Nephro-electrolytes

Question 1

SIADH:
Urine Na
Urine osmolarity

Answer 1

Urine Na > 20

Urine osmolarity > 400

Question 2

Hyponatremia with low urinary Na

Answer 2

Urinary Na < 20

Hypovolemic:
Extrarenal losses 
Vomiting 
Diarrhea 
Third spacing of fluids 
Burns 
Pancreatitis 
Trauma

Hypervolemic:

Nephrotic syndrome
Cirrhosis
Cardiac failure

Question 3

Which electrolyte disbalances potentiate digoxin toxicity

Answer 3

HyperCalcemia
HypoKalemia
HypoMagnesemia

Question 4

What reduces Dygoxin toxicity

Answer 4

HyperMagnesemia
HypoCalcemid

Treat with specific antibody in severe cases!

Question 5

SIADH WATER RESTRICTION

Formula and 3 categories

Answer 5

(UNa + UK) / SNa

< 0.5 — 1 liter
0.5 - 1 — 500 ml
> 1 — will not respond

Question 6

High dose prolonged penicillin may lead to:

Answer 6

Hypokalemia

Metabolic alkalosis

Question 7

Rhabdomyolisis electrolyte disorders

Answer 7

Hypocalcemia
HyperPhosfatemia
hyperKalemia

Question 8

Gitelmans

Answer 8

Alcalosis
HypoKalemia
HypoCalciUria

Question 9

Liddle’s

Answer 9

HypoKalemia
Hypertension
Metabolic alkalosis

(ENaC activation, mineralcorticoid like)

Question 10

RTA II

NOT READY !!

Answer 10

1 Proximal - glucozuria, aminoaciduria, posphaturia

Question 11

Salicylate poisoning

Answer 11

High anion gap metabolic acidosis + respiratory alcalosis

Question 12

Lithium intoxication

Answer 12

Low anion gap

Nephrogenic diabetes insipidus

Question 13

Low anion gap

Answer 13

Lithium intoxication (cation)
Hypoalbuminemy (anion)
Hyperviscozity and hypercholesterolemy (Na and Cl levels deviation)
Unmeasured cations (immunoglobulins in MM)

Question 14

PPI

Answer 14

HypoMagnesemia: weakness, prolonged QT

Question 15

HypoMagnesemia
ECG changes
Associated electrolyte disturbances
Drugs that can cause

Answer 15

PR and QT prolongation, negative or flat T
Hypokalemia
PPI - not absorbed

Question 16

Drugs causing HypoMagnesemia

Answer 16

PPI - low GI absorption

Diuretics
	Furosemide
	Thiazides				low renal reabsorbtion
	Osmotic diuretics
Cyclosporine
Aminoglycosides
Amphotericin B

Question 17

Refeeding syndrome electrolytes

Answer 17

HypoMagnesemia ➡️ hypoKalemia

HypoPhosphatemia

Question 18

Acute interstitial nephritis

Answer 18

15 % of Acute renal failure
Allergic interstitial nephritis - drug allergy

Fever, rash, periferic eosinophilia , oliguria
7-10 days after antibiotic treatment (beta lactams usually)

Urine -piura, hematuria, white blood cell casts

Stop drug
Steroids shorten course no survival benefit

Question 19

PolyCystic Kidney

Answer 19

AutosomalDominantPKD
ESRD 60%
Hepatic cysts, diverticulosis, mitral prolapse

ds 
Family history 
2 cysts any side or one side at age 15-29
2 cysts at each side at age 30-59
4 on each side if 60 +

40 % will have macroHematuria
20% have stones

Question 20

Nephrotic syndrome deseases

Answer 20

Minimal change
FSGS
Membranous
MPGN
Diabetic nephropathy
Amyloidosis

Question 21

FSGS

Causes

Answer 21

Viruses HIV Hepatitis  Parvovirus 
Hypertension
Reflux
Cholesterol emboli
Drugs: heroin, analgesics, bisphosphonates, extasy
Oligomeganephronia
Renal dis genesis
Alport’s - collagen IV defect. Hearing loss
Sickle cell
Lymphoma
Radiation

Question 22

Membranous glomerulonephritis

causes

Answer 22

Oncology of breast, lung , colon
Infection: HBV, HCV, siphilis, malaria, schistosomiasis
Rheumatic: lupus, RA, IGG4
Drugs: gold, mercury, NSAIDs, probenicid

Question 23

HyperCalcemia causes

Answer 23

PTH
1-25 vit D
HyperThyroidism and long laying- bone resorption
Drugs: vit A, thiazides, antiEstrogens

Question 24

Bisphosphonates FSGS or membranous

Answer 24

FSGS

Question 25

GFR to start dialysis

Answer 25

Lower 10

Question 26

Hypophospatemia causes: drugs and toxins

Answer 26

4. Drugs or toxins
   a. Ethanol
   b. Acetazolamide, other diuretics
   c. High-dose estrogens or glucocorticoids
   d. Heavy metals (lead, cadmium, saccharated ferric oxide)
   e. Toluene, N-methyl formamide
   f. Cisplatin, ifosfamide, foscarnet, rapamycin