Nephro Flashcards
Which diuretic should be used for acute pulmonary edema?
Loops
Which diuretic should be used for idiopathic hypercalciuria?
Thiazides
Which diuretic should be used for glaucoma?
Acetazolamide (carbonic anhydrase inhibitor) or mannitol if severe
Which diuretic should be used for mild to moderate CHF with expanded ECV?
loop and aldosterone antagonist
Which diuretic should be used for increased intracranial pressure?
Mannitol
Which diuretic should be used for hypercalcemia?
Loop
Which diuretic should be used for altitude sickness?
Acetazolamide (carbonic anhydrase inhibitor)
Which class of diuretics can cause ototoxicity?
Loops
Which diuretic is safe for a fluid overloaded patient with a sulfa allergy?
Ethacrynic acid (loop)
Sub-epithelial humps?
Post streptococcal glomerulonephritis
What two labs can be elevated in post streptococcal glomerulonephritis?
- Anti-DNAse B
- ASO titer (normally NOT elevated in skin infections)
endothelial deposits cause “wire loops” on LM?
Lupus nephritis
Treatment for most nephrotic syndrome?
Steroids, ACE inhibitors, statins
Kidneys, lungs and upper airway involvement?
Granulomatosis with polyangiitis (GPA) (Wegener’s)
Which lab is elevated with Wegener’s?
cANCA
Linear deposits on immunofluorescence?
Good pasture
Treatment of good pasture?
- plasmapheresis (to remove the IgG antibodies to the GBM)
- Glucocorticoids
Immunofluorescence shows mesangial deposits?
IgA nephropathy (Berger disease)
Cataracts, nephritis, high-frequency hearing loss?
Alports
Splitting of the basement membrane?
Alport disease (defect of type IV collagen)
Light microscopy showing crescent formation in the glomeruli; p-ANCA positive
Pauli-immune RPGN
What is the criteria for nephrotic syndrome?
- proteinuria >3.5g/24 hours
- hypoalbuminemia
- edema
Most common cause of nephrotic syndrome in adults?
FSGS
Thickening of the basement membrane and a “spike and dome: appearance?
Membranous nephropathy
“tram track” appearance with sub endothelial humps of IgG along the GBM?
Membranoproliferazive glomerulonephritis (MPGN)
Which type of nephrotic syndrome can Hepatitis B lead to?
Membranous
Which type of nephrotic syndrome can Hepatitis C lead to?
Membranoproliferazive glomerulonephritis (MPGN)
Congo red stain with apple-green birefringence?
Amyloidosis
Nephrotic syndrome associated with HIV?
FSGS
Glomerular histology reveals multiple mesangial nodules. what disease does the presence of this lesion suggest?
Diabetes
What is the equation for FENa?
(urine Na+/Serum Na+)/(Urine Cr/Serum Cr)
What does a FENa
Likely a pre-renal problem (pt is still conserving Na+ and H2O)
What does a BUN/Cr>20 indicate?
Pre renal
How long does impaired kidney function need to be present before it can be called chronic kidney disease?
> = 3 months
What are the indications for dialysis in a CKD patient?
- severe hyperkalemia
- severe metabolic acidosis.
- fluid overload
- uremic syndrome
- CKD (Cr>12, BUN >100)
- Severe overdose of toxin exposure
What is the first-line pharmacotherapy for idiopathic intracranial HTN?
acetazolamide
What should you consider if you have low serum Na+, high Urine Na+ (>20) and hypervolemia?
Renal failure
What should you consider if you have low serum Na+, LOW Urine Na+ (
- cirrhosis
- nephrosis
- CHF
What condition may result from the rapid correction of hyponatremia?
Central pontine myelinolysis
How fast can hyponatremia be corrected?
Only 12 mEq/L per 24 hours
What are the causes of hypernatremia?
6Ds:
- Diuretics
- dehydration
- diabetes insipidus
- Docs (iatrogenic)
- diarrhea
- disease of the kidney (hyperaldosteronism)–> will not elevate much
What can result of treating hypernatremia too quickly?
Cerebral edema
First line treatment for nephrogenic DI?
- Thiazides (causes a mild hypovolemia which causes increased H2O absorption at PCT)
- then add indomethacin
Treatment for lithium induced DI?
Amiloride
-closes the Na+ channels that let Lithium into the cell
What is the treatment for hyperkalemia?
- IV calcium gluconate (stabilize cardiac membranes)
- Insulin + glucose
- Beta agonists
Remove K+:
- Hemodialysis
- Kayexalate (Sodium polystyrene sulfonate)
- Loop diuretics (chronic hyperkalemia)
What are the causes of hypercalcemia?
- Hyperparathyroidism
- Neoplasms (paraneoplastic)
- Thiazides
- Milk-alkali syndrome
- Sarcoidosis (granulomas secrete Vit D)
- Hypervitaminosis A
What are the causes of hypocalcemia?
- Hypoparathyroidism
- Hyperphosphatemia
- Chronic renal failure
- Vit D deficiency
- Loop diuretics
- pancreatitis
- alcoholism
Electrolyte imbalance that causes prolonged QT?
Hypocalcemia
Electrolyte imbalance that causes shortened QT?
hypercalcemia
What is Winter’s formula? When is it used?
pCO2=1.5(HCO3-)+ 8 +/-2
- used to predict CO2 in metabolic acidosis.
- If actual CO2 differs from predicted pCO2–> mixed disorder
What acid-base disorder can aspirin overdose cause?
- Respiratory alkalosis (stimulated the brain to hyperventilate)
- Metabolic acidosis (leads to uncoupling of oxidative phosphorylation –> lactic acidosis)
What is the cause of Type 1 RTA? What will the urine pH, Serum K+ be? Tx?
- Impaired H+ secretion
- High urine pH
- Low serum K+
- oral HCO3-
- K+ supplements
- Thiazides
What is the cause of Type 2 RTA?What will the urine pH, Serum K+ be? Tx?
- Impaired HCO3- reabsorption
- Low urine pH
- Low serum K+
- oral HCO3-
- K+ supplements
- Thiazides
What is the cause of Type 4 RTA? What will the urine pH, Serum K+ be? Tx?
- hypoaldosteronism
- Low urine pH
- High serum K+
- Fludrocortisone (replace aldosterone)
- K+ restriction
Patient with fever, rash, elevated creatinine and eosinophilia?
Acute interstitial nephritis
Drugs that cause gynecomastia?
STACKED Spironolactone THC Alcohol (chronic) Cimetidine Ketoconazole Estrogen Digoxin
Treatment for breast abscess?
- Dicloxacillin, cephalexin, or amoxicillin/clavulanic acid
- Bactrim if suspect MRSA
- Metroidazole if suspect anaerobes
- keep breastfeeding/pumping
Multiple, bilateral breast masses that are painful and increase in size before menstruation?
Fibrocystic changes
Solitary, firm, mobile breast nodule increases in size with estrogen? Next step?
- Fibroadenoma
- > 35 –> diagnostic mammogram
- US and FNA, core biopsy or excision biopsy
Serous, “straw-colored” nipple discharge +/- streaked with blood?
Intraductal papilloma (rare malignant transformation) –> surgical excision
Large, bulky tumor with “leaf-like” projections on biopsy?
Phyllodes tumor
-monitor closely
Which type of breast carcinoma in situ is ER and PR positive?
LCIS (lobular carcinoma in situ)
-also has a higher risk for invasive cancer in either breast (not from the LCIS but for other reasons?)
Stellate border on mammography or biopsy?
Invasive ductal carcinoma
Signet ring cells or single-file rows of cells?
Invasive lobular carcinoma
Treatment of DCIS?
lumpectomy +/- radiation
Treatment of LCIS?
observation + Tamoxifen
-consider prophylactic bilateral mastectomy
Treatment of early, focal invasive carcinoma?
lumpectomy and radiation
If a breast cancer is ER or PR positive, what should they be treated with?
Tamoxifen
If a breast cancer is positive for HER2, what should they be treated with?
Trastuzumab (Herceptin)