Nephrology 1 Flashcards
What slows progression of CKD with metabolic acidosis ?
Sodium Bicarbonate/ Sodium citrate
Pt presents with edema, Albumin 2.1, Creatine 1.3, Urine protein-creatinine 8700. Kidney biopsy shows minimal change glomerulopathy, In addition to diuretics what other medication does this to diuretics what other patient need?
High dose oral prednisone.
Pt currently being evaluated for MGUS, presenting with Increase Cr. , + UA, M Spike < 10% clonal plasm cells on bone marrow biopsy, no anemia, hypercalcemia, lytic lesions, Immunofixation shows IgG monoclonal type.
What is the most appropriate diagnostic test?
Kidney biopsy to confirm Monoclonal Gammopathy of Renal Significance.
Rx for Calcium Oxalate stones in pt with who has malabsorption?
Potassium Citrate.
Forms in metabolic acidosis ( diarrhea), reduced urine citrate (inhibitor of crystallization), volume depletion from diarrhea)
Pt presents with dizziness, N/V, increased urination, metabolic acidosis, AKI, hypercalcemia. Dx?
Multiple Myeloma
- Flank pain, hematuria, oliguria , Osmol Gap, NO anion gap unless in ketosis ? Rx?
- Ketones, Osmol gap, NO anion gap? Rx?
- Vision loss, Osmol gap, and Anion gap ?
- AKI, Calcium Oxalate Crystals, Osmal gap and Anion gap?
- Ethanol poisoning (ETOH ) .
Supportive Care - Isopropyl alcohol (Rubbing ETOH) Supportive Care
- Methanol (Wiper fluid).
Formic Acid Metabolite
Fomepizole, dialysis if severe - Ethylene glycol (Anti freeze).
Fomepizole, dialysis if severe.
Oxalic Acid Metabolite
(> 10 is presence of Osmol gap)
Man presenting with 2 month hx of painless gross hematuria, hx of CKD, from Bosnia. hgb 10, Cr 4.0, Ur protein-Cr 900mg/g, UA shows numerous nondysmorphic RBCs, Kidney US shows echogenic kidneys and irregular bladder.
What is the most appropriate diagnostic test?
Endoscopy Urologic ( Cystoscopy and Retrograde Ureteropyelography) evaluation to diagnose transition cell (urethral cancer)
Pt with Pulmonary Sarcoid has Hypernatremia and dilute urine
Dx? Rx?
Central DI ( lack of ADH).
Give Desmopressin acetate (ADH) if it does not correct then pt has Nephrogenic DI.
Macroscopic hematuria that resolved, UA 1+ blood, Contrast-enhanced CT urogram shows no kidney stones, masses or cyst. Next test?
Cystoscopy.
Perform diagnostic evaluation for UA that shows > 3 erythrocytes/hpf.
- Sterile pyuria and leukocyte cast?
- Presents of erythrocyte cast?
- Tubulointerstitial nephritis.
- Glomerulonephritis.
- ATN that occurs in 48 hrs after offending agent?
- ATN occurring 7 days after vanc trough 25, pt has hx of CKD.
- CIN (contrast induced nephropathy)
- Drug-Induced AIN
Rx of Dyslipidemia and CKD 4?
Statin/Ezetimibe
Nephritic syndrome: Antibodies directed against type IV collagen, Normal complement levels, Can have MPO antibodies elevated levels of anti-GBM. Kidney biopsy shows crescentic proliferative GN with linear deposition of IgG immunoglobulin along the glomerular capillaries.
Dx?
Rx?
What is the syndrome when pulmonary hemorrhage is involved?
Anti-Glomerular basement membrane antibody disease.
Plasmapheresis, oral prednisone and cyclophosphamide.
Good Pastures Syndrome.
Nephritic syndrome:
Lung and sinus involvement, Epistaxis, AKI, hematuria, proteinuria, viral prodrome, p-ANCA directed against neutrophil enzymes myeloperoxidase (MPO) and c-ANCA directed against neutrophil proteinase 3 (PR3.)
Kidney biopsy shows crescentic glomerulonephritis but immunofluorescence shows absence of immune-type deposits.
Associated with rapidly progressive GN.
Dx?
Rx?
ANCA-Associated Glomerulonephritis (pauci-immune crescentic glomerulonephritis.)
Cyclophosphamide.
Nephritic syndrome:
Kidney biopsy shows membranoproliferative glomerulonephritis on light microscopy with immunofluorescence staining with IgG, IgM, C1, C3.
What disease is associated with this?
Rx?
Membranoproliferative GN is associated with Hep C.
Occurs in children and young adults
Nephritic syndrome:
Occurs 2 days after infection pt gets recurrent gross hematuria. Dx? Rx?
Immune Complex:
IgA nephropathy.
No immunosuppressive therapy. (genetic mutation )
Rx with ACE/ARB for proteinuria.
Nephritic syndrome: Most common childhood vasculitis that occurs after URIs. Pt presents with abdominal pain, palpable purpura, proteinuria. Dx? Rx?
Immune Complex:
IgA Vasculitis.
Self-limiting no treatment
Rx for lupus nephritis (Immune Complex) class III and IV ?
High Dose Steroids, IV Cyclophosphamide or Mycophenolate mofetil
Class I and II no therapy.
Nephritic syndrome that occurs 2 weeks after URI or 4 weeks after skin infection? Rx?
Immune Complex:
Infection related glomerulonephritis.
Rx underlying infection.
Common in whites.
Nephrotic syndrome associated with Phospholipase A2.
Secondary causes are Hep B, SLE, NSAIDs, Solid tumor, Lymphoma. Dx? Rx?
Membranous glomerulopathy.
Steroids and cyclophosphamide or calcineurin inhibitors (tacrolimus)
Medication to manage recurrent stone disease?
HCTZ in patients who have hypercalciuria (familial) with no related hypercalcemia causing the hypercalciuria.
Management of pts diagnosed with Primary Minimal Change Glomerulopathy ?
What is it associated with?
Observe for 6 to 12 months while on Conservative Therapy (RAS blockade, Statin, edema management) allow time for Spontaneous Reemission.
Hodgkin and NONHodgkin lymphoma.
Occurs in children and older adults (RARE).
Which disorders manifest with Metabolic Alkalosis, Hypovolemia and Low urinary chloride ?
Vomiting
NG tube suction
Diuretic use
They are saline responsive.
Emergent treatment for Hypermagnesium?
IV Ca2+
To determine pre-renal AKI from ATN what lab should be ordered?
Urine microscopy
To look granular cast - evidence of ATN
Stones that form with persistently elevate urine PH > 5.5, Amorphous Crystal are shown.
Calcium Phosphate
Dumbbell shape Monohydrate Crystals and Envelope- Shaped Crystals
Calcium Oxalate Crystals.
Associated with IBD.
Difference btw light chain cast nephropathy and NSAID nephropathy?
Light chain cast nephropathy will have elevated urine protein to creatinine ratio but minimal protein on urine dipstick.
Dipstick detects albumin only and not light chains.
Management of type 1 Hepatorenal Syndrome?
Restrict diuretics, sodium, water in hyponatremics, search for precipitating factors.
Give vasoconstrictors (octreotide and oral midodrine) and IV albumin.
Management of new onset gross hematuria and unexplained flank pain with kidney US showing 2 bilateral solid masses ?
Bilateral radical nephrectomy
What is the delta ratio?
Change in anion gap / change in bicarb (AG-12/25-HCO3)
< 1 there is concurrent normal anion gap acidosis.
> 2 there is concurrent metabolic alkalosis.
In a chronic respiratory alkalosis, with every decrease in 10 of the PC02? How much does the bicarb lower?
4-5
Nephrotic Syndrome:
1. Associated with obesity, heroin HIV
- Associated with solid tumors, NSAIDs, Hep B, lupus nephritis
- Associated NSAIDs and Lymphoma
- Associated with Hep C/Cryoglobulinemia, monoclonal gammopathy
- Associated with lupus nephritis
- Associated with upper respiratory tract infection.
- Focal Segmental glomerulosclerosis
- Membranous Nephropathy
- Minimal Change disease
- Membranoproliferative GN
- Diffuse proliferative GN
- IgA nephropathy
