Nephrology 2 Flashcards
Common complications (2) of ESRD patients despite EPO therapy that leads to fatigue and tiredness?
- Iron Deficiency Anemia due to blood loss (multiple blood draws.)
EPO therapy (causes high mobilization to build more RBCs) - Anemia of Chronic Disease (elevated hepcidin levels)
- Management of a patient with Hx of Cigarette Smoking, Older age, White Ethnicity with Microscopic Hematuria (>3 RBC/hpf)
- What to do if the microscopy shows RBC cast, Proteinuria, CKD ?
- What to do if the microscopy is Normal?
1 . Repeat Analysis again, if positive cystoscopy and urine cytology for Bladder Cancer.
- Evaluate for Renal causes
- Repeat in 6 months if normal then routine follow up
Pt with Nephrogenic DI due to Lithium can be treated with what medication to augment symptoms if lithium cant be stopped?
Amiloride
Pt presets with Confusion, Excessive Urination, N/V and Fatigue. She takes OTC medications for Heartburn. PTH normal and Vit D normal. CA 14.8. There is a metabolic acidosis.
PTH-Indepedent hypercalcemia - Milk Alkali Syndrome from ingestion of Calcium Carbonate.
Difference between Anti-GM (Goodpasture Syndrome) and Granulomatosis with Polyangiitis (Wegners)?
Anti-Gm does not have Constitutional vasculitis Symptoms.
Pt presents with Hematuria, Red Blood Cell Cast, Proteinuria, Hypertension and Hemoptysis. DENIES any fever, chills, weight-loss and arthralgias.
Dx?
What is the positive antibody?
What is shown on renal biopsy?
Anti-GM disease.
Anti-GM Antibody.
Linear immunofluorescence of IgG in glomerular capillaries.
In a patient with edema and CKD on a Thiazide. What would be the best course of management to improve the Persistent Edema?
Switch the thiazide to a loop diuretic.
80 y old woman presents with Fatigue, Dizzy spells, and Nausea. Pt was recently started on Thiazide Diuretic for Hypertension. Dx? Rx?
Thiazide Induced Hyponatremia
-Causes Increase Na+ Excretion and Increase ADH ( Leads to Water retention unlike Loop Diuretics that Do Not Cause Water Retention)
Check Na+ Level, Stop Thiazide and Give Normal Saline.
Rx for Renal Artery Stenosis?
ACE.
Rx for Salicylic Acid intoxication (Respiratory Alkalosis with Metabolic Acidosis )?
Alkalization of urine with IV Sodium Bicarb.
Pt present for 10 month follow up after Cadaveric Renal Transplantation. Creatinine is 2.7. UA shows WBC, RBCs, Cellular Cast and Atypical Cells with Intranuclear Inclusions?
BK Polyomavirus-Induced Nephropathy ( Develop Tublointerstial nephritis)
Management of a patient developing Possible Abdominal Compartment syndrome from massive fluid resuscitation from Sepsis or Trauma.
Measure Bladder Pressure.
Young women reports recurrent UTIs and decreased GFR. Urine pH is 8. Dx? Rx?
Stone Removal for Struvite Stone + Abx ( only way to eradicate the bacteria and restore kidney function). The struvite stone can lead to staghorn calculi caused by E. Coli and Proteus.
- Management of PSA < 3?
- Management of PSA > 7?
Follow routinely.
Referral to Urology for biopsy.
43 y M presents with Weakness, Joint Pains and Erythematous Macules on exam. AST and ALT are elevated, Hematuria and Proteinuria present in urine. Pt has LOW Complement Levels with Positive RF. Dx?
Hep C causing Mixed cryoglobulinemia causing Hep C glomerulonephritis.