Nephrology Flashcards
Leading cause of morbidity and mortality in CKD
Cardiovascular disease
Most common complications of CKD
Hypertension and LV hypertrophyF
First line of therapy in hypertension in CKD
Salt restriction
Target BP <130/80
Target Hb in CKD
110-115g/LSpon
Pregnancy is associated with high rate of spontaneous abortion at what eGFR
once eGFR reaches 40mL/min and lowerC
Contraindications to renal biopsy
Uncontrolled hypertension
active UTI
Bleeding diathesis including ongoing anticoagulation
Severe obesity
*also not advised in bilaterally small kidneys
HD access with the highest long term patency rate
Fistula
Most important complciation of AV graft
Thrombosis of the graft and graft failure
Peritoneal dialysis peritonitis defined by
Elevated peritoneal fluid leukocyte count (100/mm3) of which at least 50% are PMNs
Most common culprid - StaphC
Causes of transient/functional proteinuria (<1g/24h)
Fever, exercise, obesity, sleep apnea, emotional stress, CHF
Timing of post strep GN from impetigo
after 2-6 weeks
(vs 1-3 weeks from pharyngitis)
Natural course of PSGN
Complete resolution of azotemia, hematuria, and proteinuria in majority of children occurs within 3-6 weeks of enset of nephritis
Elderly - high indicdence of azotemia, nephrotic range proteinuria, and ESRD
Treatment is supportiver
Primary treatmetn in endocarditis-associated GN
Eradication of the infection with 4-6 weeks of antibiotics
Most common presentations of IgA nephropathy
Recurrent episodes of macroscopic hematuria during or immediately following an URTI often accompanied by proteinuria
and
persistent asymptomatic microscopic hematuria
Most common cause of nephrotic syndrome in elderly
Membranous GN
GN associated with chronic hep C
Cryoglobulinemic GN
MGN
MPGN
in decreasing frequency
(PAN, IGA nephropathy, FSGS also reported)
Schistosoma sp most commonly associated with clinical renal disease (GN)
Schistosoma mansoni
Adynamic bone disease definition
Low bone turnover with low or normal pTH levels
Two most common and well characterized rare monogenic disorders that lead to stone formation
Primary hyperoxaluria and cystinuria
High oxalate foods to avoid to reduce risk of calcium ox stones
Spinach, rhubarb, almonds, potatoes
Treatment of IgA nephropathy
No agreement on optimal treatment
Small studies support ACE inhibitors in paitents with proteinuria or declining renal function
Steroid tx or other immunosuppressives in those (+) proteinuria after ACEi
RTA types
Type 1 Distal *hypokalemia, NAGMA, Low urinary ammonia excretion
(nephrolithiasis, nephrocalcinosis, hypocitraturia, hypercalciuria)
Type 2 Proximal *glycosuria, generalized aminoaciduria, phosphaturia
Type 4 Generalized distal RTA *hyperK disproportionate to reduction in GFR
Most common causes of chronic hypokalemic akalosis
surreptitious vomiting, diuretic abuse, and GS
Cornerstone of the therapy or chronic hyponatremia
Water deprivation
Therapy for chronic hyponatremia when fluid restriction, potassium replacement, and/or increased solute intake fails
SIAD: oral furosemide, 20 mg twice a day (higher doses may be necessary in renal insufficiency),
and oral salt tablets
Demeclocycline - potent inhibitor of principal cells and can be used in patients whose Na levels do not increase in response to furosemide and salt tablets
Factors measured in 24h urine collection in work up for nephrolithiasis
total volume, calcium, oxalate, citrate, uric acid, sodium, potassium, phosphorus, pH, and creatinine
