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USMLE Step 3 Master the board > Nephrology > Flashcards

Nephrology Flashcards

1
Q

hypOvolemic hypOnatremia causes (3)

A
  1. diuretics (urine Na+ ELEVATED)
  2. GI loss of fluids (vomiting, diarrhea) (urine Na+ LOW)
  3. skin loss of fluids (burns, sweating) (urine Na+ LOW)

lose water and a little salt, but patient replaces free water only

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2
Q

causes of metabolic alkalosis (6)

A
  1. volume contraction
  2. Conn syndrome
  3. Cushing syndrome
  4. hypOkalemia
  5. milk-alkali syndrome (too much liquid antacid)
  6. vomiting
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3
Q

MOST ACCURATE test for nephrOtic syndrome

A

kidney biopsy

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4
Q

first step when patient presents with mild proteinuria

can occur in 2-10% of population at any given time

A

REPEAT UA

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5
Q

treatment for SIADH: moderate to severe hypOnatremia (confusion, seizures)

A
  • SALINE INFUSION with loop diuretics
  • HYPERTONIC (3%) saline
  • check serum Na+ frequently
  • ADH blockers (conivaptan, tolvaptan)
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6
Q

treatment for HTN, AND: CHF

A

BB, or ACEI/ARB

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7
Q

treatment for orthostatic proteinuria

A

none; does not need to be treated

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8
Q

MOST ACCURATE test for PSGN

A

kidney biopsy = SUBepithelial IgG and C3 deposits

but should NOT always be done; blood test are usually enough

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9
Q

aspirin overdose mechanism of metabolic acidosis

A
  • respiratory alkalosis from hyperventilation

- metabolic acidosis (loss of aerobic metabolism from mitochondrial poisoning leading to lactic acidosis)

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10
Q

MOST ACCURATE test for rhabdomyolysis

A

urine myoglobin

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11
Q

how does volume contraction cause metabolic alkalosis?

A

secondary hypERaldosteronism, causes increased urinary acid loss

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12
Q

test for proximal RTA (type 2)

A

administer bicarbonate

  • normal person with metabolic acidosis = will absorb bicarbonate, and will still have low urine pH
  • proximal RTA patient = cannot absorb bicarbonate, URINE pH WILL RISE
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13
Q

FIRST STEP in management of hypOnatremia

A

ASSESS VOLUME STATUS

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14
Q

treatment for HUS

A

supportive; do NOT treat with antibiotics

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15
Q

clues renal failure is ACUTE

A
  1. normal kidney size
  2. normal hematocrit
  3. normal Ca2+
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16
Q

causes of SIADH

A
  • any CNS abnormalities
  • any lung disease
  • medications (sulfonylureas, SSRIs, carbamazepine)
  • cancer
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17
Q

treatment for PRErenal azotemia

A

treat UNDERLYING cause

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18
Q

what will you see in the urine in ethylene glycol poisoning?

A

oxalate crystals

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19
Q

pseudohypERkalemia

A
  • hemolysis of RBCs

- prolonged tourniquet placement

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20
Q

diagnostic clues for Wegener granulomatosis (now known as, granulomatosis with polyangiitis)

A
  • SINUSITIS, or OTITIS (biggest clues to diagnosis, and main distinguishing factor between Goodpasture syndrome)
  • lung findings (e.g. nodules)
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21
Q

MOST ACCURATE test for primary renal d/o with NO specific PE findings (only associations)

A

kidney biopsy

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22
Q

causes of AGN (acute glomerulonephritis)

name 11

A
  • Goodpasture’s syndrome
  • Churg-Strauss syndrome
  • Wegener’s granulomatosis
  • polyarteritis nodosa
  • IgA nephropathy (Berger’s disease)
  • Henoch-Schonlein purpura
  • poststreptococcal glomerulonephritis
  • cryoglobulinemia
  • lupus nephritis
  • Alport syndrome
  • TTP/HUS
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23
Q

diagnostic clues for IgA nephropathy (Berger’s disease)

A
  • PAINLESS RECURRENT HEMATURIA
  • Asian
  • recent viral respiratory tract infection
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24
Q

causes of secondary HTN based on age: middle-aged adults (ages 40-69)

A
  • aldosteronism
  • thyroid dysfunction
  • obstructive sleep apnea
  • Cushing syndrome
  • pheochromocytoma
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25
Q

what must be true in order for postobstructive uropathy to cause renal failure?

A

MUST BE BILATERAL

UNIlateral obstructive cannot cause renal failure

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26
Q

characteristic diagnostic tests for INTRArenal renal failure

A
  • BUN:Cr ratio of 10:1
  • urinary sodium more than 40
  • urine osmolality less than 350
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27
Q

primary renal d/o with NO specific PE findings (only associations): hepatitis C

A

membranoproliferative

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28
Q

best NEXT test if SMALL kidney is seen in patient suspected to have RAS

A
  • MRA
  • duplex ultrasonogram
  • nuclear renogram
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29
Q

treatment for lupus nephritis: sclerosis ONLY

A

NO treatment

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30
Q

best INITIAL treatment for RAS

A

renal artery angioplasty and stenting

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31
Q

causes of secondary HTN based on age: older adults (age greater than 65)

A
  • atherosclerotic renal artery stenosis

- renal failure

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32
Q

what should be tested for in PAN?

A

hepatitis B and C (30% association)

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33
Q

stress incontinence

  • presentation
  • testing
  • treatment
A
  • NO pain
  • COUGHING, and LAUGHING
  • observe leakage with coughing
  • Kegel exercise/exercise cream
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34
Q

what result indicates a patient has orthostatic proteinuria?

A

protein in AFTERNOON urine ONLY, and NOT in the morning

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35
Q

treatment for hypOreninemic hypOaldosteronism (type 4)

A

fludrocortisone

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36
Q

treatment for lupus nephritis: mild disease, early stage, nonproliferative

A

steroids

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37
Q

metabolic acidosis with increased anion gap (HAGMA) causes

A

MUDPILES

Methanol
Uremia
DKA
Propylene glycol
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
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38
Q

treatment for SIADH: mild hypOnatremia (no symptoms)

A

fluid restriction

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39
Q

causes of secondary HTN based on age: children and adolescents (birth to age 18)

A
  • renal parenchymal disease

- coarctation of aorta

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40
Q

hypOreninemic hypOaldosteronism (type 4)

  • urine pH
  • serum K+
  • stones?
  • test
  • treatment
A
  • LOW urine pH
  • HIGH K+
  • NO
  • urine Na+ loss
  • fludrocortisone
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41
Q

NEXT best test for nephrOtic syndrome

A

spot urine for protein:creatinine ratio; more than 3.5:1

equal in efficacy to 24H urine protein collection

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42
Q

if proteinuria is PERSISTENT and not orthostatic, next step is

A

24H urine, OR spot protein:creatinine ratio

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43
Q

treatment for rhabdomyolysis

A
  1. NS bolus
  2. mannitol (decrease contact time of myoglobin with the tubules)
  3. alkalinization of urine (decreases precipitation of myoglobin in the tubules)
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44
Q

causes of rhabdomyolysis

A
  • crush injury
  • seizure
  • cocaine toxicity
  • prolonged immobility
  • hypOkalemia resulting in muscle necrosis
  • recent initiation of STATIN
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45
Q

first step in evaluating renal failure

A
  1. PRErenal (perfusion)
  2. RENAL (parenchymal)
  3. POSTrenal (drainage)
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46
Q

manifestation of uremia and treatment: hypocalcemia

A

vitamin D replacement

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47
Q

best INITIAL test for lupus nephritis

A
  • ANA and anti-dsDNA Ab
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48
Q

treatment for HTN, AND: CAD

A

BB

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49
Q

hypOnatremia presents with

A

NEUROLOGICAL ABNORMALITIES:

  • CONFUSION
  • DISORIENTATION
  • SEIZURES
  • COMA
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50
Q

MOST ACCURATE test for RAS

A

renal angiogram

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51
Q

hypOreninemic hypOaldosteronism (type 4)

A
  • decreased aldosterone production
  • diabetic patient with NAGMA
  • ELEVATED K+
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52
Q

if NO response to steroids AFTER 12 WEEKS for primary renal d/o with NO specific PE findings (only associations), then next in treatment

A

cyclophosphamide

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53
Q

treatment for HTN, AND: asthma

A

AVOID BB

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54
Q

which hormone needs magnesium to function

A

PTH (parathyroid hormone)

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55
Q

first step to CONFIRM orthostatic proteinuria

A

SPLIT THE URINE: morning urine AND afternoon urine

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56
Q

treatment for lupus nephritis: severe disease, advanced, proliferative

A

mycophenolate mofetil AND steroids

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57
Q

findings for SIADH

A
  • inappropriately HIGH urine Na+ (more than 20meq/L)
  • inappropriately HIGH urine osmolality (more than 100mOsm/kg)
  • LOW serum osmolality (less than 290mOsm/kg)
  • LOW serum uric acid
  • normal BUN, creatinine, and bicarbonate
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58
Q

diagnostic clues for polyarteritis nodosa (PAN)

A
  • systemic vasculitis with involvement of every organ EXCEPT the lungs
  • MULTIPLE MOTOR DEFICITS
  • SENSORY NEUROPATHY WITH PAIN
    (are key to diagnosis)
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59
Q

treatment for distal RTA (type 1)

A

bicarbonate

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60
Q

proximal RTA (type 2)

A

inability to REABSORB bicarbonate in PROXIMAL tubule

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61
Q

proximal RTA (type 2)

  • urine pH
  • serum K+
  • stones?
  • test
  • treatment
A
  • LOW urine pH
  • LOW K+
  • NO
  • give bicarbonate
  • thiazide diuretic and high dose bicarbonate
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62
Q

what will the urine osmolality, urine Na+, and urine volume be in BOTH central and nephrogenic DI, and what will happen to the urine osmolality with water deprivation?

A
  • LOW urine osmolality
  • LOW urine sodium
  • INCREASED urine volume
  • NO change in urine osmolality with water deprivation
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63
Q

what is the difference between vasopressin and DDAVP?

A
  • vasopressin aka ADH = natural de novo hormone

- DDAVP is the trade name for desmopressin = synthetic ADH replacement

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64
Q

MCC of death in ADPKD

A

ESRD

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65
Q

treatment for AIN

A

no specific therapy, resolves on its own

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66
Q

metabolic acidosis with normal anion gap (NAGMA) causes

A
  • diarrhea (bicarbonate loss)

- RTA

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67
Q

manifestation of uremia and treatment: anemia

A

erythropoietin replacement

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68
Q

treatment for moderate hypERkalemia (NO EKG abnormalities)

A
  1. IV insulin and glucose
  2. bicarbonate
  3. kayexalate
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69
Q

key to diagnosis of Addison’s disease (primary adrenal insufficiency)

A

hypOnatremia with hypERkalemia, and mild metabolic acidosis

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70
Q

how do you distinguish between diarrhea and RTA?

A

URINE ANION GAP

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71
Q

best INITIAL test for cryoglobulinemia

A
  • serum cryoglobulin component levels

- LOW complement levels (especially C4)

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72
Q

what does UA show in ATN?

A

“muddy brown,” or granular casts

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73
Q

absolute indications for dialysis (3)

A
  1. uremic pericarditis
  2. uremic pleuritis
  3. uremic encephalopathy
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74
Q

clues renal failure is CHRONIC

A
  1. smaller kidneys
  2. renal failure of more than 2 weeks will drop Hct (decreased erythropoietin production)
  3. Ca2+ levels drop (decreased vitamin D hydroxylation)
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75
Q

EKG changes from hypERkalemia in order

A
  1. peaked T waves
  2. prolonged P waves
  3. widening of QRS complexes
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76
Q

what happens in CENTRAL DI to urine volume, and urine osmolality when you give DDAVP/vasopressin?

A
  • DECREASE in urine volume

- INCREASE in urine osmolality

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77
Q

best INITIAL test for primary renal d/o with NO specific PE findings (only associations)

A

UA, then spot urine

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78
Q

best INITIAL test for PAN

A

ESR

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79
Q

test for distal RTA (type 1)

A

administer IV acid (AlCl; should lower urine pH secondary to increased H+ formation)

urine will stay abnormally basic

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80
Q

how does hypokalemia cause metabolic alkalosis?

A

K+ shifts OUT of cells to correct hypOkalemia; H+ shift INTO cells

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81
Q

how is acid excreted from the kidneys?

A

NH4Cl

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82
Q

what is methanol metabolized into?

A

formaldehyde than formic acid

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83
Q

reason Addison’s disease (primary adrenal insufficiency) causes hypOnatremia

A

insufficient ALDOSTERONE production

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84
Q

best INITIAL treatment for ALL primary renal d/o with NO specific PE findings (only associations)

A

steroids

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85
Q

treatment for HTN, AND: osteoporosis

A

thiazide

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86
Q

treatment for tumor lysis syndrome

A
  1. hydration
  2. allopurinol
  3. rasburicase
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87
Q

best INITIAL treatment for granulomatosis with polyangiitis

A

cyclophosphamide and steroids

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88
Q

best INITIAL test for nephrOtic syndrome

A

UA; shows markedly elevated protein level

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89
Q

treatment for HTN, AND: depression

A

AVOID BB

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90
Q

diagnostic clues for lupus nephritis

A
  • h/o SLE
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91
Q

when evaluating for persistent proteinuria, if 24H urine, OR spot protein:creatinine ratio is elevated next step is

A

kidney biopsy

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92
Q

best INITIAL treatment for ethylene glycol poisoning

A
  • ethanol or fomepizole

- with IMMEDIATE dialysis

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93
Q

best INITIAL test for IgA nephropathy

A

NO specific test (IgA may be elevated…)

complement levels are normal

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94
Q

diagnostic clues for Alport syndrome

A
  • congenital
  • eye and ear problems (deafness)
  • renal failure in second/third decade of life
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95
Q

treatment for severe hypERkalemia (EKG abnormalities, such as peaked T waves)

A
  1. IV calcium gluconate/calcium chloride
  2. IV insulin and glucose
  3. kayexalate
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96
Q

hypOkalemia causes

A

dietary insufficiency

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97
Q

treatment for HTN, AND: pregnancy

A

a-methyldopa, or labetalol

98
Q

cause of renal failure from rhabdomyolysis

A

direct TOXIC effect of MYOGLOBIN on kidney tubule

99
Q

what do you do for Churg-Strauss syndrome if NO response to prednisone?

A

ADD cyclophosphamide

100
Q

what test for PAN can spare the need for biopsy?

A

angiography showing “beading”

101
Q

treatment for HTN, AND: DM

102
Q

treatment for HTN, AND: BPH

103
Q

INTRArenal causes of renal failure

A
  • ATN (acute tubular necrosis)
  • AGN (acute glomerulonephritis)
  • AIN (acute interstitial nephritis)
104
Q

treatment for Alport syndrome

A
  • NO specific treatment
105
Q

at what rate should you correct hypOnatremia?

A
  • 4-6 meq/L in the FIRST 24 HOURS

- SHOULD NOT BE RAISED MORE THAN 9 meq/L within 24H

106
Q

diagnostic clues for post-streptococcal glomerulonephritis (PSGN)

A
  • dark, “tea,” or “cola” colored urine
  • PERIORBITAL EDEMA
  • HTN
  • can occur after throat and skin infections
107
Q

diagnostic clues for cryoglobulinemia

A
  • h/o hepatitis C with renal involvement
  • joint pain
  • purpuric skin lesions
108
Q

rasburicase MOA

A

breaks down uric acid

109
Q

hypERmagnesemia leads to

A
  • muscle weakness

- loss of deep tendon reflexes

110
Q

mechanism of hypOcalcemia in rhabdomyolysis

A

damaged sarcolemma outside of SER can bind as much Ca2+ as it wants

111
Q

primary renal d/o with NO specific PE findings (only associations): HIV/heroin use

A

focal segmental

112
Q

treatment for central DI

A

desmopressin or vasopressin

113
Q

best INITIAL test for ethylene glycol poisoning

A

UA (envelope-shaped oxalate crystals)

114
Q

treatment for CHRONIC SIADH (from malignancy)

A
  • demeclocycline (blocks ADH at kidney)

- conivaptan/tolvaptan (inhibit ADH at V2 receptor of collecting duct)

115
Q

the other main cause of hypERnatremia

A

diabetes insipidus (DI)

116
Q

hypERnatremia always implies

A

free water deficit

117
Q

treatment for Henoch-Schonlein purpura

A

NO specific therapy; RESOLVES SPONTANEOUSLY

118
Q

initial treatment for HTN

A

lifestyle modifications:

  • Na+ restriction
  • weight loss
  • dietary modification
  • exercise
  • relaxation techniques
119
Q

sodium disorders are NOT associated with

A

cardiac arrhythmias

120
Q

finding in congenital adrenal hyperplasia (CAH)

121
Q

best INITIAL treatment for Churg-Strauss syndrome

A

glucocorticoids (e.g. prednisone)

122
Q

cause of lactic acidosis

A

any form of hypoperfusion resulting in anaerobic metabolism

123
Q

distal RTA (type 1)

  • urine pH
  • serum K+
  • stones?
  • test
  • treatment
A
  • HIGH urine pH
  • LOW K+
  • YES
  • give acid (aluminum chloride)
  • bicarbonate
124
Q

how many days of use does it usually take for aminoglycosides to cause kidney damage?

125
Q

nephrOtic syndrome has the following:

A
  1. hypERproteinuria (more than 3.5G/day)
  2. hypOproteinemia
  3. hypERlipidemia
  4. edema
  5. HTN
  6. thrombosis
126
Q

rhabdomyolysis labs:

  • CPK level
  • potassium level
  • calcium level
  • serum bicarbonate level
A
  • ELEVATED CPK
  • hypERkalemia
  • hypOcalcemia
  • decreased bicarb
127
Q

finding in pheochromocytoma

A

EPISODIC HTN

128
Q

mechanism of hypERkalemia with beta blockers

A

block Na+/K+ ATPase channels

129
Q

primary renal d/o with NO specific PE findings (only associations): seen in adults with cancer such as lymphoma

A

membranous

130
Q

hypERkalemia can lead to

A

cardiac arrhythmia

131
Q

if proteinuria persists on repeat UA, what are 4 possibilities that need to be ruled out?

A
  1. CHF
  2. fever
  3. exercise
  4. infection
132
Q

best INITIAL test for Goodpasture syndrome

A

anti-basement membrane Abs

133
Q

mechanism of how bicarbonate lower potassium

A

bicarbonate pulls H+ CATIONS out of cells so K+ goes IN

134
Q

treatment for Addison’s disease (primary adrenal insufficiency)

A

fludrocortisone

135
Q

adverse effect of distal RTA (type 1)

A

alkaline urine = kidney stones

136
Q

treatment for dehydration, even in hypERnatremia

A

normal saline

137
Q

treatment for ATN

A

NO specific therapy

138
Q

MOST ACCURATE test for eosinophils in UA

A

Wright stain or Hansel’s stain

139
Q

tumor lysis syndrome

A

uric acid crystals

140
Q

treatment for TTP

A

plasmapheresis in SEVERE cases; do NOT treat with platelets

141
Q

MOST ACCURATE test for PAN

A

SURAL nerve biopsy, or kidney biopsy

142
Q

hypOkalemia can lead to

A
  • cardiac rhythm disturbance

- muscle weakness

143
Q

finding in Conn syndrome (primary hypERaldosteronism)

A

hypOkalemia

144
Q

common indications for dialysis (8)

A
  1. declining nutritional status (MC reason to initiate dialysis)
  2. volume overload
  3. fatigue and malaise
  4. mild cognitive impairment
  5. refractory metabolic acidosis
  6. refractory hyperkalemia
  7. refractory hyperphosphatemia
  8. toxicity with dialyzable drug (lithium/ethylene glycol/aspirin)
145
Q

MOST ACCURATE test for cryoglobulinemia

A

kidney biopsy

146
Q

treatment for aspirin overdose

A

bicarbonate

147
Q

hypERnatremia leads to

A

NEUROLOGICAL ABNORMALITIES:

  • confusion
  • disorientation
  • seizures
  • COMA
148
Q

check for secondary HTN, when?

A
  • less than 30 yoa, or more than 60 yoa
  • uncontrolled HTN with 3 medications
  • specific findings on history and PE
149
Q

diagnostic clues for distal RTA (type 1)

A
  • LOW serum K+ (since body can’t excrete H+)
  • LOW serum bicarbonate
  • metabolic acidosis
  • alkaline urine
150
Q

how do you calculate the urine anion gap (UAG)?

A

UAG = urine Na+ - urine Cl-

151
Q

treatment for hypOvolemic hypOnatremia

A

correct underlying cause, and replace with NORMAL (ISOTONIC) SALINE

152
Q

treatment for ADPKD

A

NO specific treatment

153
Q

best INITIAL test for RAS

A

renal US with DOPPLER

154
Q

MOST ACCURATE test for GN (but not always necessary)

A

kidney biopsy

155
Q

MOST ACCURATE test for lupus nephritis

A

kidney biopsy

very important; not for diagnosis, used to determine extent of disease, which determines therapy

156
Q

treatment for hypERvolemic hypOnatremia

A

correct/manage underlying cause

157
Q

diagnostic clues for proximal RTA (type 2)

A
  • initially urine pH is elevated, bc of bicarbonate loss, but then becomes acidic
158
Q

finding in RAS

159
Q

hypERmagnesemia causes

A
  • magnesium-containing laxative abuse

- iatrogenic administration

160
Q

what happens in NEPHROGENIC DI to urine volume, and urine osmolality when you give DDAVP/vasopressin?

A
  • NO CHANGE in urine volume

- NO CHANGE in urine osmolality

161
Q

how does vomiting cause metabolic alkalosis?

A

(acid loss from stomach, AND volume contraction leading to secondary hypERaldosteronism

162
Q

best INITIAL test for Henoch-Schonlein purpura

163
Q

treatment for HTN, AND: migraine

A

BB, or CCB

164
Q

BUN:Cr ratio seen in POSTrenal azotemia

A

also more than 15:1

165
Q

causes of PRErenal azotemia

A
  • ANY cause of hypOperfusion
  • hypOtension (SBP less than 90)
  • hypOvolemia (dehydration or blood loss)
  • low oncotic pressure (low albumin)
  • CHF (heart can’t PUMP)
  • constrictive pericarditis (heart can’t FILL)
  • RAS
166
Q

suicide by antifreeze ingestion (ethylene glycol)

HAGMA

A

oxalate crystals

167
Q

treatment for IgA nephropathy

A

NO proven effective therapy

  • steroids: for sudden worsening of proteinuria
  • ACEIs: used for all patients with proteinuria
168
Q

primary renal d/o with NO specific PE findings (only associations): MC in children

A

minimal change disease

169
Q

treatment for methanol poisoning

A

fomepizole or ethanol

170
Q

treatment for hypOkalemia

A
  • replace K+
  • avoid glucose-containing fluids (will increase insulin release worsening hypOkalemia)

(NO maximum rate on ORAL K+; bowel will regulate rate of absorption)

171
Q

best INITIAL test for granulomatosis with polyangiitis

A

c-ANCA (antineutrophil cytoplasmic Abs)

172
Q

what routine tests should be done in a pt with HTN?

A
  • UA
  • EKG
  • eye exam (retinopathy)
  • cardiac exam (murmur/S4 gallop)
173
Q

distal RTA (type 1)

A

inability to EXCRETE acid of hydrogen ions in DISTAL tubule

174
Q

hypOmagnesemia presents with

A

hypOcalcemia and cardiac arrhythmias

175
Q

diagnostic clues for Goodpasture syndrome

A
  • COUGH
  • HEMOPTYSIS
  • SOB
  • lung findings (e.g. diffuse infiltrates)
176
Q

treatment for ethylene glycol poisoning

A

fomepizole or ethanol

177
Q

treatment for HTN, AND: hyperthyroidism

178
Q

what does drug-induced lupus spare?

A

kidney and brain

179
Q

causes of secondary HTN based on age: young adults (ages 19-39)

A
  • thyroid dysfunction
  • fibromuscular dysplasia
  • renal parenchymal disease
180
Q

clues to obstructive uropathy

A
  • distended bladder on exam
  • large volume diuresis after Foley catheter placement
  • B/L hydronephrosis on US
181
Q

how do Conn syndrome and Cushing syndrome cause metabolic alkalosis?

A

primary hypERaldosteronism, causes increased urinary acid loss

182
Q

what can happen if you correct hypOnatremia too rapidly?

A

CENTRAL PONTINE MYELINOLYSIS

183
Q

diagnostic clues for AIN

A
  • medication ingestion
  • fever and rash
  • UA shows white cells (can’t discern between neutrophils and eosinophils)
184
Q

what is the UAG in diarrhea?

A

NEGATIVE, bc kidneys are working (able to excrete acid)

185
Q

what to do in a patient who MUST have a radiologic procedure with contrast and renal insufficiency

A

hydrate with NS, and give bicarbonate and N-acetylcysteine

186
Q

finding in coarctation of aorta

A

upper extremity pressure greater than lower extremity pressure

187
Q

treatment for Goodpasture syndrome

A

plasmapheresis and steroids

188
Q

other causes of hypOkalemia

A
  • increased urinary loss caused by diuretics
  • Conn syndrome (high aldosterone)
  • vomiting (leads to metabolic alkalosis; shifts K+ INTO cells [and volume depletion; increases aldosterone])
  • proximal (type 2) and distal (type 1) RTA
  • amphotericin (causes RTA)
  • Bartter syndrome (LOH can’t absorb Na+ or K+; causes secondary hypERaldosteronism)
189
Q

characteristic diagnostic tests for PRErenal azotemia

A
  • BUN:Cr ratio of more than 15:1, and often more than 20:1
  • LOW urinary Na+ (less than 20)
  • urine osmolality more than 500
  • may have hyaline casts on UA
190
Q

causes of ATN (acute tubular necrosis)

A
  • either hypOperfusion or toxic injury
  • surgery
  • severe burns
  • aminoglycosides/amphotericin/contrast/chemotherapy
  • rhabdomyolysis
191
Q

treatment for PSGN

A
  • PCN or other antibiotics for infection

- diuretics for HTN and edema

192
Q

EKG changes in hypOkalemia

A

U waves (Purkinje fiber repolarization)

193
Q

how does radius affect flow?

A

flow increases as radius increases

to the fourth power

194
Q

MOST ACCURATE test for IgA nephropathy

A

kidney biopsy is ESSENTIAL

195
Q

hyperlipidemia mechanism in nephrOtic syndrome

A

LDL and VLDL are removed from serum by lipoproteins; lipoproteins are lost in urine

196
Q

best INITIAL test for rhabdomyolysis

A

UA (large blood)

197
Q

hypERvolemic hypOnatremia causes (3)

A
  1. CHF
  2. nephrotic syndrome
  3. cirrhosis
198
Q

best INITIAL test for PSGN

A
  • antistreptolysin O (ASLO)
  • anti-DNase
  • antihyaluronidase
  • LOW complement levels
199
Q

best INITIAL test for Churg-Strauss syndrome

A

CBC (check eosinophil count)

200
Q

causes of POSTrenal azotemia (postobstructive uropathy)

A
  • stones
  • strictures
  • cancer
  • neurogenic bladder (MS or DM)
201
Q

MOST ACCURATE test for Churg-Strauss syndrome

A

kidney biopsy

202
Q

MOST ACCURATE test for granulomatosis with polyangiitis

A

kidney biopsy

203
Q

adverse effect of methanol poisoning

A

visual disturbance

204
Q

ALL forms of glomerulonephritis (GN) can have the following:

5 findings

A
  • RBCs in urine
  • red cell casts in urine
  • mild proteinuria (less than 2G/24H)
  • may lead to nephrOtic
  • edema
205
Q

manifestation of uremia and treatment: hypermagnesemia

A

dietary magnesium restriction

206
Q

what is the MOST effective lifestyle modification for HTN?

A

WEIGHT LOSS

207
Q

mechanism of BUN elevation in PRErenal azotemia

A

low volume status, increases ADH, and ADH increases urea transporter activity in collecting duct

208
Q

adverse effect of cyclophosphamide

A

hemorrhagic cystitis

209
Q

treatment for nephrogenic DI

A

correct underlying cause

210
Q

possible causes of hypERnatremia, aside from dehydration

A
  • poor oral intake
  • fever
  • pneumonia
  • other insensible losses
211
Q

if there is no apparent reason for proteinuria, what is the next possibility?

A

ORTHOSTATIC proteinuria

h/o patient standing all day; waiter/teacher/security guard

212
Q

HUS triad (think about the name)

A
  1. intravascular hemolysis
  2. elevated creatinine
  3. thrombocytopenia

(h/o E. coli O157:H7)

213
Q

TTP findings (again, think about the name)

A
  1. intravascular hemolysis
  2. elevated creatinine
  3. thrombocytopenia

PLUS

  1. fever
  2. neurological abnormalities
214
Q

EUvolemic hypOnatremia causes (4)

A
  1. syndrome of inappropriate ADH release (SIADH)
  2. hypothyroidism
  3. psychogenic polydipsia
  4. hypERglycemia (Na+ drops by 1.6-2.4 for every 100mg of glucose above normal)
  5. Addison’s disease (primary adrenal insufficiency)
215
Q

treatment for proximal RTA (type 2)

A
  • thiazide diuretic (causes volume contraction which concentrates serum bicarbonate)
  • large quantities of bicarbonate
216
Q

best INITIAL treatment for PAN

A

steroids and cyclophosphamide

217
Q

hypOmagnesemia causes

A
  • loop diuretics
  • alcohol withdrawal/starvation
  • gentamicin/amphotericin/diuretics
  • cisplatin
  • parathyroid surgery
  • pancreatitis
218
Q

primary renal d/o with NO specific PE findings (only associations): unclear

219
Q

urge incontinence

  • presentation
  • testing
  • treatment
A
  • PAIN followed by urge to urinate
  • urodynamic pressure monitoring
  • behavior modification/anticholinergic medications
220
Q

next step in management in a patient presenting with HTN

A

repeat BP measurement

221
Q

manifestation of uremia and treatment: hyperphosphatemia

A
  • calcium acetate

- calcium carbonate

222
Q

what are the 2 types of DI?

A
  1. central = failure to produce antidiuretic hormone (ADH) in the brain
  2. nephrogenic = insensitivity of the kidney to ADH (can result from hypOkalemia, hypERcalcemia, or lithium toxicity)
223
Q

treatment for cryoglobulinemia

A
  • hepatitis C genotype 1: ledipasvir and sofosbuvir
  • for treatment-experienced pts: add ribavirin
  • for other genotypes: sofosbuvir and ribavirin
224
Q

finding in Cushing syndrome

A
  • buffalo hump
  • truncal obesity
  • striae
225
Q

ANY of the glomerulonephritides can lead to?

A

nephrOtic syndrome

226
Q

MOST ACCURATE test for Goodpasture syndrome

A

kidney biopsy = LINEAR DEPOSITS

227
Q

mechanism of rapid onset of renal failure with contrast agent

A
  • directly toxic to kidney tubules
  • also, causes intense vasoconstriction of Afferent arterioles (decreased perfusion)

(hypOperfusion = LOW urine sodium)

228
Q

2 medications should be started if baseline BP is >?

229
Q
  • recurrent hematuria
  • stones
  • infections
  • CYSTS THROUGHOUT THE BODY (liver, ovaries, circle of Willis)
  • MVP
  • diverticulosis
A

autosomal dominant polycystic kidney disease (ADPKD)

230
Q

phosphate binders

A
  • sevelamer
  • lanthanum
  • calcium acetate
  • calcium carbonate
231
Q

treatment for hypERmagnesemia

A
  • restrict intake
  • saline administration (provoke diuresis)
  • maybe dialysis
232
Q

diagnostic clues for Churg-Strauss syndrome

A
  • ASTHMA
  • COUGH
  • EOSINOPHILIA
233
Q

diagnostic clues for Henoch-Schonlein purpura

A
  • child or adolescent
  • RAISED, NONTENDER, PURPURIC SKIN LESIONS (especially on buttocks and LE’s)
  • abdominal pain
  • possible bleeding
  • joint pain
234
Q

other causes of hypERkalemia

A
  • metabolic acidosis (transcellular shift out of cells)
  • adrenal aldosterone deficiency (Addison’s disease)
  • beta blockers
  • digoxin toxicity
  • insulin deficiency (DKA)
  • spironolactone
  • ACEIs/ARBs (inhibit aldosterone)
  • prolonged immobility
  • RTA type 4 (decreased aldosterone effect)
  • renal failure (decreased excretion)
235
Q

causes of AIN (acute interstitial nephritis)

A
  • antibiotics
  • NSAIDs
  • infection (e.g. Streptococcus, viral, Legionella)
236
Q

what is the UAG in RTA?

A

POSITIVE, bc kidneys CANNOT excrete acid (urine Cl- decreases)

237
Q

when do you initiate medical therapy for HTN?

A

3-6 months if lifestyle modifications don’t work

238
Q

potassium disorders are NOT associated with

A

seizures, or neurological disorders

239
Q

MOST ACCURATE test for Henoch-Schonlein purpura

A

kidney biopsy = IgA deposition

not necessary though

240
Q

hypERkalemia causes

A

(predominantly caused by release from tissues)

  • muscles = rhabdomyolysis, or crush injury
  • RBCs = hemolysis
  • dietary K+ ONLY in renal insufficiency
241
Q

what 3 substances lead to an increased anion gap in DKA?

A
  1. acetone
  2. acetoacetate
  3. beta hydroxybutyric acid

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