Nephrology Flashcards
Respiratory compensation for metabolic acidosis
1.5 (HCO3) + 8
Respiratory compensation for metabolic alkalosis
40 + 0.7 (change in HCO3)
Metabolic compensation for respiratory acidosis
Acute: 1 for 10
Chronic: 4 for 10
Metabolic compensation for respiratory alkalosis
Acute: 2 for 10
Chronic: 5 for 10
Delta/delta
Change in AG / change in HCO3
> 2 = HAGMA + Met alk
< 1 = HAGMA + NAGMA
1-2 = HAGMA
Ketoacidosis with hyperkalemia
Euglycemic OR Diabetic
Ketoacidosis with low or normal K
Alcohol
NAGMA + low Ur Cl
RTA (+UAG)
Early kidney disease
NAGMA + high Ur Cl
Diarrhea (-UAG)
Ureterosigmoidostomy
Metabolic alkalosis with Ur Cl < 15
Diuretics (remote) Volume depletion Vomiting NGT aspiration Exogenous alkali
Metabolic alkalosis with Ur Cl > 15
Diuretics Recent high BP Hyperaldosteronism Cushing Syndrome Licorice ingestion Liddle’s syndrome
HypoMg
HypoK
Bartter syndrome
GItelman syndrome
Decreased transport defect in ascending LoH.
Similar to furosemide.
Metabolic alkalosis. HypoK. Low BP. UrCl > 15.
Barter syndrome
Decreased transport defect in distal tubule.
Similar to thiazides.
Metabolic alkalosis. HypoK. Low BP. UrCl > 15. Decreased Ur Uric Acid and Calcium
GItelman syndrome
Increased (aldosterone) transport defect in distal tubule.
Similar to hyperaldosteronism and licorice ingestion.
Metabolic alkalosis. HypoK. High BP. UrCl > 15.
Liddle syndrome
HAGMA + rectangular shaped Ca oxylate crystals
Ethylene glycol
Elevated OG w/o metabolic acidosis
Isopropyl alcohol
Respiratory alkalosis followed by metabolic acidosis
ASA toxicity
Urine anion gap
UrNa + UrK - UrCl
Acid-base disturbance in cirrhosis
Respiratory alkalosis
Defect in reabsorption of HCO3.
HypoK. +/- stones.
Ur pH <5.5 (steady state). > 5.5 (not steady state)
Fanconi, MM, acetazolamide, osteomalacia
Proximal Type II RTA
Defect in H & K excretion.
HyperK. Ur pH < 5.5. No stones
Hypoaldosteronism. DM.
Hypoaldosterone Type IV RTA
Defect in H excretion.
HypoK. Ur pH > 5.5. + Stones (CaPO4).
Sjogrens. SLE. Amphotericin B.
Classic Distal Type I RTA
HyperNa Low Ur Na Low Ur Osm No change post-H20 deprivation Inc in post-DDAVP Ur Osm
Central DI
HyperNa Low Ur Na Low Ur Osm No change post-H20 deprivation No change in post-DDAVP Ur Osm
Nephrogenic DI
HypoNa
Low Ur Na
Low Ur Osm
Inc in post-H20 deprivation and post-DDAVP Ur Osm
Psychogenic polydipsia
Beer potomania
HypoNa
High Ur Na (specific)
High Ur Osm
SIADH
Addison’s
HypoNa
High Ur Na
High Ur Osm
Inc in post-DDAVP Ur Osm
Cerebral salt wasting
Management for acute symptomatic hyponatremia (mental status changes or seizures)
3% saline
Rate at which not to correct chronic hyponatremia
> 0.5 mEq/h
Can lead to pontine myelinolysis
Management for volume depleted hyponatremia
0.9% NaCl
Best test to measure micoalbuminuria
Spot urine alb/urine Cr > 30
Management for extreme exercise-induced hematuria
Repeat UA in 6 weeks
Dysuria
Painful intercourse
Post-void dribbling
Urethral diverticulum
Cola-colored urine
UA + RBCs, RBC casts
Sore throat < 7 days ago
IgA nephropathy
Best management to preserve renal function in ADPKD
BP control
Na < 2g
Protein restriction
Collagen IV abnormality
Renal failure
Hearing loss
Alport syndrome
Fatty, oval body casts
Nephrotic syndrome
RBC casts
Dysmorphic RBCs
Nephritis
Muddy/brown casts
Pigmented granular casts
Acute tubular necrosis
WBC casts
Granular casts
Eosinophils
Interstitial nephritis
Effacement of epithelial foot processes
Hodgkins, Leukemia, NSAIDs, Lithium, pamidronate
Minimal change disease
Effacement if epithelial foot processes
African American, HIV, Heroin
Focal segmental glomerulosclerosis
Subepithelial deposits
Thickened capillary loops
Hep B/C, solid tumors
Membranous glomerulopathy
Ribbon/sausaging of membrane in type II
Low complement
Mesangial deposits with tramtrack
SLE, cryoglobulinemia, SBE, Hep B/C
Membranoproliferative nephritis
Strep infection 1-3 weeks ago OR skin infection 3-6 weeks ago
Starry eye
Subepithelial deposits
Low C3, normal C4
Post-strep GN
Idiopathic abdominal pain
Palpable purpura
Arthritis
Henoch-Schonlein
IgA vasculitis
Goodpasture’s
Linear IgG
Rapidly proliferators GN
Low serum complement levels
PSGN MPGN SLE Cryoglobulinemia SBE Atheroembolism (+Eos)
When to continue and disco turn ACEi in setting of AKI.
Continue: if < 30% Inc in Cr
Discontinue: if > 30% Inc in Cr
Prerenal azotemia with Ur Na < 10.
Precipitated with vigorous diuretic therapy, large volume paracentesis, or SBP
Hepatorenal syndrome
Livedo reticularis
Eosinophilia
Decreased complement
Atheroembolism
Inc CK, K, Phos
Low Ca
+ Dipstick for blood
Rhabdomyolysis
Inc UA, K, Phos
Low Ca
- Dipstick for blood
Tumor Lysis Syndrome
TLS pretreatment management with
UA < 8
UA > 8
UA < 8: allopurinol
UA > 8: rasburicase
TLS pretreatment management with
WBC > 100k
WBC < 100k
WBC > 100k: Rasburicase
WBC < 100k: allopurinol
TLS management with AKI
Febuxostat
Causes of papillary necrosis
Pyelonephritis Obstruction Sickle cell TB Chronic EtOH Analgesic abuse RV Thrombosis Diabetes Mellitus
Increased use of Ca containing phosphate binders, high Ca dialysate and active Vit D analogues (calcitriol)»_space; markedly suppressed PTH (<100) and ALP (< 7)»_space; decreased bone turnover»_space; high risk for fractures, HyperCa, vascular calcification
Adynamic bone disease
Antacids to avoid in ESRD
No aluminum or Magnesium
Ischemic skin lesions
ESRD. High PTH. Inc Ca. Inc Phos
Calciphylaxis
Thickening of skin in legs and arms (peau d’orange). ESRD.
Nephrogenic fibrosing dermopathy
Management for first asymptomatic nephrolithiasis
Hydration and observation
Management for first symptomatic or recurrent nephrolithiasis
Further w/u
Best diagnostic step for nephrolithiasis
Spiral CT
Predisposing factor for hyoeroxaluria and hypocitraturia
IBD
Short bowel syndrome
Staghorn calculus
Coffin lid crystals
Mg aluminum Phos (struvite) stones
Most common cause of recurrent nephrolithiasis
Idiopathic hypercalciuria
