nephrology Flashcards
Salt supplements favored by many patients often are high in (what electrolyte?)
Salt supplements favored by many patients often are high in (potassium)
Principal cells of the collecting ducts becoming resistant to antidiuretic hormone describes what disease?
Nephrogenic diabetes insipidus
Which hormone abnormality typically causes euvolemic hypotonic hyponatremia?
SIADH
Patient with kidney disease on dialysis, longstanding hyperparathyroidism, and lytic lesions of the skeleton.
Diagnosis: Renal osteodystrophy
Reduced number of nephrons leads to a decrease in phosphate excretion ultimately leading to an increase in secretion of FGF 23 and PTH which both decrease phosphate excretion.
Serum osmole gap greater than 10 occurs with ethanol intoxication or with (what)?
ingestion of toxic alcohols.
What type of urinary casts/bodies will be seen in nephrotic syndrome?
oval fat bodies or fatty casts.
Thiazides can cause (hyper/hypo)calcemia.
Thiazides can cause (hyper)calcemia.
Obesity related glomerular hyperfiltration can damage the glomeruli eventually leading to what?
a rise in protein and creatinine.
The clinical features of nephrotic syndrome include?
hypoalbuminemia, edema, and nephrotic-range proteinuria (3500 mg/24hr)
may also see hyperlipidemia.
Chronic discomfort in pelvic or genital region with nonspecific urinary symptoms and no infection likely indicates what?
Likely diagnosis: Chronic pelvic pain syndrome
Polyuria in type 2 diabetes will typically show (higher/lower) urine osmolarity.
Polyuria in type 2 diabetes will typically show (higher) urine osmolarity.
Metabolic alkalosis can cause refractory hypokalemia by what mechanism?
As renal bicarbonate excretion increases, a cation such as sodium and potassium also needs to be excreted at the same time.
Three groups of medications that are often implicated in causing acute interstitial nephritis are?
NSAIDS, proton pump inhibitors, and antibiotics.
Painful, violaceous, nodules with CKD, hypercalcemia, hyperphosphatemia indicate what diagnosis?
DX: Calciphylaxis
Most appropriate test to establish cause of acute kidney failure in an old man with oliguria, suprapubic fullness, and tenderness?
kidney and bladder ultrasound.
What is the first-line therapy for primary fsgs
Steroids along with ace inhibitors
An ethanol level greater than what is potentially fatal.
300
An ethanol level greater than 100 is the definition for what?
ethanol intoxication.
Nephritic syndrome with low complement levels 2-3 weeks after upper respiratory infection indicates what diagnosis?
Dx: PSGN
Evaluation of recurrent kidney stones should include?
metabolic panel, a CT, 24-hour urine studies, and stone analysis.
A high serum ethanol level with an osmole gap but no anion gap is consistent with what diagnosis?
ethanol intoxication.
Fever, skin rash, and peripheral eosinophilia are three classic findings in what condition?
acute interstitial nephritis.
Patient has a urostomy with stomal stenosis and a non-anion gap metabolic acidosis; what is the initial step?
placement of a Foley catheter.
Patient presents with polyuria and hypernatremia; what is the most appropriate next step?
to measure urine osmolality.
Obesity leads to an (increase/decrease) in glomerular pressures and hypertrophy of the glomeruli.
Obesity leads to an (increase) in glomerular pressures and hypertrophy of the glomeruli which results in hyperfiltration.
Diabetes insipidus during pregnancy is caused by what?
placental production of vasopressinase.
The best screening test for diabetic nephropathy is?
urine albumin to creatinine ratio.
Stagnant urine in the intestine can result in absorption of chloride in exchange for bicarbonate, resulting in what metabolic abnormality?
hyperchloremic metabolic acidosis.
Older man with dysuria, urinary urgency, no urinary incontinence, fever, and perennial tenderness likely has?
Diagnosis: Acute bacterial prostatitis.
Diagnostic test for acute bacterial prostatitis?
urine culture.
All patients presenting with gross hematuria will be evaluated first with?
CT urography followed by cystoscopy to rule out malignancy.
Typical treatment for obesity related glomerular hyperfiltration includes?
either an ACE or an ARB.
Patient had gastric bypass surgery and multiple kidney stones; the most likely stone is made of?
calcium oxalate due to malabsorption of free fatty acids.
Asymptomatic SIADH is managed with?
limiting all fluids to less than 1L daily.
In secondary FSGS, treatment with an (what class?) drug and general blood pressure control (with/without) immunosuppressive therapy is the standard.
In secondary FSGS, treatment with an (ACE inhibitor) drug and general blood pressure control (without) immunosuppressive therapy is the standard.
Acute infection of the urinary tract alone rarely causes kidney dysfunction (T/F)?
(T) Acute infection of the urinary tract alone rarely causes kidney dysfunction.
Diagnostic test for vesicoureteral reflux?
voiding cystourethrogram.
Magnesium ammonium phosphate stones typically form in the setting of (what past medical history?)
recurrent UTI.
PPIs indirectly affect the luminal pH of the intestines which can potentially cause (hypo/hyper)magnesemia.
PPIs indirectly affect the luminal pH of the intestines which can potentially cause (hypo)magnesemia.
Lithium is known to cause what classic kidney disease?
Nephrogenic diabetes insipidus.
IV magnesium rarely works to maintain normal levels in hypomagnesemia because?
most the magnesium is filtered through the kidneys; the magnesium delivered exceeds the capacity of the kidneys to reabsorb.
Thiazides are used to (decrease/increase) urinary excretion of calcium.
Thiazides are used to (decrease) urinary excretion of calcium.
The best option outpatient for hypomagnesemia needing frequent replacements is?
sustained-release preparations taken in divided doses.
Topiramate can cause what renal abnormality?
Calcium phosphate kidney stones.
What are the clinical features of nephrotic syndrome?
Hypoalbuminemia, edema, and nephrotic-range proteinuria (3500 mg/24hr) may also see hyperlipidemia.
What can obesity-related glomerular hyperfiltration lead to?
Damage to the glomeruli, leading to a rise in protein and creatinine.
What is the next indicated step if chronic pelvic pain syndrome features in a male after a 6-week course of antibiotics did not work?
Start an alpha blocking agent such as alfuzosin.
What is the first line drug therapy for FSGS?
Prednisone along with an ACE inhibitor to reduce proteinuria.
What is the most appropriate initial diagnostic test for renal vascular hypertension and acute kidney injury?
Duplex ultrasonography of the renal arteries.
What acid-base abnormality may patients with an ileal or colonic conduit urinary diversion experiencing stomal stenosis have?
Hyperchloremic metabolic acidosis.
What is the likely diagnosis for multiple UTIs since childhood and current UTI as a young adult?
Vesicoureteral reflux.
What disease is the Streptozyme test commonly used to assess for?
Post-streptococcal glomerulonephritis (PSGN).
What is the most appropriate test to establish the cause of acute kidney failure in an old man with oliguria, suprapubic fullness, and tenderness?
Kidney and bladder ultrasound.
What should patients with intravascular volume depletion before IV acyclovir receive?
Fluid resuscitation sufficient to maintain a urine output of at least 75 mL/hour.
If a patient with primary FSGS does not respond to Prednisone or has contraindications, what initial treatment is reasonable to consider?
Initial treatment with a calcineurin inhibitor such as cyclosporine or tacrolimus.
What should evaluation of recurrent kidney stones include?
Metabolic panel, a CT, 24-hour urine studies, and stone analysis.
What may calciphylaxis patients experience in their fingers/extremities?
Pain secondary to ischemia.
What should older men with findings suggestive of prostate cancer undergo?
Evaluation with a transrectal prostate biopsy procedure regardless of prostate specific antigen level.
What should be considered in difficult to control hypertension in a patient already on multiple antihypertensives?
Consider adding a diuretic class of drug.
True or False: Older men with findings suggestive of prostate cancer should undergo evaluation with transrectal prostate biopsy regardless of prostate specific antigen level.
True.
Gabapentin is cleared by the…
kidneys
What abnormalities will an electrocardiogram (ECG) show in hyperkalemia?
Peaked T waves and QRS widening
What serum potassium level indicates immediate treatment for hyperkalemia?
> 6.5 mEq/liter
What should be treated immediately in patients with abnormal ECG findings due to hyperkalemia?
Intravenous calcium
How does intravenous calcium affect cardiac cells?
Raises the threshold resting membrane potential and makes cells less excitable
What form is calcium usually provided in for treatment of hyperkalemia?
Calcium gluconate
Why is calcium chloride not given through a peripheral intravenous line?
It can cause local tissue necrosis if there is tissue extravasation
Fill in the blank: Intravenous calcium raises the _______ resting membrane potential.
threshold
What is the most likely diagnosis in a patient presenting with diffuse pulmonary infiltrates, hemoptysis, epistaxis, hematuria, and acute kidney injury?
Granulomatosis with polyangiitis
Granulomatosis with polyangiitis, previously known as Wegener’s granulomatosis, is a small-vessel vasculitis that can affect multiple organs including the lungs and kidneys.
What organ damage can aminoglycoside therapy commonly lead to?
Acute kidney injury
This is a significant complication associated with the use of aminoglycosides.
What is the relationship between cumulative exposure and kidney injury in aminoglycoside therapy?
The effect is related to cumulative exposure and usually does not occur until the patient has received 5 to 7 days of therapy
This indicates that prolonged use increases risk.
What type of kidney injury is typically associated with aminoglycoside toxicity?
Nonoliguric kidney injury
This refers to a decreased ability to concentrate urine.
What type of renal damage is involved in aminoglycoside toxicity?
Distal tubular damage
This damage is a key factor in the development of acute kidney injury.
What electrolyte imbalances can occur due to aminoglycoside toxicity?
- Hypomagnesemia
- Hypokalemia
These imbalances result from tubular toxicity.
What is the most important objective of hypertension treatment in a patient on dialysis?
Control of chronic volume overload.
Chronic volume overload can lead to further complications in patients on dialysis.
What is a potential cause of acute kidney injury in older patients taking nonsteroidal antiinflammatory drugs?
Minimal-change disease or membranous nephropathy with or without interstitial nephritis.
These conditions can lead to significant proteinuria.
How is abdominal compartment syndrome defined?
Intra-abdominal pressure >20 mm Hg accompanied by organ dysfunction
What are the risk factors for abdominal compartment syndrome?
- Intra-abdominal or retroperitoneal infection or inflammation
- Abdominal trauma or surgery
- Massive fluid resuscitation (>5 liters per 24 hours)
What effect do high intra-abdominal pressures have on the kidneys?
They increase renal venous pressure and vascular resistance, decreasing renal perfusion
Can AKI related to abdominal compartment syndrome be reversed?
Yes, if treated promptly by decompression of the abdomen with paracentesis
Fill in the blank: Abdominal compartment syndrome is defined as intra-abdominal pressure >______ mm Hg.
20
True or False: Massive fluid resuscitation is a risk factor for abdominal compartment syndrome.
True
What are common features of Scleroderma renal crisis?
Malignant arterial hypertension, accelerated kidney failure, markedly increased levels of plasma renin activity
These features characterize the clinical presentation of Scleroderma renal crisis.
Why are ACE inhibitors considered advantageous in Scleroderma renal crisis?
They are mechanistically advantageous due to the large rise in renin during a scleroderma renal crisis
ACE inhibitors help manage hypertension and renal complications associated with Scleroderma renal crisis.
Which ACE inhibitor may be particularly beneficial for Scleroderma renal crisis and why?
Captopril, because of its rapid onset
Captopril has been used more than other ACE inhibitors in patients with Scleroderma renal crisis.
Fill in the blank: Common features of Scleroderma renal crisis include malignant arterial hypertension, accelerated kidney failure, and markedly increased levels of _______.
plasma renin activity
True or False: Captopril is less commonly used than other ACE inhibitors in patients with Scleroderma renal crisis.
False
Captopril has been used more than other ACE inhibitors in this patient population.
What is a key characteristic of Captopril that makes it suitable for Scleroderma renal crisis?
Rapid onset
What is prerenal azotemia?
A condition that causes acute kidney injury due to inadequate blood flow to the kidneys
Prerenal azotemia is often reversible if the underlying cause is addressed promptly.
What happens to sodium conservation in prerenal azotemia?
The kidney retains the ability to conserve sodium
This is a compensatory mechanism due to low blood flow.
What is typically observed in urinary sodium levels during prerenal azotemia?
Urinary sodium is typically low
This reflects the kidneys’ attempt to retain sodium in response to perceived low blood volume.
What does a finding of granular casts in urine suggest?
Acute tubular necrosis
Granular casts are indicative of kidney injury, particularly in acute tubular necrosis.
What sodium level in urine is suggestive of acute tubular necrosis?
> 30 mEq/liter
Elevated sodium levels in urine can help differentiate acute tubular necrosis from other types of kidney injury.
What is the typical serum creatinine level expected in older individuals?
≤1 mg/dL
This is due to reduced muscle mass in older individuals.
What is postinfectious glomerulonephritis?
A renal-limited process that occurs after a streptococcal infection
When can postinfectious glomerulonephritis manifest after a streptococcal infection?
2 weeks or more
What activates cellular and humoral immunity in postinfectious glomerulonephritis?
Nephritogenic strains of group A beta-hemolytic streptococcus
What laboratory finding is typically observed in postinfectious glomerulonephritis?
Hypocomplementemia
What symptoms do patients present with 2 to 3 weeks after the onset of infection?
- Hypertension
- Edema
- Active urinary sediment including hematuria
- Proteinuria
How can the symptoms of postinfectious glomerulonephritis vary?
Sometimes mild, leading to identification weeks to months later with mild hematuria and proteinuria
What happens to serum complement levels in postinfectious glomerulonephritis?
If depressed, they should return to normal within 3 months
Are rash and other systemic symptoms seen in postinfectious glomerulonephritis?
No
What is the most likely diagnosis for a patient with a rash and acute kidney injury 2 weeks after starting a beta-lactam antibiotic?
Acute interstitial nephritis
The diagnosis is supported by the presence of sterile pyuria.
What percentage of patients with interstitial nephritis typically show peripheral eosinophilia?
23%
Peripheral eosinophilia is not a common finding in all patients with interstitial nephritis.
What is the occurrence rate of the full triad of fever, rash, and peripheral eosinophilia in patients with interstitial nephritis?
<10%
This indicates that the triad is rare among patients with this condition.
Is the finding of urinary eosinophils sensitive or specific for interstitial nephritis?
Neither sensitive nor specific
The diagnosis relies more on clinical course or renal biopsy.
What diagnostic methods are most useful for confirming acute interstitial nephritis?
Clinical course or renal biopsy
These methods provide more reliable information than urinary eosinophils.
