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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
linear deposits on renal biopsy
goodpasture | most accurate test
26
treatment for goodpasture
plasmapheresis and steroids
27
asthma, cough, and eosinophila with RBCs in urine
Churg-Strauss syndrome
28
MPO-ANCA pos and eosinophilia
churg-strauss | best initial
29
treatment churg strauss
glucocorticoids | add cyclophosphamide if no response
30
upper respiratory problems (sinusitis, otitis) + lung problems + RBCs in urine
wegener - granulomatosis with polyangiitis | systemic vasculitis so will also have joint, skin, eye, brain, and GI problems
31
c-ANCA or antiproteinase 3-ANCA
granulomatosis with polyangiitis/wegener | best initial test
32
treatment of granulomatosis with polyangiitis
cyclophosphamide or rituximab and steroids
33
lung + renal + systemic vasculitis + no granulomas on biopsy + no eosinophils/asthma
microscopic polyangitis | + MPO-ANCA
34
tx microscopic polyangitis
steroids and cyclophosphamide or rituximab
35
polyarteritis nodosa (PAN)
``` 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
diagnostics for PAN
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
beading on angiography
PAN
38
treatment of PAN
cyclophosphamide and steroids
39
recurrent hematuria in an asian patient after a recent viral URI + proteinuria, red cells, and red cell casts in urine
IgA nephropathy | Berger disease
40
diagnostic testing of IgA nephropathy
IgA sometimes elevated renal biopsy most accurate and essential for dx complement levels normal
41
tx IgA nephropathy
steroids in boluses when sudden worsening of proteinuria ACEi fish oil may delay progression
42
tx IgA nephropathy
steroids in boluses when sudden worsening of proteinuria ACEi fish oil may delay progression
43
adolescent/child with raised, nontender purpuric skin lesions, abdominal pain, poss bleeding, joint pain + renal involvement
Henoch-Schonlein Purpura
44
diagnosis of HSP
combined presentation of GI, joint, skin, and renal | biopsy showing IgA deposition is most accurate
45
tx HSP
usually not necessary | steroids or ACEi if proteinuria
46
cola-colored urine, periorbital edema, hypertension after throat/skin infection
post-streptococcal glomerulonephritis
47
best initial test in PSGN
antistreptolysin O, anti-DNase, antihyaluronidase in blood | complement levels low
48
most accurate in PSGN
biopsy
49
subepithelial deposits of IgG and C3
PSGN
50
tx PSGN
antibiotics (penicillin) do not reverse disease control hypertension/fluid overload with diuretics

COMLEX Level 3 (5 decks)

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