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MTBs Step 2CK > Nephro > Flashcards

Nephro Flashcards

1
Q

when are urine nitrates positive? what 3 UTIs are they not positive in?

A

positive with gram -.

3 gram + UTIs: GBS, Staph Saph & Enterococcus

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2
Q

Urinalysis shows pyuria, what does this tell u? what does this not tell u?

A

great! theres wbc in the urine. cant tell u which ones though so u dnt know if its a bunch of neutrophils or eosinophils(AIN)

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3
Q

how can you detect eosinophils on urinalysis?

A

Wright & Hansel Stain

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4
Q

Casts associated with…

glomerulonephritis

A

RBC

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5
Q

Casts associated with…

pyelonephritis

A

WBC

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6
Q

Casts associated with…

Acute/Allergice intersitial nephritis

A

eosinophils

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7
Q

Casts associated with…

dehydration

A

hyaline

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8
Q

Casts associated with…

chronic renal disease

A

broad/waxy

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9
Q

Casts associated with…

acute tubular necrosis

A

granular “muddy/brown”

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10
Q

whats another name for acute renal failure?

A

acute kidney injury!

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11
Q

3 type of AKI/ARF

A

prerenal azotemia, postrenal azotemia & intrinsic

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12
Q

symptoms of SEVERE AKI

A

confusion(uremia), Arrhythmia(hyperkalemia and acidosis), Pleuritic chest pain(uremic pericarditis)

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13
Q

Prerenal Azotemia
BUN/Cr? Una?Uosm?
^why?

A 
BUN/Cr = >20:1
Una = low <20
Uosm = high >500

*prerenal = kidney not getting enough blood flow =thinks ur hypotensive = responds by absorbing Na & water = urine has low Na and is very concentrated =)

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14
Q

Postrenal Azotemia

causes?sx?

A

causes: stones, strictures, cancers, neurogenic bladder
sx: distended bladder, large volume diuresis, bilateral hydronephrosis on U/S

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15
Q

Intrarenal Azotemia
BUN/Cr? Una?Uosm?
^why?

A

BUN/Cr = 10:1, Una = high >40, Uosm = low <350

*kidney itself is damaged = cant do what its suppose to do = absorb water and na =(

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16
Q

Causes of Intrarenal azotemia

A

Acute tubular necrosis, allergie interstitial nephritis, Toxin-induced injury, rhabomyolytisi, crystal-induced/ethylene glycol, contrast induced,

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17
Q

Acute Tubular Necrosis

whats dis?

A

hypoperfusion or some shit that has caused death of the tubular cells. = intrarenal azotemia(BUN/Cr = 10:1, Una = high >40, Uosm = low <350) + granular muddy/brown casts

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18
Q

Allergic Interstial Nephritis

sx?

A

allergy to some shit pissed off the kidney!
sx: intrarenal azotemia(BUN/Cr = 10:1, Una = high >40, Uosm = low <350) , eosinophilic casts(wright& Hensel stain), rash, fever, ARTHRALGIAS

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19
Q

Toxin-induced renal failure drugs?

A

aminoglycosides, amphotericin, vancomycin, acyclovir, cyclosporin, cisplatin

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20
Q

How long before chemo drugs dmg the kidney?

A

5-10 days

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21
Q

How long before abx dmg kidney?

A

4-5 days

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22
Q

How long before you see tumor lysis syndrome(hyperuricemia) dmg kidney?

A

1-2days

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23
Q

How long before you see contrast fuck up the kidney?

A

12 hours

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24
Q

Why is contrast nephropathy so different from the other Intrarenal azotemias?

A

it causes intrarenal dmg but it does by causing spam of arrerent arteriol = presents like pre-renal(BUN/Cr = >20:1, Una = low <20, Uosm = high >500)

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25
Q

What will you see with Ethylene Glycol induce nephritis?

A

renal failure, HYPOCALCEMIA, ENVELOPED SHAPED CYRSTALS IN URINE + intrarenal azotemia(BUN/Cr = 10:1, Una = high >40, Uosm = low <350)

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26
Q

What will you see with Rhabdomyolysis induced nephritis?

A

hx of large M necrosis =

  • intrarenal azotemia(BUN/Cr = 10:1, Una = high >40, Uosm = low <350)
  • ELEVATED CPK, K, HYPERURICEIMIA(crap from inside cells)
  • hypocalcemia bc K binds the Ca
  • elevated urine myoglobin
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27
Q

tx of ethylene glycol induced nephritis?

A

FOMEPIZOLE + Dialysis

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28
Q

tx of Rhabdomyolysis induced nephritis?

A

Bolus NS, mannitol & diuresis +/- alkalinization of the urine

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29
Q

person comes in with obvious Rhabdomyolysis. whats the first thing u shoudl do? why?

A

ECG!! = all that K poring out of cells can cause arrhythmias

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30
Q

How can you prevent contrast induced renal failure?

A

give lots of water!

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31
Q

NSAID induced kidney dmg

sx?

A

AIN, Nephrotic synd, decreased perfusion due to afferent arteriolar vasoconstriction & PAPILLARY NECROSIS(fever, flank pain, hematuria but no bacteria(ddx pyelo))

32
Q

Glomerulonephritis

whats this? what will you see?

A

Kidney filter is messed up = kidney is losing crap it shouldnt be loosing!

sx: hematuria, RBC casts, Protinuria, edema
* NORMAL Una or Low bc tubules are working fine

33
Q

Goodpastures syndrome

sx? tx?

A

Ab to A3 chain of T4 collagen = lung & kidney probelms

sx: cough, hemoptysis, SOB and lung shit
tx: plasmapheresis & steroids

34
Q

Churg-Strauss Syndrome

A

Eosinophilic granulomatosis with polyangiitis = lungs + kidneys, eosinohphilic pneumonitis, allergies, asthma, PANCA

**looks alot like wegners but with peripheral eosinophilia!

35
Q

Wegner’s Granulomatosis

sx?

A

C-dz = lungs, kidneys & nasopharynx

36
Q 
Polyarteritis Nodosa(PAN)
sx? dx? tx?
A
  • systemic vasculitis that spares the lungs
    sx: renal, myalgias, GI bleeding/ab pain, purpuritc skin lesions(petechia, livedo reticularis), stroke, uveitis, neuropathy(mononeuritis multiplex)
    dx: assoc hep B/C, inflammatory markers elevated, angiography showing beading
    tx: cyclophosphamide and steroids
37
Q

IgA Nephropathy

sx? dx? tx?

A

IgA & IC depo in glomerulus 1-2 days after infection

sx: painless recurrent hematuria, recent viral infection
dx: bx
tx: steroids & ACEi

38
Q

Henoch-Schonlein Purpura

sx? dx? tx?

A

systemic IgA mediated vasculitis

sx: raised nontender purpuric skin lesions, abdominal pain, bleeding, joint pain, renal involvement
dx: bx
tx: none

39
Q

PSGN

sx? dx? tx?

A
  • compliment deposition in subepithelium
    sx: hematuria(coca-cola colored urine), PERIOBITAL EDEMA, HTN, hx of skin infection 1-3 weeks ago
    dx: Antistretolysin Ab(ASO), Anti-DNase, Anti-Hyaluronidase, low compliment
    tx: PCN + control HTN w/diuretics
40
Q

Drug induced lupus spares….

A

kidney and brain!

41
Q

Alport Syndrome

sx? tx?

A
  • XL defect in T4 collagen
    sx: eye, ear and kidney prob
    tx: none
42
Q

Nephrotic Syndrome

sx?

A
  • > 3.5g/protein/d
  • edema
  • hyperlipidemia
  • thrombosis(los of PC&PS
43
Q

What is associated with the nephrotic syndrome:

minimal change disease

44
Q

What is associated with the nephrotic syndrome:

membranous glomerulonephritis

A

adults, cancers

45
Q

What is associated with the nephrotic syndrome:

membranoproliferative glomerulonephritis

46
Q

What is associated with the nephrotic syndrome:

FSGS

A

HIV, heroin use

47
Q

End-Stage Renal Disease Sx?

A
  • hyperphos = cant excrete
  • hypermag = cant excrete
  • anemia = no epo
  • hypocalcemia = no 1,25D
  • Osteoporosis = 2nd Hyperparathyroidism due to hyperP&hypoCa cause increased in PTH
  • Bleeding = platelets cant degraulate, neither can wbc = infections
48
Q

Diabetes Insipidus(DI)

A

failure to produce ADH or failure of kidneys to respond to ADH

49
Q

Neprogenic Vs Central DI

dx?

A

*water deprivation test
corrects = psycogenic
doesnt correct = give ADH ~ if this corrects = central DI if doesnt correct = nephrogenic DI

50
Q

tx of Nephrogenic DI

A

Thiazide Diuretics or correct underlying cause

51
Q

tx of central DI

A

vasopressin

52
Q

Na excess/deficits cause —- where as K causes —–.

A

Na=CNS sx

K=Muscle weakness & heart sx

53
Q

sx of hyper/hyponatremia

A

neurological abnormalities, confusion, disorientation, seizures, coma

54
Q

Causes of Hypervolemic Hyponatremia

A

CHF, nephrotic syndrome, Cirrhosis =decrased intravascular volume = ADH baroreceptors activated = increased free water absorption

55
Q

Causes Hypovolemic Hyponatremia

A

Diuretics, GI loss of fluids(vomiting, diarrhea), Skin loss of fluids(burns, sweating) = isotonic fluid loss

56
Q

Causes of Euvolemic Hyponatremia

A

SIADH, Hypothyroidism, Psychogenic polydipsia, Hyperglycemia, Addisons

57
Q

Why does hyperglycemia cause hyponatremia

A

Na drops 1.6pts for each 100mg of glucose above normal

58
Q

tx of moderate hypoglycemia

A

loop diuretics

59
Q

tx of severe hypoglycemia

A

hypertonic saline, ADH blockers(conivaptan, tolvaptan)

60
Q

Causes of hyperkalemia

A
  1. decreased excretion = low aldo, renal failure

2. increased release from tissues = cell lysis, low insulin, acidosis, drugs

61
Q

metabolic —— causes hyperkalemia

62
Q

Pseudokyperkalemia

A

artifact caused by the hemolysis of red cells in the laboratory or prolonged tourniquet placement during phlebotomy == repeat the test!

63
Q

EKG sx seen with Hyperkalemia

A

1st = peaked T-wave
2nd = absent/flat P-waves
3rd = wide QRS
*in this order

64
Q

tx of hyperkalemia without EKG changes

A

Insulin + glucose & Kayexalate

65
Q

tx of hyperkalemia with EKG changes

A

Calcium gluconate IV, insulin+glucose + Kayexalate

66
Q

EKG changes seen with hypokalemia

A

Uwave = repolarization of the purkinji fibers seen as a peak just after the Twave

67
Q

refractory hypokalemia despite K replacement coudl be caused by….

A

hypoMg = low Mg increases excretion of K in kidneys

68
Q

Formula to calculate anion gap

A

Na - (Cl + HCO3) = 6-12

69
Q

Aspirin overdose causes what pH abnormality? tx?

A

respiratory alkalosis from hyperventilation then metabolic acidosis.

tx: bicarb

70
Q

Methanol intoxication

sx? tx?

A

sx: metabolic acidosis, Inflammed retina
tx: fomepizole

71
Q

Ethylene Glycol

tx?

A

fomepizole

72
Q

causes of normal metabolic acidosis

A
  1. Diarrhea
  2. Renal Tubular Acidosis
    - RTA1 =cant excrete H
    - RTA2 =cant reabsorb HCO3
    - RTA4 = decreased aldosterone production
73
Q

RTA 1

Urine pH? serum K? Stones? tx?

A

high pH, low K, stones, tx bicarb

74
Q

RTA 2

Urine pH? serum K? Stones? tx?

A

low pH, low K, no stones, tx thiazide diuretic + HD bicarb

75
Q

RTA 4

Urine pH? serum K? Stones? tx?

A

low pH, high K, no stones, tx fludrocortisone(aldo agonist)

76
Q

HTN in person >60

77
Q

HTN in normal person

MTBs Step 2CK (20 decks)

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