Nephrology Flashcards
In a young muscular man, can measure ____ instead of Cr to get accurate kidney function
Cystatin C
ART, H2 blockers, Bactrim can increase Cr by default, so simply repeat later in time
Urine reddening drugs_____
Phenytoin, Pyrazinamide (Pyridium), Rifampin
Rhomboid crystals with low urine pH______
Uric acid, gout
Coffin crystals with high urine pH
struvite, proteus
Hexagonal crystals______
Homocysteinuria
Envelope shaped crystals______
Calcium oxalate, ethylene glycol, high calcium/oxalate in serum
If there is a proteinuria but dipstick with trace protein indication of____
bend jones light chain from MM, unmeasured from the urinalysis assay
Nephrolithiasis best seen with _____
NON contrast CT Scan, might do US renal first
CT Urography used for malignancy
Hypernatremia: If the losses are nonrenal, urine osmolality will be _____
elevated to >600 mOsm/kg H2O
Body is trying to retain as much water as possible, ADH activity
Hypokalemia urine studies : A value ____ mEq/g identifies hypokalemia secondary to lack of intake, transcellular shifts, or gastrointestinal losses.
<13 (Potassium/Cr ratio)
_____, increased sodium reabsorption in the distal nephron causes hypertension, metabolic alkalosis, and potassium wasting
In Liddle syndrome
HypoK syndromes: Liddle, Gittleman, Barter
*Mag potentiates Ca2+ and K+
EKG changes with hypokalemia_____
U wave, ST depression, low T amplitude
____ is a medication that can cause hypokalemia through hypoaldosteronism
Heparin
EKG changes with hyperkalemia______
Peaked T wave, short QT, Wide QRS and PR, almost invisible P wave
Symptoms of ____ ion deficiency: nclude tremors, fasciculations, muscle weakness, carpopedal spasm, Chvostek and Trousseau signs, seizures, and cardiac arrhythmogenicity.
Mg2+ and Ca2+
Acetaminophen in strict vegetarians can causes metabolic acidosis (T/F)
True
Ethylene glycol has gap acidosis and _____
Osmolar gap
_______ RTA is associated with falcon syndrome, which has glucose/phosphate/amino acids in the urine
Type II, hypokalemia
*Type 1 associated with Sjogrens, drugs (amphoterecin), hallmark of type 1 is normal urine pH because urine can’t be acidified (H+ failure)
_____ drug associated with RTA, and formation of calcium phosphate stones, low urine citrate
Topiramate
The most common causes of ______ are associated with chloride depletion: vomiting, nasogastric suction, and diuretic use.
metabolic alkalosis
*Low urine chloride<15, implies chloride wasting and supplement with NaCl
____ poisoning associated with respiratory alkalosis, metabolic acidosis
ASA (salicyclate)
Baseline electrocardiography is appropriate for all patients with newly diagnosed hypertension.
Special populations: African American
In general, ACE inhibitors are less efficacious in lowering BP in Black patients than are CCBs. Additionally, a landmark trial (ALLHAT) revealed that in Black patients, a thiazide diuretic was more effective in improving cardiovascular outcomes compared with an ACE inhibitor,
Common medications causing interstitial nephritis
Lithium, NSAIDS, H2 blocker/PPI, HIV meds, Abx, anti-cancer medications
Kidney involvement in______ is common and can manifest as nephrocalcinosis from hypercalcemia and hypercalciuria, obstructive uropathy, and TIN due to granulomatous interstitial nephritis.
sarcoid
Heavy metal causing nephrotic syndrome_________
Lead
In immunosuppressed patients with transplanted organs, _______ can cause interstitial nephritis. Diagnosis of BK virus nephropathy can be difficult to distinguish from acute cellular rejection. The most important treatment intervention is to decrease immunosuppressive therapy.
BK virus
Fanconi syndrome characterized by____
Phosphate amino acids glucose in the urine, acidosis, associated with cisplatin use, Wilsons disease
____ causes multiple types of renal injury: nephrogenic DI, TIN, Type 1 RTA
Lithium
definition of nephrotic range proteinuria ______
3500mg over 24 hrs
___________is a leading cause of the nephrotic syndrome in White adults.
Membranous glomerulopathy (membranous nephropathy)
Can be associated with PLA2R
Patients with newly diagnosed primary forms of membranous glomerulopathy are usually observed for 6 to 12 months on conservative therapy (renin-angiotensin system blockade, cholesterol-lowering medication, and edema management) before initiating a course of immunosuppression for patients with persistent nephrotic-range proteinuria: Tacro/Pred
The biopsy finding of nodular mesangial sclerosis with glomerular and tubular basement thickening, in the absence of immune deposits, is the classic description of ______
diabetic nephropathy
most common etiologies seen in RPGN cases are ANCA-associated glomerulonephritis, lupus nephritis, and anti–glomerular basement membrane glomerulonephritis.
RPGN is a G.nephritis
Anti GBM disease is a type of RPGN, linear staining of type 4 collagen antibody
Types of G Nephritis: Lupus, post strepp, IgA, MPGN, cryoglobinemia
Treatment for anti-GBM disease consists of plasmapheresis, pulse glucocorticoids (high doses of intravenous glucocorticoids over a short period of time) followed by oral prednisone, and cyclophosphamide.
More than half of patients with anti–glomerular basement membrane antibody disease have lung involvement manifesting as hemoptysis, shortness of breath, or cough.
____________ is typically characterized by a vasculitic prodrome of malaise, arthralgia, myalgia, and skin findings; hematuria, proteinuria, and acute kidney injury are present, and kidney biopsy will confirm diagnosis
ANCA-associated glomerulonephritis
Typical induction therapy consists of glucocorticoids combined with either cyclophosphamide or rituximab. Plasmapheresis is reserved for patients with evidence of alveolar hemorrhage or severe kidney failure. Other induction options include cyclophosphamide or rituximab-based therapies.
Hint to immune complex mediated G.nephritis__________
Low C3/C4
IgA nephropathy is actually a G.nephritis, associated among asian patients,
Preferred treatment of lupus nephritis_______
Mycophenylate
Treatment of classes I and II lupus nephritis (LN) includes conservative therapy with an ACE inhibitor or angiotensin receptor blocker; classes III, IV, and V LN may require aggressive immunosuppressive therapy; and class VI LN may be treated with conservative therapy.
Common viral cause of MPGN______
Hepatitis C, MPGN is a type of G.nephritis
≥60 years old if blood pressure is >150/90 mm Hg, with a goal of reducing systolic blood pressure to <150 mm Hg
Varies by organization
