarb lost from body then acidic (bc distal tubule doing the work)
Accurate test: Give bicarb and measure urine pH- urine pH will rise

Tx: difficult to treat
Give bicarb and thiazie (volume depletion helps bicarb reabsorption).

25
Q

Hyporeninemia, hypoadosteronism (Type IV RTA)

A

Occurs in diabetes
Decreased amount or effect of aldosterone- loss of Na, retention of K and H

Dx: persistently high urine Na, despite sodium restricted diet
Hyperkalemia

26
Q

Hypotension/hypoperfusion

Anion gap metabolic acidosis

A

Acid: lactate
Test: blood lactate level
Treatment: correct hypoperfusion

27
Q

DKA/Starvatoin

Anion gap metabolic acidosis

A

Acid: Ketoacid
Test: Acetone level
Treatment: Insulin and fluid

28
Q

Ethylene glycol overdose

Anion gap metabolic acidosis

A

Acid: Oxalic acid
Test: Crystals on UA
Treatment: Fomepizole or dialysis

29
Q

Methanol overdose

Anion gap metabolic acidosis

A

Acid: Formic acid
Test: Inflamed retina (going blind from moonshine)
Treatment: Fomepizole or dialysis

30
Q

Renal failure

Anion gap metabolic acidosis

A

Acid: Uremia
Test: BUN/Cr
Treatment: Dialysis

31
Q

Aspirin overdose

Anion gap metabolic acidosis

A

Acid: Salicylates
Tests: Aspirin level
Treatment: Alkanize urine

Step 2 (12 decks)

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