nephrology Flashcards

0
Q

Prevention of kidney injury due to tumor lysis syndrome following chemotherapy

A

Allopurinol, Hydration, Rasburicase

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1
Q

When is dialysis required for patients with ATN

A
Fluid overload
Metabolic acidosis
Encephalopathy
percarditis 
hyperkalemia
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2
Q

treatment of Rhabdomyolysis

A

Hydration
mannitol
Bicarbonate

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3
Q

Drug(s) that causes ototoxicity

A

Loop diuretics such as furosmide

Also caused by aminoglycoside antibiotics

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4
Q

Hepatorenal syndrome lab work shows

A

Very low urine sodium (20:1)

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5
Q

Treatment of hepatorenal syndrome

A

Midodrine
Octreotide
Albumin

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6
Q

Presentation of atheroembolic acute kidney injury

A

Blue/purplish skin lesions in the fingers and toes
livedo reticularis
ocular lesions

-occurs in a patient who undergoes coronary angioplasty and several days later develops renal failure

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7
Q

Lab tests for Atheroembolic disease

A

Eosinophilia
Low complement levels
Eosinophiluria
elevated ESR

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8
Q

Most accurate diagnostic test for atheroemboli

A

biopsy of on of the skin lesions

  • usually shows cholesterol crystals
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9
Q

treatment of atheroemboli

A

No specific therapy

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10
Q

Presentation of AIN

A

Fever
Rash
Eosinophilia
arthralgia

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11
Q

What is different about urinalysis on NSAIDs causing AKI

A

NO EOSINOPHILS are seen in the urine

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12
Q

AIN: labs

A

Eosinophilia
Eosinophiluria
BUN:Cr <20:1
Una and FeNa: increased

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13
Q

AIN: best initial test and most accurate test

A

Best initial: UA - shows WBCs

Most accurate: Hansel and Wright stain - determines the type of WBC- eosinophils

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14
Q

AIN treatment

A

Resolves spontaneously with stopping the offending agent or controlling infection and autoimmune diseases

  • if still no response: STEROIDS
  • Sever disease: dialysis
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15
Q

Presentation of Papillary necrosis

A

Sudden onset of flank pain, fever and hematria in a patient taking NSAIDs with underlying diseases that affect kidney function:

Sickle cell disease
diabetes
urinary obstruction
Chronic pyelonephritis

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16
Q

How do NSAIDs cause Papillary necrosis

A

by analgesic mediated vasoconstriction of medullary blood vessels which causes death of the cells in the papillae

17
Q

Papillary necrosis: best initial test

A

UA which shows RBC, WBC, and necrotic kidney tissues

18
Q

Papillary necrosis: most accurate test

A

CT scan - shows abnormal internal structures of the kidney from the loss of the papillae

19
Q

Papillary necrosis teatment

A

None

20
Q

Dital RTA (type I)

A

Distal tubules cannot generate HCO3 therefore acid cannot be excreted in the tubules from the serum.

No acid in the tubules= increase urine PH

decrease serum K+

21
Q

most accurate test for RTA type 1

A

Acid load test:
-acid is infused into the patients blood with ammonium chloride. A healthy person will pill it out into the tubules making the urine acidic. In RTA type 1, patient is unable to excrete acid into tubules therefore urine stays basic

22
Q

Treatment of RTA type 1

A

Replace bicarbonate along with K+ supplements

23
Q

What causes RTA type 1

A
Autoimmune disease (RA, SLE, sjogren syndrome)
Drugs (amphotericin B and Lithium)
24
Q

Complications of RTA type 1

A

Nephrocalcinosis (Calcium Oxalate stones)

25
Q

What causes RTA type 2

A
Amyloidosis
Meyloma
Fanconi syndrome
acetazolamide
heavy metals
26
Q

Labs seen in RTA type 2

A

urine PH- is initially high (>5.5), once all the HCO3 is lost in the urine, PH decreases (<5.5)

urine HCO3- due to inability to reabsorb HCO3, it is lost in the urine therefore urine HCO3 is low

Serum K+ is low due to increased exchange at the distal tubules

27
Q

most accurate test for RTA type 2

A

HCO3 load test: give patients HCO3 and test urine PH

-Urine PH will rise due to inability to reabsorb in the PCT

28
Q

Treatment of RTA type 2

A

Thiazides

Thaizides cause volume depletion which enhances HCO3 reabsoprtion

29
Q

Type IV RTA pathophysiology

A

Decrease in the amount of Aldosterone which leads to Na loss and K and H retention

30
Q

What causes RTA type IV

A

Diabetes
Addisons disease
Sickle cell disease
Renal insufficiency

31
Q

Diagnosis of RTA type IV

A

High urine Na despite a Na depleted diet

32
Q

RTA type II complications

A

Osteomalacia and Rickets

33
Q

Treatment of RTA type IV

A

Fludrocortisone (mineralocorticoid)

34
Q

RTA: urine anion gap

A

Positive

RTA- defect in acid excretion into the urine so the amount of Cl (acid buffer) in the urine is diminished. This gives a + number when calculating Na-Cl.

35
Q

Diarrhea: Urine anion gap

A

Negative

-Diarrhea is associated with metabolic acidosis therefore the kidney tries to compensate be increasing acid excretion. There is more acid in the urine. More acid in the urine means more Cl (buffer) in the urine. Na-Cl becomes negative!

36
Q

Normal anion gap (6-12) is seen in :

A

RTA, TPN, and Diarrhea

37
Q

Elevated anion gap is seen in:

A

MUD PILES

38
Q

What is emphysematous pyelonephritis

A
  • a complications of pyelonephritis seen in diabetic women

- there is air in the renal parenchyma–usually due to gram negative organism such as E.coli

39
Q

Treatment for emphysematous pyelonephritis

A

Antibiotics and surgery

40
Q

Perinephric abscess: radiologic finding

A
  • focal, hypodense, mass like lesion
  • followed by liquefaction, which walls off the center of the pyelonephritic area leaving a hyperdense rim of contrast surrounding the walled-off abscess cavity.