Nephrology 3 Flashcards
Presentation of PD-associated peritonitis
abdominal pain + nausea
*often don’t have a fever or white count
PD-associated peritonitis diagnosis
Peritoneal fluid with over 100 WBCs or 50% PMNs
Treatment of PD-associated peritonitis
- Intraperitoneal vancomycin and cefepime
treat empirically for both gram-positive and gram-negative organisms
Why recurrent urolithiasis occurs in gastric bypass patients
- hyperoxaluria and hypocitraturia (malabsorption causes more intenstinal fatty acid binding to calcium, which increases colonic oxalate absorption and renal oxalate excretion)
- applies to all malabsorption
Management of recurrent calcium oxalate stones in patients with malabsorption (Crohn’s)
- low oxalate diet + exogenous citrate supplementation
significance of blood clots with hematuria
- non-glomerular source of urinary tract bleeding (glomerular bleeding presents with dysmorphic RBCs-casts)
Significance of hematuria in a patient with previous cyclophosphamide exposure
- high risk for bladder cancer, patient needs cyclophosphamide
Key feature of rhabdo
blood on dipstick (3-4+) but no RBCs on microscopic urinalysis
cystinuria clinical features
- hexagonal (benzene ring) crystals in a *young patient with multiple stones
Treatment of nephrogenic DI
- stop lithium
IF patient can’t stop lithium – salt restriction + trial of diuretics (amiloride blocks sodium channels in collecting ducts to prevent lithiums entry, thiazides promote hypovolemia which increases proximal sodium and water reabsorption)
What is amiloride?
a diuretic
Management of Simple renal cyst
observation, no need for imaging unless symptomatic
Lab features of surreptitious diuretic use
- intermittent hypokalemia
- metabolic alkalosis
- variable urinary chloride (diuretics cause a high urine chloride but urine chloride returns to low levels once effect wears office, thus level is variable)
Lab features of surreptitious vomiting
- metabolic alkalosis + low urinary chloride
Management of hypercalcemic patient with nephrolithiasis
Repeat BMP + obtain PTH (rule out primary hyperparathyroidism)
Clinical features of anti phospholipid antibody syndrome
- CVA or VTE in a young patient
- recurrent miscarriage and or fetal loss
lab features of anti phospholipid antibody syndrome
- thrombocytopenia (more than 25% of patients)
- prolonged PTT
- lupus anticoagulant
- anticardiolipin antibody
- anti-beta-2 glycoprotein antibody
First step before anticoagulation patient with anti phospholipid antibody syndrome
- MRI brain (risk stratification)
other presentation of TTP
Fever
Major side effect of hydroxychloroquine
retinopathy
pathogen that is the cause of anal pruritus
- enterobius vermicularis (pinworm)
First line treatment of listeriosis
ampicillin
Presentation of listeriosis in immunocompromised or elderly patient
- invasive disease (bacteremia, sepsis, meningitis)
diabetic nephropathy features vs. GN
DN = albuminuria + bland UA (but can occasionally see RBC casts and hematuria) +
*slowly progressive (takes years to develop)
GN = active sediment (hematuria, RBC casts) + HTN + *rapidly progressive
management of patient with features of diabetic nephropathy but also GN features
biopsy
When to call urology for nephrolithiasis
- stone greater than 10 mm
- no passage within 4-6 weeks
- complicated nephrolithiasis (AKI, sepsis, complete obstruction, uncontrolled pain)
initial workup of suspected nephrolithiasis
- noncon CT scan
Management of fulminant cdiff
add IV flagyl
treatment of first recurrence of cdiff
- prolonged course of oral vanc pulse dosed (QID for 10-14 days) and then slowly tapered over 2-8 weeks
- can also use fidaxomicin
Management of cholecystitis in patient with high surgical risk (elderly with multiple comorbidities)
- percutaneous cholecytostomy
Dietary modifications for reducing calcium-containing kidney stone formation in patients with hypercalciuria
- low sodium (increased proximal tubule calcium and sodium reabsorption and reduced calcium excretion)
- low animal protein diet (decreases acid load and urinary calcium excretion)
- increase calcium intake
- increase citrate intake
- increase fluids, fruits, and vegetables
Management of bilateral urinary obstruction complicated by post-obstructive diuresis
- Volume repletion at significantly *lower rate than urine volume loss (matching volume repletion with UOP can worsen diuresis)
bilateral urinary obstruction with post-obstructive diuresis physiology
- patient has underlying bilateral obstruction (typically due to intrabdominal disease, mets), which when relieved leads to post obstructive diuresis (kidneys attempt to excrete retained fluid)
Initial steps in suspected hepatorenal syndrome
- albumin + *48 hour trial of diuretic cessation
hepatorenal syndrome management
- midodrine, octreotide, albumin
- levophed in ICU
- transplant (best definitive treatment)
Renovascular HTN due to renal artery stenosis clinical features
- recurrent flash pulmonary edema + severe HTN + AKI + underlying atherosclerosis
