Nephrology Flashcards
Loop diuretics/thiazide diuretics adverse side effects
Decreased electrolytes such as hypokalemia, hypocalcemia, hypomagnesemia, ototoxicity, sulfa allgery susceptible, hyperuricemia (can precipitate gout), hyperglycemia
K+ sparing diuretics adverse effects
Hyperkalemia due to retention of K+, anti androgen effects like gynecomastia, erectile dysfunction, decreased libido
Nephrotic syndrome definition
Kidney disease characterized by proteinuria, hypoalbuminemia, hyperlipidemia, and edema, caused primarily by minimal change disease in children and membranous nephropathy in adults (SLE, viral hepatitis, malaria, medications)
Most common secondary etiology of nephrotic syndrome in adults
DM
Most definitive accurate test for nephrotic syndrome that is rarely done, best initial test that is often done
Renal biopsy, UA is best initial test and microscopy might show fatty casts
First line management of minimal change disease
Glucocorticoids
Management of nephrotic syndrome
Glucocorticoids or other immunomodulators, edema reduction with diuretics, proteinuria reduction with ace inhibitors, statin therapy for hyperlipidemia
Acute glomerulonephritis (nephritic syndrome) characteristics
Hypertension, hematuria, azotemia (proteinuria)
Most common causes of acute glomerulonpehritis (nephritic syndrome)
IgA nephropathy (Bergerr’s disease) after URI or GI infection
Post streptococcal post infectious
Goodpasture’s disease (glomerulonephritis plus hemoptysis)
Pre renal acute kidney injury diagnosis
BUN:Cr ratio >20:1, FENA <1%, concentrated urine
Most common type of intrinsic acute kidney injury
Acute tubular necrosis
Intrinsic acute kidney injury diagnosis
BUN:Cr ratio <15:1, FENA >2%, dilute urine
Management of acute tubular necrosis
Removal of offending agents and IV fluids first line
RBC casts indicate \_\_\_ Muddy brown casts indicate \_\_\_ WBC casts indicate \_\_\_ Waxy casts indicate\_\_\_ Fatty casts indicate \_\_\_\_ Hyaline casts indicate \_\_\_
Acute glomerulonephritis Acute tubular necrosis Pyelonephritis Chronic acute tubular necrosis or glomerulonephritis or end stage renal disease (broad waxy casts is key) Nephrotic syndrome (hyperlipidemia) Nonspecific (normal)
Clinical manifestations of PKD
Abdominal and flank pain, nephrolithiasis, UTI, hematuria
Most widely used diagnostic imaging test of PKD
Ultrasound
Normal GFR, Stage 1-5 kidney disease
Normal is 120-130, Stage 1 kidney damage with normal GFR or >90 Stage 2 60-89 Stage 3 30-59 Stage 4 15-29 Stage 5 <15
First and second most common causes of end stage renal disease
DM, htn
Single best predictor of chronic kidney disease progression
Spot urine albumin/ucreatinine ratio (ACR), proteinuria
HbA1c goal for management in chronic kidney disease patients
<7%, regular diabetics without CKD between 7-8%
Best initial test in evaluating a horseshoe kidney
CT urography
Gold standard non invasive and invasive and therapeutic diagnostic studies for renal artery stenosis
CT angiography, renal catheter arteriography
What drugs are contraindicated in a patient with bilateral renal artery stenosis or in patients with a solitary kidney
ACE and ARBs as may lead to AKI
Earliest sign of hypokalemia
T wave flattening followed by prominent u wave development
Management of severe hypermagnesemia (rare)
IV calcium gluconate plus IV fluids plus furosemide, dialysis if severe enough
Hypokalemia and hypomagnesemia can precipitate what cardiac arrhythmia? What is the treatment of this arrhythmia?
Torsades de pointes, IV magnesium sulfate
Most common initial symptom of hypernatremia
Thirst, followed by confusion, lethargy, dry mouth and mucus membranes
Rapid over correction of hypernatremia with hypotonic fluids can lead to…
…cerebral edema
Rapid over correction of hyponatremia with volume replacement can lead to
central pontine myelinolysis
Most common initial symtpom of hyponatremia
Neurologic issues due to cerebral edema
Hypomagnesemia presents with similar findings such as increased DTRs and tetany as well as signs of hypo___ because the two are connected as magneisum is needed to make a hormone that controls this
hypocalcemia
Hypokalemia is associated with metabolic ___ while hyper is associated with ___
alkalosis, acidosis
Hypokalemia management
KCl replacement and if hypomagnesemia present then replace that too
MUDPILERS acronym and what does it mean?
Methanol Uremia DKA Propylene glycol Isoniazid Lactic acidosis Ethylene glycol Salicylates
Means anion gap metabolic acidosis, (too much acid or too little bicarb, true regardless if anion gap present or not)
Steps to solve an acid base disorder
1) pH <7.35 is acidotic, pH >7.45 is alkalotic
2) Is the pCO2 low or high (35-45)
3) In primary respiratory disorders, pCO2 does the OPPOSITE of the pH
4) Is HCO3 low or high (22-26)
5) In primary metabolic disorders, the HCO3 does the same as the pH
6) IF metabolic acidosis is present, calculate anion gap Na - (Cl+HCO3), normal is 10-12
A left sided varicocele can be indicative of…
…renal cell carcinoma
Most common abdominal mass in children, most commonly manifested as a palpable abdominal mass that doesn’t cross midline
Wilms tumor (nephroblastoma)
best initial test in suspected wilm’s tumor, how is it treated?
Abdominal ultrasound, treated with total nephrectomy followed by chemotherapy
