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OME Cards > Nephro > Flashcards

Nephro Flashcards

1
Q

How to reduce contrast induced kidney injury?

A

Vigorous intravenous hydration has proven to reduce risk of contrast induced nephropathy

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2
Q

what is side effect of giving EPO in ESRD?

A

Erythopoitein is given to patients on dialysis in order to correct anemia of chronic kidney disease. EPO can worsen hypertension though.

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3
Q

When should EPO be given to ESRD patients?

A

EPO therapy is indicated for ESRD patients w/ Hgb <10

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4
Q

African American and AIDS nephropathy?

A

Focal Segmental glomerular sclerosis (FSGS)

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5
Q

IgA nephropathy:

A

Hx of strep infx (pharyngitis/URI/ skin infx)

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6
Q

Kimmelstiel- wilson Nodules:

A

Associated it Diabetes

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7
Q

Calcium oxalate stone in kidney treatment:

A

Most common type of kidney stone

1) Reduce calcium w/ thiazide diuretics
2) Reduce oxolate by decreasing meat consumption & VITAMIN C
3) Increase citrate levels by eating more fruit

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8
Q

If you suspect kidney stone.. what is best test for size and location?

A

Non-contrast CT scan

U/S in pregnant patient

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9
Q

Treatment for kidney stone <5mm

A

Stone will pass spontaneously. Hydration (IVF) and pain control is all that is needed

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10
Q

Treatment for kidney stone <7mm

A

Use medical expulsive therapy: CCB (amlodipine) and Alpha blockers (terazosin) to dilate the ureters.

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11
Q

Treatment for kidney stone <1.5cm

A

Stone will need to be broken down in order to pass. Use ureteroscopy for distal stones and lithotripsy for proximal stones

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12
Q

Treatment for kidney stone >1.5cm

A

Stone will need to be resected.
Proximal stones w/ laparoscopic exploration

Distal stones w/ percutaneous anterograde nephrolithotomy

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13
Q

Treatment for kidney stone w/ sepsis, kidney failure etc

A

Use nephrostomy tube for proximal stone and stent for distal stone until pt is stabilized and ready for surgery.

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14
Q

Old man w/ frequent UTIs and alkaline urine. What kind of kidney stone?

A

Alkaline environment is perfect for magnesium ammonium phosphate stones (struvite stones) staghorn calculi throughout renal pyramids

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15
Q

Management of hyperkalemia WITHOUT ECG changes:

A

1) Furosemide diuresis- renally excreting the potassium

2) Kayexalate - Excreting it thru the stool

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16
Q

Management of hyperkalemia WITH ECG changes:

A

Intravenous calcium carbonate is used to stabilize the myocardium in hyperkalemia with abnormal ECG findings.

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17
Q

Person with hypokalemia due to HCTZ. What can you add to manage HTN and prevent hypokalemia?

A

Add Ace-inhibitor or ARb which are K sparing. Will help with BP and hypokalemia

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18
Q

what is used to replete potassium?

A

Potassium chloride

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19
Q

what are the 3 phases of treating symptomatic hyperkalemia with EKG changes?

A

1) Stabilization of the myocardial membrane (IV Ca carbonate or gluconate)
2) Temporizing the potassium out of the blood (Na bicarbonate, insulin D50 & Beta-2 agonists (albuterol)
3) Eliminate K from blood (Furosemide, kayexalate, hemodialysis

20
Q

Young man with a family history of calcium disorders who has an asymptomatic hypercalcemia. He has a modestly elevated calcium, modestly elevated PTH, and a barely low phosphorous.

A

familial hypocalciuric hypercalcemia-Diagnosis is made by urinary calcium

21
Q

Patient is older, has a smoking history, and has a lung mass.
PTH is undetectable, the calcium elevated and the phosphorous is low. How to diagnose?

A

Serum PTH-rp

22
Q

Sestamibi scan of neck showing a single adenoma definitively means

A

primary hyperparathyroidism- high calcium, low phos, and high PTH in the setting of normal renal function- biopsy would be prudent to confirm it is non malignant, but the treatment is still resection, parathyroidectomy.

23
Q

Treatment for acute, severe, and symptomatic hypercalcemia as a temporizing measure while fluids are being given

A

Calcitonin (calci-tone-down)

24
Q

Hungry Bone syndrome

A

Hungry bone syndrome occurs after a parathyroidectomy; a parathyroid adenoma resection. As the adenoma autonomously secretes PTH the calcium rises and phos falls. The high calcium activates the calcium sensing receptor and turns off endogenous production of PTH, leading to atrophy of the normal parathyroid glands. When the adenoma is removed the normal parathyroid glands need time to “turn back on,” presenting with low phos, low calcium, and low PTH immediately post-operatively. Unlike the total loss of parathyroid glands that can accompany thyroidectomy, hungry bone syndrome will resolve as the parathyroid glands come back on line.

25
Q

If symptomatic hypocalcemia, give

A

intravenous calcium (Ca gluconate)

26
Q

When is Intravenous calcitriol used to treat hypocalcemia in patients?

A

Calcitriol is 1, 25-Vit D analogue. Intravenous calcitriol is used to treat hypocalcemia in patients where the impairment of 25-Vit D to 1, 25-Vit D is so severe is causes hypocalcemia. This would be in chronic kidney disease patients.

27
Q

How is hypercalcemia due to sarcoid treated?

A

Prednisone can be used to quell inflammatory diseases like sarcoid. Granulomatous diseases can increase Vit D and cause a hypercalcemia through hypervitaminosis D. Steroids decrease the inflammation, decrease the granulomatous disease, and decrease the hypercalcemia.

28
Q

Patient with high calcium and low phosphorous with normal kidneys. Diagnosis?

A

The most common cause of hypercalcemia in the outpatient setting is primary hyperparathyroidism. Regardless, with an elevated calcium and a low phos, that speaks to PTH activity in the kidney (which works). To ensure this is true a PTH level should be measured.

29
Q

Management of hypercalcemia of malignancy

A

Vigorous fluids and bisphosphonates (Alendronate) are the treatment of choice for sustained reduction in the calcium level.

30
Q

Diagnosis of hyperparathyroidism is obvious: high calcium, low phosphorous, and very high PTH.

The difficulty is separating WHICH hyperparathyroidism it is - Primary or tertiary?

A

multiple adenomas in multiple places and the history of chronic kidney disease nearing end-stage renal disease, that is certainly to be tertiary hyperparathyroidism.

Primary hyperparathyroidism will present WITHOUT renal failure and with a SINGLE nodule.

31
Q

Type I (Distal) Renal tubular acidosis

A

Impaired distal acid secretion

Urine pH >5.5

Serum Potassium- Low

Positive urine anion gap

32
Q

Type II (Proximal) Renal tubular acidosis

A

Impaired proximal bicarbonate reabsorption

Urine pH < 5.5

Serum Potassium- Low

Negative urine anion gap

33
Q

Type IV

A

Hypoaldosteronism or aldosterone resistance

Urine pH < 5.5

Serum Potassium- high

Positive urine anion gap

34
Q

What is Alport syndrome?

A

Usually in boys aged 5-20

Defect in alpha chain of type 4 collagen

Glomerulonephritis, deafness, eye disorder

Glomerular basement splitting (hematuria)

Nephritic- mild proteinuria of 1 to 2 g/24 hours.

35
Q

Hypercalcemia affects:

A

Renal- it causes afferent arteriole vasoconstriction (polyuria, polydipsia, kidney stones, nephrogenic DI, Distal renal tubular acidosis

Cardic- shorterned QT interval , bradycardia, hypertension

36
Q

Urinalysis of a diabetic patient

A

1st sign on urinalysis is proteinuria

Nephrotic syndrome (Kimmelstiel-Wilson) that is characterized by a protein loss > 3.5 g/day

Kimmelstiel-Wilson disease because of the presence of pink nodules of hyaline in the glomerular capillaries

37
Q

Urinalysis of a Acute Tubular necrosis

A

Muddy brown casts

Can result from ischemia due to shock or chronic renal artery stenosis or nephrotoxic agents, such as cisplatin, aminoglycosides, and ethylene glycol ingestion.

38
Q

Liddle syndrome

A

Autosomal dominant condition that causes genetic mutation causing the epithelial sodium channel (ENaC) in the distal tubule to become constitutively active. This causes hypernatremia (HTN) and hypokalemia (metabolic alkalosis)

Look for HTN in young patient

Tx: Amiloride

39
Q

Bartter syndrome (Mimics loop diuretics)

A

Autosomal recessive mutation that causes reabsorption defect at thick ascending loop. Affects Na/K/2Cl cotransporter.

Results in hypokalemia and metabolic alkalosis w/ hypercalciuria

40
Q

Gitelman syndrome (Mimics thiazide diuretics)

A

Autosomal recessive mutation causing reabsorption defect of NaCl at DCT

Leads to hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria.

41
Q

Treatment for severe (<120 mEQ/L) hyponatremia

A

Raising the serum sodium by 4-6 mEq/L should result in relief of symptoms while preventing herniation.

Use 100-mL bolus of 3% saline. If symptoms persist, 2 additional 100-mL doses (total of 300 mL) can be given over 10 minutes

42
Q

Nail changes and diseases

A

Koilonychia- Spoon shaped nail- Iron deficiency anemia

Onychorrhexis- Vertically ridged or split nail- Physiologic in elderly

Paronychia- Painful redness and swelling of nail folds- Local bacterial, fungal, or viral infection

Onycholysis- Splitting of distal nail plate from nail bed- Psoriasis, atopic dermatitis, trauma

Pitting- Indentations of nail plate- Psoriasis, alopecia areata

43
Q

Risk factors for Pancreatic cancer

A

1) smoking
Male gender
Age > 60 years
Being African American.

44
Q

Acute interstitial nephritis (AIN) secondary to chronic NSAID exposure

A

Unlike other etiologies of AIN, NSAID-induced AIN can present months, rather than days, after exposure

Urinalysis is often negative for eosinophils, and patients have significant proteinuria

45
Q

Diagnosis for acute interstitial nephritis

A

Renal biopsy provides the definitive diagnosis

Biopsy often reveals mononuclear, eosinophilic cellular infiltrate within the renal parenchyma with sparing of the glomeruli.

OME Cards (20 decks)

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