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COMLEX Level 3 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

acute renal failure

A

normal kidney size
normal hematocrit
normal calcium level

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2
Q

chronic renal failure

A

> 2wks
reduced kidney size
reduced hct (loss of erythropoietin production)
reduced calcium (loss of vitD hydroxylation)

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3
Q

prerenal azotemia causes

A

hypoperfusion

  • hypotension
  • hypovolemia
  • low oncotic pressure (low albumin)
  • CHF
  • constrictive pericarditis
  • renal artery stenosis
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4
Q

diagnostic testing for prerenal azotemia

A 
BUN:Cr > 15:1 and often >20:1
low urinary sodium <20
FENa <1% 
urine osm >500
poss hyaline casts on urinalysis
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5
Q

treatment for prerenal azotemia

A

based on underlying cause

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6
Q

tests for all renal cases

A

urinalysis, urine sodium, potassium
chemistries
renal ultrasound

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7
Q

postrenal azotemia causes

A

obstructive uropathy

  • stone in bladder or ureters
  • bilateral strictures
  • cancer of bladder, prostate, or cervix
  • neurogenic bladder
  • prostate hypertrophy/BPH
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8
Q

diagnostic testing for postrenal azotemia

A

BUN:Cr >15:1
distended bladder on exam
large volume diuresis after passing a urinary catheter
bilateral hydronephriss on ultrasound

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9
Q

intrarenal causes of renal failure diagnostic testing

A

BUN:Cr 10:1 (<20:1)
urinary sodium >40
urine osm <350
FENa >2%

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10
Q

ATN causes

A 
hypoperfusion to the point of death of tubular cellls or toxic injuries
aminoglycosides
amphotericin
contrast
chemo (cisplatin)
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11
Q

nephrotoxic agents

A 
gentamicin
aminoglycoside
cisplatin
ACEi (renal protective in DM)
NSAIDs
loop diuretics
cyclosporine
tacrolismus
acyclovir
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12
Q

urinalysis in ATN

A

muddy brown or granular casts

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13
Q

what to do if AIN does not improve in 48hrs

A

steroids

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14
Q

rhabdomyolysis causes

A 
crush injury
seizure/cocaine toxicity
prolonged immobility in an intoxicated patient
hypokalemia -> muscle necrosis
patient recently started on statin
low serum phosphate
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15
Q

rhabdomyolysis findings

A

urinalysis (best initial) + large amounts of blood
CPK elev
urine myoglobin (most accurate)
also order: potassium (hyper), calcium (hypo), chemistries (dec bicarb)

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16
Q

treatment of rhabdo

A

bolus of NS
mannitol diuresis to dec contact time of myoglobin with tubule
alkalinzation of the urine to decrease precipitation of myoglobin at the tubule

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17
Q

crystal-induced renal failure

A

from oxalate or uric acid crystals

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18
Q

oxalate crystals:

A

suicide by antifreeze ingestion, intox with metabolic acidosis and elevaed anion gap

  • UA: envelope-shaped oxalate crystals
  • tx: ethanol or fomepizole with immediate dialysis
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19
Q

uric acid crystals

A

tumor lysis syndrome, often after chemo for lymphoma

tx hydration, allopurinol, rasburicase

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20
Q

cholesterol embolism

A

livedo reticularis, low C3 and C4, and increased eosinophils

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21
Q

kidney damage from NSAIDs

A

direct toxicity and papillary necrosis
allergic interstitial nephritis with WBCs and eosinophils in urine
nephrotic syndrome
afferent arteriolar vasoconstriction and decreased perfusion of glomerulus, worsening renal function

22
Q

glomerulonephritis characteristics

A

RBCs in urine
red cell casts in urine
mild degreees of proteinuria (<2g per 24hr)
edema
may lead to nephrotic syndrome
most accurately diagnosed by kidney biopsy

23
Q

cough, hemoptysis, SOB, and lung findings along with RBC in urine

A

Goodpasture

24
Q

anti-basement membrane antibodies

A

goodpasture

best initial

25
Q

linear deposits on renal biopsy

A

goodpasture

most accurate test

26
Q

treatment for goodpasture

A

plasmapheresis and steroids

27
Q

asthma, cough, and eosinophila with RBCs in urine

A

Churg-Strauss syndrome

28
Q

MPO-ANCA pos and eosinophilia

A

churg-strauss

best initial

29
Q

treatment churg strauss

A

glucocorticoids

add cyclophosphamide if no response

30
Q

upper respiratory problems (sinusitis, otitis) + lung problems + RBCs in urine

A

wegener - granulomatosis with polyangiitis

systemic vasculitis so will also have joint, skin, eye, brain, and GI problems

31
Q

c-ANCA or antiproteinase 3-ANCA

A

granulomatosis with polyangiitis/wegener

best initial test

32
Q

treatment of granulomatosis with polyangiitis

A

cyclophosphamide or rituximab and steroids

33
Q

lung + renal + systemic vasculitis + no granulomas on biopsy + no eosinophils/asthma

A

microscopic polyangitis

+ MPO-ANCA

34
Q

tx microscopic polyangitis

A

steroids and cyclophosphamide or rituximab

35
Q

polyarteritis nodosa (PAN)

A 
systemic vasculitis of every organ except lung
- renal
- myalgias
- GI bleeding and abd pain
- purpuric skin lesion
- stroke
- uveitis
- neuropathy
nonspecific findings of fever, weight loss, fatigue
36
Q

diagnostics for PAN

A

ESR and markers of inflammation (best initial)
biopsy of sural nerve or kidney (most accurate)
hepB and C (assoc w 30% of PAN)
angiography shows “beading” can spare need for biopsy

37
Q

beading on angiography

A

PAN

38
Q

treatment of PAN

A

cyclophosphamide and steroids

39
Q

recurrent hematuria in an asian patient after a recent viral URI + proteinuria, red cells, and red cell casts in urine

A

IgA nephropathy

Berger disease

40
Q

diagnostic testing of IgA nephropathy

A

IgA sometimes elevated
renal biopsy most accurate and essential for dx
complement levels normal

41
Q

tx IgA nephropathy

A

steroids in boluses when sudden worsening of proteinuria
ACEi
fish oil may delay progression

42
Q

tx IgA nephropathy

A

steroids in boluses when sudden worsening of proteinuria
ACEi
fish oil may delay progression

43
Q

adolescent/child with raised, nontender purpuric skin lesions, abdominal pain, poss bleeding, joint pain + renal involvement

A

Henoch-Schonlein Purpura

44
Q

diagnosis of HSP

A

combined presentation of GI, joint, skin, and renal

biopsy showing IgA deposition is most accurate

45
Q

tx HSP

A

usually not necessary

steroids or ACEi if proteinuria

46
Q

cola-colored urine, periorbital edema, hypertension after throat/skin infection

A

post-streptococcal glomerulonephritis

47
Q

best initial test in PSGN

A

antistreptolysin O, anti-DNase, antihyaluronidase in blood

complement levels low

48
Q

most accurate in PSGN

A

biopsy

49
Q

subepithelial deposits of IgG and C3

A

PSGN

50
Q

tx PSGN

A

antibiotics (penicillin)
do not reverse disease
control hypertension/fluid overload with diuretics

COMLEX Level 3 (5 decks)

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