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RC Studying > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Define Stage 1, 2 and 3 AKI per 2022 KDIGO staging.

A

Stage I: Cr 1.5-1.9x baseline in 7 d OR increase >/=0.3mg/dl in 48hr, U/O <0.5ml/kg/h for 6-12hr
Stage II: Cr 2-2.9xbaseline, <0.5ml/kgh for >/=12hrs
Stage III: Cr >/=3x baseline or >4mg/dl or initiation of RRT or eGFR<35ml/min/1.73m2, U/O <0.3 for >/=24hr or anuria for >/=12hrs

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2
Q

DDx for pre-renal AKI?

A

GI losses, hemorrhage, decreased cardiac output, decreased vascular resistance (sepsis), nephrotic syndrome, liver failure, impaired renal autoregulation (hyperCa+, ACEi, NSAIDs, tacrolimus, cyclosporine)

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3
Q

DDx for renal AKI?

A

Tubules/interstitium: ischemic tubular injury, nephrotoxic AKI, acute interstitial nephritis
Glomerulus: PIGN, HUS
Blood vessels: renal vein thrombosis

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4
Q

DDx for post-renal AKI?

A

UPJ obstruction, ureteric obstruction, bladder obstruction, urethral obstruction
*Both kidneys need to be obstructed!

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5
Q

Name 5 medications known to be nephrotoxic.

A

Acyclovir, AmphoB, Captopril, Cisplatin, Cyclosporine, Enalapril, Gentamicin, Ibuprofen, Ketorolac, Lisinopril, Tacrolimus, Tobramycin, Vancomycin

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6
Q

Name the ECG changes associated with hyperkalemia

A

Tall peaked T waves, flattened/absent P waves, sine wave, prolonged PR, widened QRS, bradycardia/Vtach/VFib

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7
Q

What are the indications for dialysis?

A

AEIOU
A: acidosis
E: electrolyte abnormalities (hyperK, hyperNa, hyperPO4)
I: ingestions (methanol, ethylene glycol, ASA, lithium)
O: fluid overload
U: symptoms of uremia (pericarditis, encephalopathy, seizures, bleeding)

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8
Q

What is the criteria for CKD?

A

Either of the following present for >3 months:
Markers of kidney damage (1 or more): albuminuria, ACR >30mg/g or 3mg/mmol, urine sediment abN, abN ‘lytes due to tubular d/o, abN histology, structural anomaly, hx transplant
Decreased GFR: < 60ml/min per 1.73M2

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9
Q

What is the most common cause of childhood CKD?

A

Renal dysplasia: hypodysplasia, solitary kidney, VUR, posterior urethral valves
- Dx on U/S: sm kidneys, echogenic parenchyma, cortical cysts
2nd most common: glomerulopathy
3rd most common: cystic kidney disease

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10
Q

What is oligohydramnios sequence (Potter’s phenotype)?

A

Deep set eyes, beaked nose, micrognathia, low set ears, extremity contractures, pulmonary hypoplasia (about 1/2 die soon after birth of pulmonary insuff)

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11
Q

What are the features of a distal RTA (Type 1)?

A 
Impaired hydrogen ion excretion
Urine pH >5.5 
HypoK
Renal stones, hypercalciuria
ALL RTAs = hyperchloremic metabolic acidosis w/ normal serum AG
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12
Q

What are the features of a proximal RTA (Type 2)?

A

Impaired bicarbonate reabsorption
High urine pH initially, later <5.5
HypoK
ALL RTAs = hyperchloremic metabolic acidosis w/ normal serum AG

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13
Q

What are the features of a Type IV RTA?

A

Decreased aldosterone secretion or aldosterone resistance
Urine pH <5.5
HyperK
ALL RTAs = hyperchloremic metabolic acidosis w/ normal serum AG

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14
Q

What findings do you expect in SIADH for the following parameters:

  • Serum Na
  • Urine Na
  • Serum osm
  • Urine osm
A
  • HypoNa
  • Urine Na >20meq/L
  • Low serum osm
  • Elevated urine osm (>100)
  • Fun fact: uric acid does the same as sodium; SIADH will have low serum uric acid and high urine excretion of uric acid
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15
Q

What is the most common pathogen associated with infection in patients with nephrotic syndrome?

A

S. pneumoniae (patients with nephrotic syndrome are at risk for SBP)

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16
Q

What is the in utero US measurement which defines severe antenatal hydronephrosis?

A

Renal pelvis diameter >10mm in second trimester or >15mm in third trimester is defined as severe ANH
-Earlier fetal age at diagnosis protends a more severe condition

17
Q

What is in the differential diagnosis of antenatal hydronephrosis?

A
  • Transient/physiologic (50-70%)
  • Ureteropelvic junction obstruction (10-30%)
  • Vesicoureteral reflux (10-20%)
  • Megaureter/ureterovesical junction obstruction (5-15%)
  • Multicystic dysplastic kidney (5%)
  • Posterior urethral valves (1-2%)
18
Q

How many mmol of Na is found in 1000mL of NS solution?

A

154 mmol

19
Q

What is the most common cause for hypoalbuminemia in children?

A

Renal disorder - need to check urinary protein!

20
Q

Nephrotic syndrome with a low C3 and a normal C4. What is the most likely cause?

A

PSGN/PIGN

21
Q

Nephrotic syndrome with a low C3 AND low C4. What is the most likely cause/DDx?

A
  • Lupus nephritis
  • Membranoproliferative GN
  • Chronic bacteremia (endocarditis, shunt nephritis)
22
Q

Nephrotic syndrome with normal complements (C3 and C4). What is most likely cause/DDx?

A
  • IgA nephropathy
  • Alport syndrome
  • Henoch-Schonlein purpura nephritis
  • ANCA vasculitis
  • Granulomatosis with polyangitis
  • Microscopic polyangitis
23
Q

What syndrome is defined by the following triad?

  1. Abdominal muscle deficiency
  2. Severe urinary tract abnormalities
  3. B/L cryptorchidism in males
A

Prune Belly Syndrome

-Most have VUR

24
Q

What is the recommended fluid volume for oral rehydration solution in moderate dehydration?

A

100ml/kg plus replacement of continuing losses over 4 hours
-50mL/kg for mild
(from retired CPS statement)

25
Q

What vaccine do you recommend for children with nephrotic syndrome considering their increased risk of infection?

A

Pneumococcal 23/PCV 23
Other vaccine recommendations:
-PCV 13 (4 doses given in routine schedule <15mo)
-Annual flu vaccine
-Defer live vaccines until 1 month after D/C of high dose steroids (CPS)
-Live vaccines C/I in children on cyclosporine or cyclophosphamide
-Give VZV Ig after close contact with varicella infection, immunize healthy family members

26
Q

What is the treatment for a torsion of the appendix testis?

A

-Analgesics, bed rest and scrotal support

27
Q

What is the most common renal stone in children?

A

Calcium

-Calcium oxalate > calcium phosphate

28
Q

What is the triad of hemolytic uremic syndrome?

A
  • Microangiopathic hemolytic anemia
  • Thrombocytopenia
  • Renal insufficiency
29
Q

What is the most common cause of renal mass in newborns?

A

Hydronephrosis

30
Q

What is the most common cause of nephrotic syndrome?

A

Minimal change disease

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