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nephrology 2 Flashcards

1
Q

who should be tested

A 
ppl >60
CKD
HTN or DM
blacks, native americans, hispanics and asians
fx of kidney disease
polycystic kidney disease
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2
Q

first sign of diabetic neuropathy

A

microalbuinuria

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3
Q

tx recommendations for state 3 and 4

A

decrese phosphorus intake and use phosphorus binder therapy
treat elevated PTH w/ vitamin D
normalize serum calcium

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4
Q

how to help prevent CKD from getting worst

A 
alcohol awarness
tobacco awarness (wellbutrin and patch)
control lipids (niacin or statins)
control BP (ACEI or ARBS)
tight control of diabetes
stay away from nephrotoxic meds (NSAIDS, be careful w/ abc)
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5
Q

what is leading cause of death in CKD pts

A

cardiovascular disease

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6
Q

most important predictors of poor outcome in ESRD

A

increasing age
CVD
diabetes
poor nutrition

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7
Q

KUB

A

looking for stones (has to be pretty big stones)

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8
Q

US

A 
Ultrasound is very non invasive and is good to use to check the anatomy
safe for pregnant women
tell if mass is a cyst or solid
detects obstruction
Polycystic kidney disease
Chronic renal failure
maybe see stones
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9
Q

Intravenous pyelogram

A

suspect an obstruction to flow of urine

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10
Q

CT

A 
CT is still the gold standard for:
Renal stones
Stage renal cell carcinoma
Diagnose renal vein thrombosis
Polycystic kidney disease
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11
Q

MRI

A

usually done on pts w/ CT contraindications

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12
Q

renal arteriography

A

Gold standard for renal artery stenosis

Renal arteriography used with suspected Polyarteritis nodosa… aneurysms

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13
Q

Renal venography

A

to determine if renal vein thrombosis

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14
Q

nuclear imaging

A

can predict GFR
good to evaluate for nephrectom
evaluates function

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15
Q

what detects vescouretal refulx

A

Voiding Cystourethrogram

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16
Q

Voiding Cystourethrogram

A

usually done in children w/ uti

in males evaluate for renal abnormalities

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17
Q

most accurate test for kidney stone

A

CT

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18
Q

A 64 year old man has a Cr of 2.3 and has been diagnosed with chronic renal failure. What is the best initial imaging test?

A

US

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19
Q

A 56 yo woman presents with flank pain and bloating. What would be your initial imaging test?

A

KUB (looking for stone)

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20
Q

Your patient has had 6-10 RBC’s on his UA x 3. All other labs are WNL. You decide to consult to nephrology. What would be the best initial study to do prior to him being seen by the specialist?

A

US

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21
Q

Along with renal venography and CT, MRI is reliable for the diagnosis of renal vein thrombosis. MRA is playing an increasing role in suspected renovascular hypertension

A

true

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22
Q

what is lost in nephrotic syndrome

A

albumin
Clotting proteins (antithrombin 3)
immunoglobulins
binding proteins ( stuff that bind vit D)

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23
Q

what is most common thrombosis in nephrotic syndrome

A

renal vein thrombosis

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24
Q

etiology of nephrotic syndrome

A

Adults:
systemic disease (lupus, DM, amyloidosis)
NSAIDS
minimal change disease, focal glomerulosclerosis, membranous nephropathy
Children:
minimal change disease

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25
Q

what happens in minimal change disease

A

fusion of podocytes

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26
Q

focal and segmental glomeruloscelrosis

A

Hard to treat so give prednisone for 6 months
Characterized by the presence in some of the glomeruli of segmental areas of mesangial collapse and sclerosis
Idiopathic syndrome or may be associated with issues such as HIV infection or massive obesity
since its only focal can do biopsy and might be negative

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27
Q

membranous glomerulopathy

A

Characterized by basement membrane thickening with little or no cellular proliferation or infiltration, presence of electron dense deposits across the basement membrane
Idiopathic but can be associated with processes such as hepatitis B, autoimmune diseases, cancer, or use of certain drugs
If do biopsy and come back positive for this need to do some other tests to check for cancer, etc

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28
Q

post strep glomerulnephritis

A 
SUDDEN onset of gross hematuria
edema
HTN
back pain
oliguria
renal insufficiency
heart failure from volume overload
azotemia
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29
Q

tetrad for henoch scholein purpura

A

palpable purpura w/out thrombocytopenia
arthralgias
abdominal pain
renal disease

HSP characterized by tissue deposition of IgA-containing immune complexes. its basically the same thing except IgA is only in kidney and HSP is systemic

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30
Q

IgA nephropathy

A

aka verger’s disease
Most common lesion to cause primary GN in the developed world
GROSS HEMATURIA (usually after URI)
protinuria
flank pain
diagnosis is confirmed w/ Prominent IgA deposits in the mesangium and along glomerular capillary walls

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31
Q

rapidly progressive glomerulonephritis

A

Crescent formation nonspecific response to severe injury to glomerular capillary wall
Development of fibrous crescents represent disease stage resistant to therapy**

principal signs are 
oliguria
edema
hematuria
anemia
32
Q

cause of rapidly progressive glomeurlonephritis

A 
good pastures (anti GBM)
Immune complex (ig A or post infectious strep)
Pauci immune (few or no immune deposits)-ANCA (P and C)/Wegener’s Granulomatosis
33
Q

presentation of rpg

A 
Insidious onset:
Fatigue 
Edema
More acute onset:
Macroscopic hematuria
Oliguria
Edema
Renal insufficiency
34
Q

tx or RPG

A

pulse methylprednisone
then daily prednisone
Oral or IV cyclophophamide

35
Q

goodpastures

A

antibodies against GBM
pulmonary hemorrhage and RPGN with circulating antibodies against basement membrane antigens.
It has a course of rapidly progressive renal failure with hemoptysis, pulmonary infiltrates, dyspnea and renal failure.
Associated with cigarette exposure

36
Q

ANCA disease

A

Anti neutrophil cytoplasmic antibody
Wegener’s granulomatosis
Biopsy shows no immunofluorescense: pauci-immune crescentic GN

37
Q

C anka

A

cytoplasmic antibody
proteinase 3 antigen (PR3)
often w/ respiratory tract involvement

38
Q

p anka

A

perinuclear staining
myeloperoxidase 3 (MP3)
only in kidney

39
Q

membranoproliferative glomerulonephritis

A 
accounts for 10% of all nephrotic syndrome in adults
Thickening of GBM due to immune complex deposition
presentation:
decrease GFR
acute glomerulonephritis
nephrotic syndrome
hematuria
HTN
40
Q

interstitial nephritis

A

Interstitial inflammatory response with edema and possible tubular cell damage
drugs account for 70% of cases, also infectious disease and systemic illnesses
sxs-fever, rash, arthralgias, peripheral blood esoniphilia, red and white cells in urine, oliguria, azotemia

41
Q

risk factors for renal cell carcinoma

A 
smoking
obesity
HTN
acquired cystic disease
occupational exposure
analgesics
genetic factors
hepatitis C
42
Q

what are clear cell carcinoma associated w/

A

von hippel lindau disease

43
Q

papillary (chromophillic) carcinoma

A

usually multi focal and bilateral

44
Q

triad for renal cell carcioma

A 
flank pain
hematuria
palpable mass
also non specific sxs (fatigue and weight loss)
can have scrotal variocele 
paraneoplasic syndromes
45
Q

major criteria for cyst

A

sharply demarcated
non echoic
strong exterior wall echo meaning good presentation (black)

46
Q

assessing for mets in RCC

A

CT scan
bone scan
MRI of IVC and right atrium
pet scan

47
Q

staging and prognosis of RCC

A

stage 1 confined in cortex 7cm
stage 3 tumor has got to adrenal gland, major vein, gerota fascia (1 lymph node involvement)
stage 4 beyond gerota fascia or >1 lymph node

48
Q

tx of choice for RCC

A

surgery, nephrectomy

49
Q

nephron sparing surgery

A

usually do this for small mass <4 cm or bilateral masses or kidney failure or systemic disease (diabetes)

50
Q

wilms tumor

A 
nephroblastoma
pediatric tumor
mean age 3.5 years
present-
palpable mass
abdominal pain
HTN
hematuria
51
Q

transitional cell carcinoma

A

starts in renal pelvis and then erodes out (whereas RCC starts in cortex and erodes in)

52
Q

renal papillary adenoma

A

tx as cancer

arrise in renal tubules

53
Q

renal fibroma/hamartoma

A

nodules in renal pyramids

54
Q

colloid fluid

A

albumin
Fresh frozen plasma
hydroethyl starch (hetastarch)
dextran

55
Q

crystalloids

A

hypotonic, hypertonic, and isotonic

56
Q

hypotonic

A

fluid flows out of vascular into cell

.45% NaCl

57
Q

Isotonic

A

D5W
.9 NaCl
lactated ringer

58
Q

hypertonic

A 
7-7.5% NaCl
D5 in ½ NS
Dextrose 5% in NS
Dextrose 10%
D50
59
Q

when determining fluid status it is important to note

A

urine output
serum sodium
urine osmolality

60
Q

what are adults obligate fluid loss

A

1600 mL

61
Q

ideal maintence fluid

A

0.45% NaCl + 20 mEq KCl (the kidney will regulate Na, K and H20 retention)

62
Q

how much do water requirements increase w/ fever

A

Water requirement increases 100-150ml/day for each degree fever > 37C

63
Q

Hypovolemia due to decreased intake or excess excretion

A

0.45% NaCl until labs are back
If serum Na > 145 change to 0.25% NaCl
If serum Na < 138 change to 0.9% NaCl (NS)
Initially run at 125 ml/hr unless hemodynamically unstable
Monitor electrolytes and vitals
Gross estimate of renal perfusion is to make 30cc/hr (minimum) urine

64
Q

hypovolemia due to vomitting or diarrhea

A

0.9% NaCl (NS) until labs are back
If serum Na > 145 change to 0.45% NaCl
Initially run at 125 ml/hr unless hemodynamically unstable
Monitor electrolytes and vitals
Gross estimate of renal perfusion is to make 30cc/hr (minimum) urine

65
Q

hypovolemia due to hemorrhage

A

Bolus 1-2 LITERS 0.9% NaCl (NS) or LR through large bore IVs until labs are back
Continue fluid resuscitation based on vital signs and urine output
Packed Red Blood Cells (PRBC) as soon as available
Monitor electrolytes, ABGs and vitals
Gross estimate of renal perfusion is to make 30cc/hr (minimum) urine

66
Q

hypovolemia due to burns

A

Bolus 1-2 LITERS 0.9% NaCl (NS) or LR through large bore IVs until labs are back
Continue fluid resuscitation based on vital signs and urine output
Consider Albumin early to maintain pressure and limit edema
Monitor electrolytes, ABGs and vitals
Gross estimate of renal perfusion is to make 30cc/hr (minimum) urine

67
Q

pt fluid needs

A

Patient fluid needs are 1600ml/day plus any urine output over 500 ml plus any measured or quantified loss (diarrhea, vomiting, NG suction, drains, or bleeding) [Don’t forget increased need with fever = 150ml per degree C over 37]

68
Q

if pt comes in and needs fluid

A

get CBC, CMP, UA
then start 1L NS or LR for approx 1 hr until labs get back
do not stop fluids until pt can urinate

69
Q

different types of stones

A 
calcium oxylate
uric acid
calcium phosphate
struvite
cystine
70
Q

most common stone and what causes

A

calcium oxalate from RTA (decrease Ca reabsorption or primary parathyroid0

71
Q

imaging for stones

A

non contrast CT (gold standard)
US (gold standard for pregnant ppl)
KUB
IVP

72
Q

workup for first time presenting kidney stone

A

UA- consider straining for composition
minimal labs (UA, BMP, PTH if Ca is elvated)
imaging to confirm diagnosis

73
Q

top tx for stones

A

increase water input so have ATLEAST 2 liters of fluid per day

74
Q

calcium oxylate stones

A

hypercalcuria (primary hyperparathyroid, idiopathic, increased absorption) tx w/ thiazide diuretics and decerase sodium intake
hyperoxaluria (decrease oxylate intake and increse Ca intake)
hypocitraturia (RTA and idiopathic) tx w/ potassium citrate

75
Q

uric acid stones

A

hyperurocosuria (gout, low urinary pH, malignancy)

tx allopropinol for hyperuricemia and potassium citrate to increase pH of urine

76
Q

struvite stones

A

recurrent UTI w/ urea splitting organisms: proteus and ureaplasma
proteus is most common

77
Q

cystine stones

A

Autosomal recessive disorder leading to decreased cystine resorption in the kidney- acidic urine
often presents in childhood
tx-Hydration, urine alkalization, Low Na/protein diet cystine binders

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