Nephrology Flashcards
1
Q
tamm horsfall protein is
A
normal <30-50 mg/24 hrs
2
Q
very large amounts of protein =
A
glomerular disease
3
Q
persistent proteinuria requires
A
biopsy
4
Q
urine dipstick only detects what proteins
A
albumin
5
Q
to detect bence jones proteins use
A
immunoelectrophoresis
6
Q
best 24 hr protein measure
A
protein to creatinine ratio
7
Q
tx for proteinuria in DM
A
ACEi and ARBs
8
Q
microalbuminuria values
A
30-300mg/24 hrs
9
Q
eosinophils in urine =
A
allergic or acute interstitial nephritis
10
Q
wright stain detects
A
eosinophils in urine
11
Q
hansel stain detects
A
eosinophils in urine
12
Q
are there eosinophils in the urine of NSAID induced renal disease
A
no
13
Q
persistent WBCs in urine with negative culture
A
TB
14
Q
dysmorphic RBCs in urine =
A
glomerulonephritis
15
Q
IV pyelogram is the answer when
A
NEVER
16
Q
most accurate test of bladder
A
cytoscopy
17
Q
do cystoscopy when
A
hematuria w/o infection or prior trauma and renal US or CT does not show etiology or bladder US shows mass (possible biopsy)
18
Q
red cell casts =
A
glomerulonephritis
19
Q
white cell casts =
A
pyelonephritis
20
Q
eosinophil casts =
A
acute interstitial nephritis
21
Q
hyaline casts =
A
tamm horsfall protein from dehydration
22
Q
broad waxy casts =
A
chronic renal disease
23
Q
granular muddy brown casts =
A
ATN
24
Q
urine osmolality in ATN
A
In ATN urine cannot be concentrated because cells are damaged → inappropriately low urine osmolality (isosthenuria – same osmolality as blood) aka renal tubular concentrating defect
25
BUN:creatinine >20:1
| UNa 500
prerenal azotemia
26
BUN:creatinine 10:1
UNa >20, FeNa >1%
Urine osmolality <300
Intrinsic renal disease (ATN)
27
NSAIDs constrict
afferent arteriol
28
ACEi cause vasodilation of
efferent arteriol
29
retroperitoneal fibrosis is caused by
bleomycin, methylsergide, radiation
30
prevention of contrast renal toxicity
saline hydration
31
low magnesium can increase risk of renal toxicity from
aminoglycosides or cisplatin
32
time frame for drugs causing ATN
5-10 days
33
prevent tumor lysis syndrome with
allopurinal, hydration, and rasburicase prior to chemo
34
ethylene glycol causes precipitation of what in tubules
oxalic acid, calcium oxalate
35
best initial test for rhabdomyolysis
UA
36
most specific test for rhabdomyolysis
urine for myoglobin
37
tx of rhabdomyolysis
saline hydration, mannitol, bicarb
38
how does bicarb help in rhabdomyolysis
drives K back into cells preventing precipitation of myoglobin in kidney tubule
39
best initial test for ATN
BUN and creatinine
40
best initial imaging test for ATN
renal US
41
most accurate test for allergic interstitial nephritis
renal biopsy
42
most accurate test for poststreptococcal glomerulonephritis
renal biopsy
43
furosemide adverse effect
ototoxicity, dose and how fast its given dependent
44
dialysis if
fluid overload, encephalopathy, pericarditis, metabolic acidosis, hyperkalemia
45
things that do NOT help ATN
Low dose dopamine, diuretics, mannitol, steroids
46
Cirrhosis, low urine sodium, FeNA 20:1
hepatorenal syndrome
47
tx for hepatorenal syndrome
midodine, octreotide, albumin
48
After catheter procedure, blue/purplish skin lesion in fingers/toes, livedo reticularis, ocular lesions
atheroemboli
49
most accurate test for atheroemboli
biopsy of purplish skin lesion
50
tx of atheroemboli
no specific tx
51
dx of atheroemboli
eosinophilia, low complement, eosinophiluria, elevated ESR
52
most common meds causing allergic interstitial nephritis
PCN, cephalosporins, sulfa (diuretics), phenytoin, rifampin, quinolones, allopurinol, PPIs
53
the meds that cause allergic interstitial nephritis also cause
drug allergy and rash, stevens Johnson syndrome, TEN, hemolysis
54
rising BUN/creatinine, fever, rash, arthralgias, eosinophilia, eosinophiluria
acute interstitial nephritis
55
most accurate test for acute interstitial nephritis
hansel or wright stain
56
acute interstitial nephritis, inciting drug stopped, but creatinine continues to rise, tx?
glucocorticoids
57
Sudden flank pain, fever, hematuria, grossly necrotic material in urine
analgesic nephropathy (papillary necrosis)
58
best initial test for analgesic nephropathy
UA
59
most accurate test for analgesic nephropathy
CT
60
tx for analgesic nephropathy
no specific tx
61
Acute, toxins, none nephrotic, no biopsy, no steroids, never immunosuppressive agents
tubular disease
62
Chronic, not from toxins, all potentially nephrotic, biopsy, steroids
glomerular diseases
63
best initial test for goodpasture syndrome
antiglomerular basement membrane antibodies
64
most accurate test for goodpasture syndrome
lung or kidney biopsy
65
goodpasture syndrome affects what organs
lungs and kidney
66
tx for goodpasture syndrome
plasmapheresis and steroids
67
kidney biopsy in goodpasture disease shows
linear deposits
68
most common cause of glomerulonephritis
IgA nephropathy (berger disease)
69
Recurrent gross hematuria 1-2 DAYS post URI
IgA nephropathy
70
tx of IgA nephropathy
ACEi and steroids if severe proteinuria
71
hematuria 1-2 WEEKS Post URI
postinfectious glomerulonephritis
72
dark (cola) urine, periorbital edema, HTN, oligouria
postinfectious glomerulonephritis
73
tx for postinfectious glomerulonephritis
supportive (antibiotics and diuretics)
74
dx of postinfectious glomerulonephritis
confirm with ASO titer and anti DNAse antibody titers
75
hematuria, Sensorineural hearing loss, visual disturbances
alport syndrome
76
alport syndrome is d/t
congenital defect of type IV collafen
77
tx for alport syndrome
no specific therapy
78
best initial test for polyarteritis nodosa
Angiogrpahy of renal, mesenteric, or hepatic artery showing aneurysmal dilation in association with new onset HTN and characteristic symptoms
79
biopsy is done in lupus nephritis to
gage tx, not to dx, but is most accurate test
80
tx for lupus nephritis
glucocorticoids with cyclophophomide or mycophenolate
81
most accurate test for amyloidosis
biopsy
82
Green birefringence with congo red
amyloidosis
83
tx of amyloidosis
control underlying disease, then melphalan and prednisone
84
edema, hyperlipidemia, thrombosis, infection
nephrotic syndrome
85
thrombosis in nephrotic syndrome is d/t
urinary loss of protein C, S and antithrombin
86
infection in nephrotic syndrome is d/t
urinary loss of Ig and complement
87
most common cause of nephrotic syndrome
DM and HTN
88
nephrotic syndrome in CA of solid organs
membranous
89
nephrotic syndrome in children
minimal change disease
90
nephrotic syndrome in IV drug users and AIDS
focal segmental
91
nephrotic syndrome SLE
any
92
best initial test for nephrotic syndrome
UA (maltese crosses)
93
Hyperproteinuria (>3.5/24hr), hypoproteinemia, hyperlipidemia, edema
nephrotic syndrome
94
best initial tx for nephrotic syndrome
glucocorticoids --> cyclophosphamide
95
end stage renal disease most commonly from
DM and HTN
96
metabolic acidosis, fluid overload, encephalopathy, hyperkalemia, pericarditis
uremia
97
hypocalcemia in end stage renal disease d/t
decreased conversion of 25 to 1,25 vit D
98
osteodystrophy in end stage renal disease d/t
low Ca leads to secondary hyperparathyroidism
99
bleeding in end stage renal disease d/t
failure of platelet degranulation
100
infection in in end stage renal disease d/t
failure of neutrophil degranulation
101
hyperphosphatemia in end stage renal disease d/t
high PTH releases phosphate from bones
102
hypermagnesemia in end stage renal disease d/t
loss of ability to excrete
103
why are aluminum phosphate binders never used
cause dementia
104
when Vit D replaced for hypocalcemia always give
phosphate binders or vit D will increase GI absorption of phosphate
105
phosphate binders used in end stage renal disease
calcium acetate, Calcium carbonate, sevelamer, lanthanum
106
most common cause of death in end stage renal disease
atherosclerosis and HTN --> cardiac
107
next step in management of complex renal cysts
aspirate to r/o malignancy
108
TTP is associated with
HIV, CA, cyclosporine, ticlopidine, clopidogrel
109
intravascular hemolysis, renal insufficiency, thrombocytopenia
HUS and TTP
110
TTP is associated with what symptoms in addition to the ones seen in HUS
neuro symptoms and fever
111
PT and PTT in HUS and TTP
normal
112
tx of TTP or severe HUS
plasmapheresis
113
best initial test for diabetes insipidus
water deprivation test
114
high volume nocturia =
diabetes insipidus
115
tx of nephrogenic diabetes insipidus
correct K and Ca, hydrochlorothiazide or NSAIDs
116
causes of hyponatremia with hypervolemia
CHF, nephrotic syndrome, cirrhosis
117
causes of hyponatremia with euvolemia
hyperglycemia, psychogenic polydipsia, hyopthyroidism, SIADH
118
aldosterone causes
Na reabsorption
119
for every 100 mg/dL glucose above normal, sodium ...
decreases 1.6 mEq/L
120
thyroid hormone effect on water
needed to excrete it
121
msot accurate test for SIADH
high ADH
122
tx of acute hyponatremia
hypertonic saline, conivaptan, tolvaptan
123
conivaptan, and tolvaptan (MOA)
antagonists of ADH
124
tx of chronic hyponatremia
demeclocycline
125
demeclocycline MOA
blocks ADH at collecting ducts
126
insulin effect on K
drives K into cells
127
acidosis effect on K
cells pick up H and release K
128
beta blocker and digoxin effect on K
inhibit Na/K/ATPase increasing K
129
most urgent test in severe hyperkalemia
EKG
130
EKG changes in hyperkalemia
peaked T waves, wide QRS, PR prolongation
131
tx of hyperkalemia that is cardioprotective
Calcium chloride and calcium gluconate
132
tx of hyperkalemia that removes K from body via bowel
Kayexalate (sodium polystyrene sulfonate)
133
tx of hyperkalemia best used in acidosis
bicarb - drives K into cells
134
primary hyperaldosteronism aka
conn syndrome
135
conn syndrome K level
hypokalemic
136
barter syndrome d/t
salt loss in loop of henle
137
EKG changes in hypokalemia
U waves, flattened T waves, ST depression
138
tx of hypokalemia
IV K, but too fast can cause fatal arrhythmia. Oral K – can’t give too much
139
anion gap =
Na - (Cl + HCO3)
140
causes of metabolic acidosis with normal anion gap
RTA and diarrhea
141
tx for lactic acidosis
correct hypoperfusion
142
dx for anion gap from ketoacids
acetone level
143
tx for anion gap from ketoacids
insulin and fluids
144
dx for anion gap from oxalic acid
crystals on UA
145
RTA type I is d/t
Distal tubule – normally generates new bicarb (under aldosterone)
146
best initial test for RTA type I
infuse acid into blood with ammonium chloride. Cannot excrete acid so urine pH remains basic
147
urine pH >5.5, nephrocalcinosis, hypokalemic
RTA type I
148
tx of RTA type I
replace bicarb
149
RTA type II d/t
Proximal tubule - normally 85-90% filtered bicarb reabsorbed
150
variable urine pH, hypokalemic, metabolic acidosis
RTA type II
151
tx for RTA type II
thiazides cause volume depletion which enhances bicarb reabsorption
152
most accurate test for RTA type II
give bicarb and test urine pH. Cannot absorb bicarb so urine pH rises
153
RTA type IV d/t
Most often in DM. Decreased amount or effect of aldosterone on kidney tubule
154
test for RTA type IV
persistently high urine Na despite Na depleting diet
155
urine pH <5.5, hyperkalemia
RTA type IV
156
tx for RTA type IV
fludrocortisone (highest mineralcorticoid or aldosterone like effect)
157
urine anion gap =
Na - Cl
158
positive UAG =
RTA
159
negative UAG =
diarrhea
160
minute ventilation =
RR*tidal volume
161
most common cause of kidney stones
calcium oxalate
162
chrons disease is associated with what type of kidney stone
calcium oxalate, from increased oxalate absorption
163
kidney stones associated with UTI
struvite stones
164
struvite stones are composed of
magnesium, ammonium, phosphate
165
kidney stones that are radiotranslucent
uric acid stones
166
most accurate test for nephorlithiasis
CT
167
best initial tx for nephrolithiasis
analgesics and hydration
168
tx for kidney stones <5 mm
let pass spontaneously
169
tx for kidney stones 5-7 mm
nifedipine and tamsulosin – helps pass
170
tx for kidney stones .5-2 cm
lithotripsy
171
tx for hydronephrosis d/t nephrolithasis
stent placement
172
tx for chonic nephrolithaisis
hydrochlorothiazide - removes Ca from urine
173
metabolic acidosis/alkalosis increases kidney stone formation
acidosis
174
tx for cystine stones
alkalinize urine
175
tx for struvite stones
surgical
176
best initial tx for HTN
weight loss
177
how long should lifestyle modification be tried before treating HTN
3-6 mo
178
best initial drug tx for HTN
thiazides
179
best tx for HTN in pregnancy
BB
180
best tx for HTN in CAD
BB, ACE, ARB
181
best tx for HTN in DM
ACE, ARB (<130/80)
182
best tx for HTN in BPH
alpha blockers
183
best tx for HTN in depression
NOT BB
184
best tx for HTN in asthma
NOT BB
185
best tx for HTN in hyperthyroidism
BB
186
best tx for HTN in osteoporosis
thiazides
187
tx for hypertensive crisis
labetolol
188
why isn't nitroprusside used first in hypertensive crisis
needs monitoring with arterial line
189
if BP is lowered to normal in hypertensive crisis, increased risk of
stroke
