Nephrology Flashcards
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��”Q001. Dx? Rapid onet of oliguria with increasing BUN and creatinine often occurs in hospitalized patients”
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A001. Acute Renal Failure
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Q002. ARF class:; weight loss or gain, poor skin turgor, edema/ascites, renal artery bruit
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A002. Pre renal ARF
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Q003. ARF class:; weight gain, obtundation, hypotension to HTN, JVD, evidence of muscle trauma, infection, contaminated IV lines
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A003. Intrinsic ARF
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Q004. ARF class:; weight gain, enlarged prostate, pelvic mass, bladder distension
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A004. Post renal ARF
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Q005. Etiology of pre renal ARF; (4 and example of each)
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A005. 1. Hypovolemia (including hemorrhage and GI loss); 2. Third spacing (including nephrotic syndrome, burns and cirrhosis); 3. Low cardiac Output (including CHF and shock); 4. Renal hypoperfusion (including renal artery stenosis, NSAIDs + ACEi)
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Q006. Etiology of Intrinsic ARF; (5)
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A006. 1. Hyperviscosity (multiple myeloma); 2. Acute Tubular Necrosis (due to: meds or rhabdomyolysis); 3. Glomerular injury (Nephrotic syndrome, vasculitis, GN); 4. Acute Interstitial Nephritis; 5. Renovascular infarction
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Q007. Etiology of Post renal ARF; (3)
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A007. 1. Urinary tract obstruction; 2. enlarged prostate; 3. bladder dysfunction
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Q008. Define:; Oliguria
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A008. Urine output < 400 mL/day
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Q009. Indications for Dialysis:; (5)
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A009. AEIOU:; Acidosis; Electrolyte abnormalities; Ingestions; Overload; Uremic symptoms (pericarditis, encephalopathy)
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Q010. Pre renal amounts for:; 1. BUN/creatinine ratio; 2. Fe Na; 3. Urine Na; 4. Urine Osmolality; 5. Urine specific gravity
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A010. 1. > 20; 2. < 1%; 3. < 20; 4. > 500; 5. > 1.020
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Q011. Intrinsic renal (ARF)amounts for:; 1. BUN/creatinine ratio; 2. Fe Na; 3. Urine Na; 4. Urine Osmolality; 5. Urine specific gravity
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A011. 1. < 20; 2. > 1%; 3. > 40; 4. < 350; 5. = 1.010
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Q012. What (2) Dx test and results point to a post renal ARF problem?
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A012. Fe Ne > 4%; Urine Na > 40
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Q013. Equation for Fractional Excretion of Sodium (Fe Na)
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A013. Fe Na = (urine Na/plasma Na) / (U creatinine/P creatinine) x 100%
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Q014. MCC of intrinsic ARF
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A014. Tubulointerstitial diseases; (ATN and AIN)
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Q015. Dx:; Acute damage of renal tubules due to ischemic or toxic insult
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A015. Acute Tubular Necrosis
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Q016. Etiology of Ischemic (4) and Toxic (4) causes of ATN
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A016. Ischemic:; Shock;; Trauma;; Sepsis;; Hypoxia; Toxic:; Rhabdomyolysis;; Aminoglycosides;; IV contrast;; Tumor lysis
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Q017. (3) Dx findings for ATN
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A017. Muddy brown granular casts;; High urine sodium;; Fe Na > 1%
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Q018. Tx for ATN; (4)
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A018. NS for volume replacement;; IV diuretic in early stages;; match I and O; manage electolyte disturbance
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Q019. Dx:; Inflammation of the renal parenchyma
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A019. Acute Interstitial Nephritis
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Q020. (3) basic classes of etiologies of AIN
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A020. Systemic diseases;; Systemic infections;; Medications
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Q021. (3) systemic diseases that causes AIN
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A021. Sarcoidosis;; Sjogren syndrome;; Lymphoma
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Q022. (4) systemic infections (bugs) that cause AIN
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A022. Syphilis;; Toxoplasmosis;; CMV;; EBV
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Q023. (3) medication classes that can cause AIN
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A023. Beta blockers;; Diuretics;; NSAIDs
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Q024. How do NSAIDs cause AIN?
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A024. inhibit prostaglandin synthesis, which decreases GFR and start renal failure in patient with underlying renal problems
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Q025. Dx findings of allergic AIN; (3)
A025. WBCs;; Eosinophils;; White (or red) cell casts
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Q026. Tx of allergic AIN?; (2)
A026. 1. stop offending agent; 2. Steroids
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Q027. initial microscopic finding in ATN
A027. blebbing of the PTC and loss of brush boarder
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Q028. microscopic finding of ischemic (2) ATN versus toxic
A028. Ischemic: BM damage; skipped areas of damage; Toxic: no BM damage; Uniform damage with sparing of DT
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Q029. Lab:; Oxalate crystal formation in kidney
A029. Ethylene glycol ATN
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Q030. Retention of what (3) things causes anion gap increase with CRF?
A030. Phosphates; H+; Sulfates
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Q031. what does the ultrasound show w/:; 1. CRF; 2. Diabetes; 3. Amyloidosis; 4. Poylcyctic Kidney Disease
A031. 1. shrunken kidneys; 2 4. Enlarged kidneys
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Q032. What (3) endocrine functions are lost with CRF?; what is the result of each on the patient?
A032. Synthesis of:; 1. Vitamin D hypocalcemia;; 2. Ammonia anion gap met acidosis;; 3. Erythropoietin anemia
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Q033. Tx for Chronic renal failure; (3)
A033. ACEi;; low protein diet;; Dialysis
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Q034. Dx:; pale complexion, wasting, purpura, N/V, itching, tubular casts in urine
A034. Uremic syndrome
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Q035. Waxy casts in urine
A035. Chronic Renal Failure
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Q036. CNS problems from Uremia; (5)
A036. Foot drop;; Carpal tunnel;; Clonus;; Asterixis;; Seziures
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Q037. Cardiac / Pulmonary problems from Uremia; (5)
A037. HTN;; Pericarditis;; Valve calcification;; Pulmonary edema;; Pulmonary effusions
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Q038. Hematologic problems from Uremia; (3)
A038. Normochromic, normocytic anemia;; Low platelet function (prolonged bleeding time);; low WBC increased infections
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Q039. (2) metabolic problems from Uremia
A039. High triglycerides;; Insulin resistance
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Q040. Dx:; Inability for kidney to concentrate urine; (stays fixed with specific gravity = 1.010)
A040. Isostheuria
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Q041. Dx:; enlarged kidneys with multiple cysts presenting in mid 30's to 40's with flank pain; what can it lead to?
A041. ADPKD; Berry aneurysms
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Q042. Dx:; Metabolic acidosis with normal anion gap
A042. Renal Tubular Acidosis
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Q043. Renal Tubular Acidosis Type I:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
A043. 1. H+ secretion causing Acidosis; 2. Low; 3. pH > 5.3; 4. Low; 5. DT defect
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Q044. Renal Tubular Acidosis Type II:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
A044. 1. Decreased Bicarb reabsorption; 2. 12 20; 3. pH > 5.3; 4. Low normal; 5. PCT defect
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Q045. Renal Tubular Acidosis Type IV:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
A045. 1. Decreased Aldosterone; 2. > 17; 3. pH < 5.3*; 4. High*; 5. DT
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Q046. Etiology of Renal Tubular Acidosis Type I; (4)
A046. Lithium;; Amphotericin B;; SLE;; Sarcoidosis
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Q047. Etiology of Renal Tubular Acidosis Type II; (3)
A047. Heavy Metals;; Acetazolamide;; Multiple myeloma
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Q048. Etiology of Renal Tubular Acidosis Type IV; (3)
A048. Renal transplant;; Obstructive uropathy;; Diabetic nephropathy;
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Q049. Dx:; Radiopaque stone seen in inflammatory bowel diseases, decreased citrate & uricourea; Tx?
A049. Calcium Oxalate stone; Tx: Thiazides
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Q050. Dx:; moderately readiopaque stone common in Proteus or staph Saprophyticus UTI due to high urinary pH; Tx?
A050. Struvite (ammonium, magnesium, phosphate) stone; Tx: lower urine pH
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Q051. Dx:; Radiolucent stone caused by myeloproliferative diseases and gout; Tx?
A051. Uric Acid stone; Tx: raise urine pH
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Q052. Dx:; moderately radiopague stone that has hexagonal crystals and is positively birefringent; What congenital disorder is cause?; Tx?
A052. Cystine Stones; Disorder: Cystinuria; Tx: raise urine pH
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Q053. Dx:; 39 yo man with severe back pain and hematuria, nausea and unable to find a comfortable position.
A053. Renal stone; (Urolithiasis)
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Q054. Dx:; sudden HTN with low K+; How do you do a screening Dx?; Tx?
A054. Renal artery stenosis; give oral captopril to induce increase of renin; Tx: surgery or angioplasty
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Q055. Etiology of renal artery stenosis; (2)
A055. Plaque; Fibromuscular dysplasia
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Q056. Dx:; hematuria, palpable mass, flank pain, fever, secondary polycythemia
A056. Renal Cell Tumor
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Q057. MC person to get Renal cell CA; Where does it disseminate to?; Tx? (2)
A057. 50 70 yo Male smoker; moves to: Renal veins and Vena cava; Tx: resection, IL 2 immunotherapy
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Q058. (3) causes of Ketones in the urine
A058. 1. DKA; 2. Alcohol intox; 3. starvation
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Q059. What does Nitrite in urine indicate?
A059. Gram negative rods
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Q060. What does a positive Leukocyte esterase in urine indicate?
A060. White cells and infection
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Q061. What do eosinophils in the urine indicate?
A061. Allergic Interstitial Nephritis
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Q062. What do Squamous cells in the urine indicate?
A062. contaminated specimen
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Q063. What does Bilirubin in the urine indicate?
A063. Extravascular hemolysis
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Q064. What does Hemoglobin in the urine indicate?
A064. Intravascular hemolysis
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Q065. What do Hyaline casts in the urine indicate?
A065. Pre renal azotemia
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Q066. MCD in ARF?
A066. infection
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Q067. Defition of ARF?
A067. rapid decline in renal function with an increase in Cr level; relative increase of 50% or absolute increase of 0.5 to 1.0 mg/dL
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Q068. MCC of postrenal failure
A068. BPH urethral obstruction
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Q069. MCC chronic renal failure
A069. diabetes!
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Q070. azotemia refers to?
A070. elev. of BUN
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Q071. uremia refers to?
A071. si/sx associated with accumulation of nitrogenous wastes due to impaired renal function; usually, BUN>60mg/dL
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Q072. 3 key features of nephrotic syndrome
A072. proteinuria; hypoalbuminemia; hyperlipidemia
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Q073. Examination of urine sediment:; RBC =; WBC =; Fatty casts =
A073. RBC = GN; WBC = pyelonephritis & interstitial nephritis; Fatty casts = nephrotic syndrome
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Q074. Gross painless hematuria
A074. bladder ca
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Q075. microscopic hematuria v. gross hematuria
A075. microscopic = glomerular; gross = post renal causes trauma, stones, malignancy)
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Q076. hyperkalemia how can you remove K from serum? (3)
A076. 1. dialysis; 2. diuretics; 3. cation exchange resins kayexalate (sodium polystyrene sulfonate)
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Q077. MOA of Kayexalate
A077. cation exchange resin acts in the GI tract by promoting exchange of Na for K and thereby increasing excretion of K
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Q078. Indications for Dialysis
A078. AEIOU and sometimes Y; Acidosis, pH<7.2; Electrolytes, refractory hyperkalemia; Intoxication, methanol, ethylene glycol, ASA, lithium; Overload, hypervolemia, pulmonary edema; Uremic pericarditis/encephalopathy/neuropathy; Yhtapolugoac, secondary to renal failure
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Q079. nephrotic syndrome + abdominal pain + fever + hematuria =
A079. renal vein thrombosis;; antithrombin III is lost in urine putting patients at increased risk of venous/arterial thrombosis
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Q080. nephrotic syndrome is most commonly caused by?
A080. adults: membranous glomerulonephritis; children: minimal change diseases
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Q081. What serum Cr level is safe for contrast CT?
A081. 1.5 use non ionic contrast OR ultrasound
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Q082. MCC of glomerular hematuria
A082. IgA nephropathy (Berger's disease)
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Q083. MCC of nephritic syndrome
A083. poststreptococcal GN
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Q084. Poststreptococcal GN occurs after infection with ______.
A084. group A beta hemolytic streptococcal infection of respiratory tract
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Q085. proliferative GN + pulmonary hemorrhage + IgG anti glomerular basement membrane antibody
A085. Goodpasture's syndrome
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Q086. MCC of acute interstitial nephritis
A086. acute allergic reaction to a medication
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Q087. eosinophils in urine suggest what?
A087. acute interstitial nephritis
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Q088. What disease has a defective amino acid transporter (in the kidney)?
A088. Hartnup syndrome decreased intestinal and renal reabsorption of neutral aa's, such as tryptophan, causing nicotinamide deficiency
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Q089. What kidney disease manifests like pellagra?
A089. 3 D's:; dermatitis,; dementia,; diarrhea; Hartnup syndrome
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Q090. Adult polycystic Kidney Disease associated finding in the brain?
A090. intracerebral berry aneurysm
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Q091. medullary sponge kidney is thought to be associated with what other disease?
A091. hyperparathyroidism and parathyroid adenoma
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Q092. most common cause of secondary HTN?
A092. renal artery stenosis decreased blood flow to JG apparatus, RAA system becomes activated, HTN
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Q093. What HTN drug is contraindicated in patients with renovascular HTN?
A093. ACEI
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Q094. MC site of nephrolithiasis impaction
A094. ureterovesicular junction
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Q095. Prostate Ca commonly begins where in the gland?
A095. periphery then moves centrally obstructive symptoms LATE
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Q096. Dx:; Edema, lipiduria, foamy urine, hypoalbuminemia, hyperlipidemia, hypercoagulation, protein in urine
A096. Nephrotic syndrome
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Q097. Dx:; "Maltese crosses" in urine
A097. cholesterol in urine; (Nephrotic syndrome)
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Q098. Why does the nephrotic syndrome patient have edema?; hypercoaguability?
A098. Edema decrease ion serum proteins and oncotic pressure; Hypercoag loss of Proteins C and S and antithrombin III
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Q099. Dx:; child with epithelial foot process loss on EM; Tx?
A099. Minimal Change Disease; Tx: steroids
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Q100. Dx:; glomerular scarring involving limited number of glomeruli with IgG and complement deposition; Most common in what patients?; (5)
A100. Focal Segmental Glomerulosclerosis; Common in (Halt MID Stream):; HIV;; Men (younger) with HTN; IV drug users;; DM;; Sickle cell
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Q101. What can Focal Glomerulosclerosis lead to?; (2); Tx?
A101. HTN and Chronic Renal Disease; Tx: Cyclophosphamide
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Q102. First line of Tx for all Nephrotic syndrome
A102. Protein and NaCl restriction
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Q103. Dx:; MCC of Nephrotic Syndrome in adults that is slow to progress and has little response to steroids; Etiology? (6)
A103. Membranous Glomerulonephritis Etiology (SHIT):; SLE / Syphilis;; HBV / HCV;; Idiopathic;; Tumor
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Q104. Rule of thirds for Membranous GN
A104. 1/3 get CRF; 1/3 have spontaneous remission; 1/3 remain nephrotic without progression
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Q105. Tx for Membranous GN; (2)
A105. Cyclophosphamide; Chlorambucil
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Q106. Dx:; Abrupt onset hematuria with RBC casts, smoky brown urine, proteinuria, hypertension, edema and azotemia (low GRF)
A106. Acute Glomerulonephritis; (Nephritic syndrome)
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Q107. Dx:; presents 2 weeks after pharyngitis or impetigo with dark urine and edema
A107. Poststrep. GN
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Q108. Deposition of what causes glomerular damage in poststrep GN?; Tx?
A108. Deposition of IgG, C3 and C4 in a granular pattern; Tx underlying infection
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Q109. Dx:; hematuria immediately after an infection or exercise
A109. IgA nephropathy; (Berger's Disease)
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Q110. what (and where) is the immune complex deposition of IgA nephropathy?
A110. Mesangeal deposition of IgA and C3
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Q111. Dx:; immune deposits on BM cause it to look double layered; what is it associated w/?; (2)
A111. Membranoproliferative ("Tram track" appearance) Assoc with:; Hepatitis C; Cryoglobinemia
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Q112. How is type I membranoproliferative different then type II?
A112. Type I: slowly progressive; Type II: low serum C3 due to Auto Ab vs C3
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Q113. Tx of Membranoproliferative for adults (2) and kids
A113. Adults: ASA, Dipyridimole; Kids: Steroids
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Q114. Dx:; Fulminant renal failure with proteinuria, hematuria and RBC casts and epithelial cell proliferation in glomeruli; (2 names)
A114. Rapidly Progressive GN; (Cresentric GN)
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Q115. (3) types of Rapidly Progressive GN
A115. 1. Pauci Immune RPGN; 2. Immune complex RPGN; 3. Anti glomerular BM Ab Disease
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Q116. Serum marker for Pauci Immune RPGN
A116. ANCA positive; (Wegner's = c ANCA); (polyarteritis nodosa = p ANCA)
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Q117. Etiology of Immune Complex RPGN; (5)
A117. SPLIT:; Syphilis;; Post strep GN;; Lupus nephritis;; IgA nephritis;; Tumors
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Q118. another name for Anti GMB Ab disease; what cells cause problem?
A118. Goodpasture's disease; Cytotoxic T cells (CD 8)
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Q119. Tx for all RPGN; (2); what percent go on to end stage renal disease?
A119. Tx:; steroids; cyclophosphamide; 80%
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Q120. Renal involvement with Lupus type I V; Which has "wire loop" abnormality?
A120. I: no renal involvement; II: Focal Segmental; III: Focal Proliferative; IV: Diffuse Proliferative (most severe wire loop); V: Membranous
121
Q121. MCC of End Stage Renal Disease; What is the early manifestation?; What do Biopsy show?
A121. Diabetes; starts with microalbuminuria; Biopsy: Kimmelstiel Wilson nodules
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Q122. Dx:; palpable purpura on buttocks and legs of kids, abdominal pain, vomiting, hematuria and GI bleeding
A122. Henoch Schonlein purpura
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Q123. Dx:; Tubule plugging with Bence Jones proteins; what electrolyte disorder from Dx also leads to kidney trouble?; What causes patient to go into CRF?
A123. Multiple myeloma; Hypercalcemia; E.Coli infection of kidney from abnormal Ab production
124
Q124. (3) major toxins that increase the serum's osmolarity
A124. EtOH; Methanol; Ethylene glycol
125
Q125. ICF is what fraction of TBW?; Major cations of ICF? (2); Major anions? (2)
A125. ICF = 2/3 of TBW; Cations: K, Mg; Anions: Proteins, Organic Phosphates (ATP, ADP, AMP)
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Q126. ECF is what fraction of TBW?; Major cation of ECF?; Major anions? (2)
A126. ECF = 1/3 of TBW; Cation: Na; Anions: Cl, HCO3
127
Q127. What composition does interstitial fluid resemble?; What is different?
A127. resembles Plasma; Interstitial fluid contains little protein (ultrafiltrate)
128
Q128. What (2) compartments does water shift between?; If solutes (glucose, sodium, mannitol) dont cross the cell membrane, what osmolarity do they contribute to?
A128. ECF + ICF; ECF
129
Q129. Formula for Serum Osmolarity; Normal Serum Osmolarity?
A129. SO = 2(Na+K) + Glucose/18 + BUN/2.8; 300 mOsm/kg
130
Q130. Define:; Hyponatremia
A130. plasma sodium < 134mEq/L
131
Q131. What are the (3) categories of Hyponatremia?
A131. Hypovolemic; Isovolemic; Hypervolemic
132
Q132. How can you distinguish b/t renal and extrarenal causes of hypovolemic hyponatremia?
A132. Urine Sodium:; U Na > 20 = Renal; U Na < 10 = Non renal
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Q133. Extra renal causes of hypovolemic hyponatremia; (5)
A133. GI loss (Vomiting/Diarrhea); Extensive burns; Dehydration; 3rd spacing (pancreatitis, peritonitis)
134
Q134. Renal causes of Hypotonic Hypovolemic Hyponatremia; (5)
A134. TANAS:; Thiazides (diuretics);; ACEi;; Nephropathies;; Addisons Disease (Mineralcorticoid deficiency);; Salt wasting nephropathies
135
Q135. Etiology of Hypotonic Euvolemic Hyponatremia; (separate into 2 categories 8 total)
A135. Less dilute urine (SHiT):; SIADH; Hypothyroidism; Idiosyncratic drug reaction (Thiazides, ACEi) More dilute urine (Huge PEPE):; Hypokalemia; Post op Hyponatremia; EtOH addiction; Psychogenic polydipsia; Exercise
136
Q136. "tonic" as in hypertonic refers to what?
A136. serum osmolality
137
Q137. Serum osmolality level for:; Hyponatremia; Hypernatremia
A137. Hyponatremia: < 280 mOsm/kg; Hypernatremia: > 300 mOsm/kg
138
Q138. Etiology of Hypotonic Hypervolemic Hyponatremia; (4)
A138. CLAN:; CHF; Liver disease; Advanced Renal Failure; Nephrotic syndrome
139
Q139. Etiology of Isotonic Hyponatremia; (2)
A139. Hyperproteinemia; Hyperlipidemia
140
Q140. Etiology of Hypertonic Hyponatremia; (2)
A140. Facticious Hyponatremia:; Hyperglycemia; Hypertonic infusions; (mannitol, glucose, contrast)
141
Q141. How does each 100 mL/dL increase in serum glucose above normal cause sodium to decrease?
A141. Sodium decreases by 1.6 mEq/L
142
Q142. Signs/Sx of moderate hyponatremia or gradual onset; (4)
A142. Confusion; Muscle cramps; Anorexia; Nausea
143
Q143. Signs/Sx of severe hyponatremia or rapid onset; (2); At what level is considered severe?
A143. Seizures or Coma; Severe: < 115 mEq/L
144
Q144. With low serum osmolarity (< 280), what signs should be observed to differentiate b/t Hypovolemia, Isovolemia, & Hypervolemia?
A144. Hypovolemia:; Tachycardia; Hypotension; poor skin turgor; Isovolemia:; Normal vital signs without edema; Hypervolemia:; peripheral Edema
145
Q145. Dx:; measured & calculated serum osmolarities are different; What (2) problems is it seen in?
A145. Pseudohyponatremia; Seen in:; Multiple myeloma; Hyperlipidemia
146
Q146. Tx of Hypovolemic Hyponatremia; (2)
A146. 1. address underlying disorder; 2. replace volume with NS; (monitor Na to prevent CPM)
147
Q147. Tx of Isovolemic or Hypervolemic Hyponatremia; (2)
A147. 1. address underlying disorder; 2. Sodium + water restriction
148
Q148. What is Tx for CHF induced Hypervolemic Hyponatremia?; (2)
A148. 1. Sodium + water restriction; 2. Combination of Captopril & Furosemide
149
Q149. Rules for correcting Hyponatremia by increasing serum sodium; (2); Why?
A149. 1. only go into low normal range in forst 24 hours; 2. never correct sodium faster then 1 mEq/L/hr; Can lead to Central Pontine Myelinolysis (CPM), seizures, coma
150
Q150. What are pre menopausal women at high risk for during an acute episode of Hyponatremia?
A150. Cerebral edema
151
Q151. Dx:; Osmotic demyelination syndrome occurring as a treatment complication of severe or chronic hyponatremia
A151. Central Pontine Myelinolysis; (CPM)
152
Q152. Serum sodium level that is considered Hypernatremia
A152. Serum Na > 145 mEq/L
153
Q153. Type of Hypernatremia:; Loss of both water + sodium; (water loss >> sodium loss)
A153. Hypovolemic Hypernatremia
154
Q154. Type of Hypernatremia:; Decreased TBW, normal body sodium, decreased ECF
A154. Isovolemic Hypernatremia
155
Q155. Type of Hypernatremia:; Increased TBW, markedly Inc total body Na, Inc ECF
A155. Hypervolemic Hypernatremia
156
Q156. Etiology of Hypervolemic Hypernatremia; (3)
A156. Hypertonic fluid administration;; Mineralcorticoid excess (Cushing's, Conn's);; Excess salt ingestion
157
Q157. Etiology of Isovolemic Hypernatremia; (2)
A157. Diabetes Insipidus;; Skin losses (due to hyperthermia)
158
Q158. Etiology of Renal related Hypovolemic Hypernatremia; (3)
A158. Diuretics;; Acute/chronic Renal failure;; Partial obstruction
159
Q159. Etiology of Extra renal related Hypovolemic Hypernatremia; (5)
A159. Hyperpnea;; Excessive sweating;; Diarrhea;; Burns;; Dialysis
160
Q160. formula for Water Deficit in Hypernatremia patient
A160. WD (liters) = 0.6 x body wt (kg) x (measured Na/140) 1
161
Q161. Tx for Hypovolemic Hypernatremia
A161. Fluid replacement with NS; (correct plasma osmolarity no faster then 2 mOsm/kg/hr)
162
Q162. Tx for Isovolemic Hypernatremia; What additionally should you do if Dx is Central Diabetes Insipidus?
A162. Fluid replacement with 1/2 NS; (correct only half of the deficit in first 24 hrs); C DI: Vasopressin
163
Q163. Tx for Hypervolemic Hypernatremia; (2)
A163. 1. Fluid replacement with 1/2 NS (for hypertonicity); 2. Loop diuretic (furosemide) to inc Na excretion
164
Q164. Normal range of Potassium
A164. 3.3 5.5; (below is hypokalemia; above is hyperkalemia)
165
Q165. Difference b/t Periodic paralysis of Hypokalemia vs. Hyperkalemia
A165. Hypokalemia presents in teens; Hyperkalemia presents in infancy
166
Q166. What heart drug causes a greater toxicity if patient goes into Hypokalemia?; How is this avoided?
A166. Digitalis; check K+ regularly
167
Q167. (4)* general ways we can lose potassium (become Hypokalemia)
A167. 1. Cellular shift + undetermined mechanisms; 2. Inc renal excretion; 3. GI losses; 4. Sweating
168
Q168. Cellular shift + undetermined mechanisms of Hypokalemia; (5)*
A168. A Deadly VIBe:; 1. Alkalosis; 2. Digoxin toxicity correction (with digibind); 3. Vitamin B 12; 4. Insulin; 5. Beta adrenergics
169
Q169. in Alkalosis, how does each 0.1 increase in pH affect K+?
A169. decreases serum K+ by 0.5 mEq/L
170
Q170. What does insulin do to K+?
A170. drives it into the cells
171
Q171. Etiology of Hypokalemia due to Increased renal excretion mechanisms; (6)*
A171. 1. Cushings (Inc Mineralcorticoid activity); 2. HypoMagnesium; 3. Bartter's syndrome; 4. Osmotic diuresis (mannitol); 5. Renal tubular acidosis; 6. Medications
172
Q172. Dx:; JG cell hyperplasia causing increased renin/aldosterone, met alkalosis, Hypokalemia, muscle weakness and tetany; seen in young adults
A172. Bartter's syndrome
173
Q173. (3) GI loss causes of Hypokalemia
A173. 1. Vomiting; nasogastric suction; 2. Diarrhea; laxative abuse; 3. Inadequate dietary intake (anorexia)
174
Q174. Dx:; Impaired gastric motility, nausea, vomiting, muscle weakness (to paralysis), rhabdomyolysis, atrial + ventricular arrhythmias
A174. Hypokalemia
175
Q175. What is the Tx for urgent Hypokalemia? (2); What works faster?; What type of patient must be monitored closely?
A175. give IV + oral potassium simultaneously; oral works faster; monitor patient with renal failure
176
Q176. At what level should K+ be peri MI to prevent arrhythmias?
A176. K+ > 4.0
177
Q177. IV infusion of K+ should not exceed what number/hour?; How much does that raise serum K+?
A177. IV no more then 20 mEq/hr; Increases K+ by 0.25 mEq/L
178
Q178. what diagnostic procedure should be performed on patients with moderate or severe Hyperkalemia?
A178. Stat EKG
179
Q179. The only Tx of Hyperkalemia (aside from dialysis) that removes K from the body
A179. Kayexalate
180
Q180. MCC of Hyperkalemia in lab results; What should be done?
A180. Pseudo Hyperkalemia:; falsely elevated measurement due to hemolysis; Re run lab test
181
Q181. (4)* causes of ICF to ECF potassium shifting causing Hyperkalemia
A181. Heavy exercise; Acidosis; Insulin deficiency; Digitalis toxicity
182
Q182. (3) causes of an increased potassium load causing Hyperkalemia
A182. IV potassium supplements; K+ medications; Increased cellular breakdown
183
Q183. Causes of decreased potassium excretion causing Hyperkalemia; (3 renal and 3 drugs)*
A183. ROB A K:; Renal failure;; Obstructive uropathies;; Beta blockers;; Aldosterone deficiency / ACEi;; K sparing diuretics
184
Q184. Dx:; N/V/D; muscle cramps, weakness, areflexia, tetany, confusion; respiratory insufficiency; arrhythmias, cardiac arrest
A184. Hyperkalemia
185
Q185. EKG changes when potassium equals:; 1. 6.5 7.5 (3); 2. 7.5 8.0 (2); 3. 10 12; What does it lead to? (3)
A185. 1. Tall, peaked T waves; short QT; prolonged PR; 2. QRS widening; Flat P wave; 3. QRS degrades into SIN wave; leads to: V fib, complete heart block or asystole
186
Q186. Hyperkalemia is most common with what (2) causes
A186. Renal failure; muscle breakdown
187
Q187. What are the Tx of Hyperkalemia in order of Stabilize, Shift, Remove?*
A187. Can Get In A Bad K Day:; Stabilize Calcium; Shift Glucose + Insulin; Albuterol; Bicarbonate; Remove Kayexalate; Dialysis
188
Q188. When is calcium contraindicated for Hyperkalemia?
A188. if patient is on Digoxin
189
Q189. Polycystic Kidney Disease What is it
A189. AD bilateral cysts progressively develop, late onset, usually asymptomatic until 30 y/o, 50% ESRD with dialysis by 60 y/o; AR less common, more severe, often lethal in 1st few years infants and kids, renal failure, liver fibrosis, portal HTN
190
Q190. Polycystic Kidney Disease History/PE
A190. Hematuria; HTN; pain sharp & localized, from ruptured cysts,; infection,; renal calculi; large, palpable kidneys; liver cysts; berry aneurysms; mitral valve prolapse; colonic diverticula
191
Q191. Polycystic Kidney Disease Dx
A191. US or CT
192
Q192. Polycystic Kidney Disease Tx
A192. Prevent complications,; slow progression to ESRD: early management of UTI prevent renal cyst infection; control BP; ESRD dialysis, renal transplant
193
Q193. Nephrolithiasis MC in what population; Risk factors
A193. MC in older men risk factors; family History,; low fluid intake; gout; postcolectomy; postileostomy; spec. enzyme disorder; RTA; hyperparathyroidism
194
Q194. Nephrolithiasis History/PE
A194. Acute onset; severe colicky flank pain; may radiate to testes or vulva; n/v; pt. freq. shift position
195
Q195. Nephrolithiasis Dx
A195. Spiral CT test of choice; UA best 1st test; KUB; renal US; IVP confirm; noncontrast abdominal CT; UA hematuria, altered urine pH
196
Q196. Nephrolithiasis Tx
A196. Initial Tx hydration; analgesia; < 5mm can pass thru urethra; < 3 cm ESWL (extracorporeal shock wave lithotripsy); percutaneous nephrolithotomy
197
Q197. Nephrolithiasis Calcium Oxalate/; Calcium Phosphate; Characteristics; Tx
A197. MC (83%); idiopathic hypercalciuria; primary hyperparathyroidism; hyperoxaluria; hypocitraturia; alkaline urine; radiopaque; Tx hydration, thiazide diuretic
198
Q198. Nephrolithiasis Struvite (Mg NH4 PO4); Characteristics; Tx
```
A198. "Triple phosphate stones due to urease producing organism Proteus
Staghorn calculi
alkaline urine
radiopaque
Tx hydration
treat UTI
if present"
```
199
Q199. Nephrolithiasis Uric Acid; Characteristics; Tx
A199. Hyperuricemia; gout; high purine turnover states; acidic urine (pH < 5.5); radiolucent; Tx hydration, alkalinize urine with citrate, citrate converted to HCO3 in liver
200
Q200. Nephrolithiasis Cystine; Characteristics; Tx
A200. Due to defect of tubular amino acid transporter for cystine, ornithine, lysine & arginine (COLA); yellow brown hexagonal crystal; radiopaque; Tx hydration, alkalinize urine, if neither works penicillamine
201
Q201. Ureteral Reflux What is it
A201. Retrograde flow of urine from bladder back up, due to insuff. Submucosal length of ureter => ineffect. restricting; retrograde flow during contraction of bladder; recurrent UTIs
202
Q202. Ureteral Reflux Dx; Tx
A202. Dx VCUG: Voiding CystoUrethroGram detects abnormality at ureteral insertion site; classifies grade of reflux; Tx tx infections aggressively �% mild reflux no dilation, often resolves spontaneously �% mod to severe reflux surgery (uret. reimplantation)
203
Q203. Renal Cell Carcinoma What is it; Risk factors
A203. MC kidney cancer (80 90%); adenocarcinoma arises from tubular epith cells => renal vein => IVC => mets to lung & bone; risk factors men, smoking, VHL disease
204
Q204. Renal Cell Carcinoma History/PE
A204. Classic triad; hematuria; flank pain; palpable flank mass; polycythemia; constitutional Sxs; enlargement of left testicle
205
Q205. Renal Cell Carcinoma Tx
A205. Surgical resection curative if local; notoriously resistant to chemo & radiation
206
Q206. Cryptorchidism What is it
A206. Failure of testes to descend into scrotum; bilateral associated with oligospermia & infertility; risk factor prematurity
207
Q207. Cryptorchidism History/PE
A207. Testes can't be manipulated into scrotal sac with gentle pressure; may be palpated anywhere along inguinal canal or in abdomen
208
Q208. Cryptorchidism Tx
A208. Orchiopexy after 1 y/o & before 5 y/o; in 99%, testes descend by 1 yr; find later in life orchiectomy to avoid risk of testicular Ca
209
Q209. Erectile Dysfunction What is it; Risk factors
A209. 10 25% of mid aged or elderly; fail to init, fill or store risk factors:; DM; atherosclerosis; meds B blockers, SSRIs; HTN; heart disease. spinal cord injury; surgery or radiation for prostate cancer
210
Q210. Erectile Dysfunction History/PE
A210. Ask about:; risk factors; meds; recent life changes; psych stressors; psychological if pt. has nocturnal or early morning erections; situation dependent
211
Q211. Erectile Dysfunction Dx
A211. Check for hypogonadism; testosterone levels; gonadotropin levels; prolactin levels; evaluate for neuro dysfunction anal tone; lower ext sensations
212
Q212. Erectile Dysfunction Tx
A212. Psychotherapy; sex therapy; testosterone if hypogonadism; sildenafil PDE5 inhibitor, increased cGMP => smooth mus relaxation => increased blood flow in corpora cavernosa
213
Q213. Nephritic Syndrome What is it
A213. Manifestation of glomerular; inflammation (glomerulonephritis)
214
Q214. Nephritic Syndrome History/PE
A214. Hematuria smoky brown; HTN; oliguria; edema low pressure areas (periorbital, scrotum)
215
Q215. Nephritic Syndrome Dx
A215. UA hematuria, (possible) mild proteinuria; decreased GFR; increased BUN/Cr; ANA; ANCA; anti gbm Ab; renal Biopsy
216
Q216. Nephritic Syndrome Tx (in general)
A216. Tx HTN, fluid overload and uremia; salt restriction; water restriction; diuretics; dialysis (if necessary); corticosteroids
217
Q217. Postinfectious GN What is it
A217. Nephritic Syndrome; usually associated with recent strep infection, group A, B hemolytic
218
Q218. Postinfectious GN History/PE
A218. Smoky brown urine; HTN; oliguria; periorbital edema
219
Q219. Postinfectious GN Labs & Histology
A219. Low serum C3; increased ASO titer; lumpy bumpy immunofluorescence
220
Q220. Postinfectious GN Tx & Prognosis
A220. Supportive; almost all kids & most adults have complete recovery
221
Q221. IgA Nephropathy (Berger's) What is it
A221. Nephritic Syndrome; MC type worldwide; associated with URI or GI infections; young men
222
Q222. IgA Nephropathy (Berger's) History/PE
A222. Gross hematuria
223
Q223. IgA Nephropathy (Berger's) Labs & Histology
A223. Increased serum IgA; Biopsy & immunofluorescence mesangial IgA deposits
224
Q224. IgA Nephropathy (Berger's) Tx & Prognosis
A224. Glucocorticoids; 20% progress to ESRD
225
Q225. Wegener's Granulomatosis What is it
A225. Nephritic Syndrome; granulomatous inflammation of respiratory tract & kidney; necrotizing vasculitis; paucimmune form of RPGN
226
Q226. Wegener's Granulomatosis History/PE
A226. Fever; weight loss; hematuria; respiratory & sinus Sxs; cavitary pulmonary lesions bleed => hemoptysis
227
Q227. Wegener's Granulomatosis Labs & Histology
A227. c ANCA
228
Q228. Wegener's Granulomatosis Tx & Prognosis
A228. High dose corticosteroids; cytotoxic agents; patients tend to have freq relapses
229
Q229. Alport's Syndrome What is it
A229. Nephritic Syndrome; hereditary; boys 5 20 y/o
230
Q230. Alport's Syndrome History/PE
A230. Asymptomatic hematuria; nerve deafness; eye disorders
231
Q231. Alport's Syndrome Labs & Histology
A231. GBM splitting on electron microscope
232
Q232. Alport's Syndrome Tx & Prognosis
A232. Progress to RF; anti GBM nephritis may recur after transplant
233
Q233. Goodpasture's Syndrome What is it
A233. Nephritic syndrome; GN & pulmonary hemorrhage; men in mid 20's; immune form of RPGN
234
Q234. Goodpasture's Syndrome History/PE
A234. Hemoptysis; dyspnea; possible respiratory failure
235
Q235. Goodpasture's Syndrome Labs & Histology
A235. Linear anti GBM on IF; iron deficient anemia; CXR pulmonary infiltrates; sputum hemosiderin filled macrophages
236
Q236. Goodpasture's Syndrome Tx & Prognosis
A236. Plasma exchange therapy (plasmapheresis); pulsed steroids; cyclophosphamide; may progress to ESRD
237
Q237. Nephrotic Syndrome What is it
A237. Increased permeability of glomerulus to protein => proteinuria = or > 3.5 g/day; hypoalbuminemia; hyperlipidemia; hyperlipiduria; edema; predisposed to hypercoag state; 1/3 due to systemic disease DM; SLE; amyloidosis
238
Q238. Nephrotic Syndrome History/PE
A238. Generalized edema; foamy urine; if severe dyspnea, ascites, increased susceptibility to infections, venous thrombosis; PE
239
Q239. Nephrotic Syndrome Dx
A239. UA proteinuria > 3.5g/day; lipiduria; decreased albumin (< 3g/dL); hyperlipidemia; Biopsy Dx underlying etiology
240
Q240. Nephrotic Syndrome Tx (in general)
A240. Steroids best initial Tx; cyclophosphamide; restrict salt; diuretics; statins
241
Q241. Minimal Change Disease What is it
A241. Nephrotic syndrome; common in children; idiopathic etiology
242
Q242. Minimal Change Disease History/PE
A242. Tendency towards infections, thrombosis
243
Q243. Minimal Change Disease Labs & Histology
A243. Normal under light microscope; electron microscope shows fusion of epithelial foot processes
244
Q244. Minimal Change Disease Tx & Prognosis
A244. Steroids; excellent prognosis
245
Q245. Focal Segmental; Glomerulosclerosis (FSGS) What is it
A245. Nephrotic syndrome; idiopathic; IVDU; HIV
246
Q246. Focal Segmental; Glomerulosclerosis (FSGS) History/PE
A246. Especially common in black men with uncontrolled HTN
247
Q247. Focal Segmental; Glomerulosclerosis (FSGS) Labs & Histology
A247. Microscopic hematuria; Biopsy sclerosis in capillary tufts
248
Q248. Focal Segmental; Glomerulosclerosis (FSGS) Tx & Prognosis
A248. Prednisone; cytotoxic therapy; Poor prognosis
249
Q249. Membranous Nephropathy What is it
A249. Nephrotic syndrome; MC white adult nephropathy; MC idiopathic form in adults; immune complex disease
250
Q250. Membranous Nephropathy History/PE
A250. Associated with:; HBV; syphilis; malaria; gold (drug); penicillamine; cancer; SLE
251
Q251. Membranous Nephropathy Labs & Histology
A251. "spike and dome due to granular deposits of IgG and C3 at basement membrane"
252
Q252. Membranous Nephropathy Tx & Prognosis
A252. Steroids are of little use
253
Q253. Diabetic Nephropathy What is it
A253. Nephrotic syndrome; Diffuse hyalinization; nodular glomerulosclerosis; Kimmelstiel Wilson lesions
254
Q254. Diabetic Nephropathy History/PE
A254. Usually have long standing,; poorly controlled DM
255
Q255. Diabetic Nephropathy Labs & Histology
A255. Thickened glomerular basement membrane; increased mesangial matrix
256
Q256. Diabetic Nephropathy Tx & Prognosis
A256. Tight glucose control; protein restriction; ACEIs
257
Q257. Lupus Nephritis What is it
A257. Nephrotic & nephritic syndrome; WHO types I V; severity of renal disease; determines overall prognosis
258
Q258. Lupus Nephritis History/PE
A258. Proteinuria or RBCs in UA
259
Q259. Lupus Nephritis Labs & Histology
A259. Mesangial proliferation; subendothelial immune complex deposits
260
Q260. Lupus Nephritis Tx & Prognosis
A260. May reduce disease progression prednisone, cytotoxic therapy
261
Q261. Renal Amyloidosis What is it
A261. Nephrotic syndrome; primary plasma cell dyscrasia; secondary infectious, inflammatory
262
Q262. Renal Amyloidosis History/PE
A262. Patients may have multiple myeloma; or chronic inflammatory disease (RA, TB)
263
Q263. Renal Amyloidosis Labs & Histology
A263. Abdominal fat Biopsy; congo red stain; apple green birefringence under polarized light
264
Q264. Renal Amyloidosis Tx & Prognosis
A264. Prednisone; melphalan; BMT for multiple myeloma
265
Q265. Membranoproliferative; Nephropathy (MPGN) What is it
A265. Nephrotic & nephritic syndrome; 3 types
266
Q266. Membranoproliferative; Nephropathy (MPGN) History/PE
A266. Immune deposits; low complement; associated with HCV; slow progression to RF
267
Q267. Membranoproliferative; Nephropathy (MPGN) Labs & Histology
A267. "Tram tracks" double layered basement memb; type I subendo deposits; type II decreased C3; C3 nephritic factor; (IgG autoAb)
268
Q268. Membranoproliferative; Nephropathy (MPGN) Tx & Prognosis
A268. Corticosteroids; cytotoxic agents
269
Q269. BPH What is it
A269. Normal part of aging; seen in > 80% by age 80; patients usually > 50 y/o
270
Q270. BPH History/PE
A270. Obstructive hesitancy, weak stream, intermittent stream, incomplete emptying, urinary retention, bladder fullness; irritative nocturia, daytime frequency, urge incontinence, opening hematuria; DRE uniformly enlarged, rubbery; BPH in central zone (may not be detected on DRE)
271
Q271. BPH Dx
A271. R/o possible dangerous causes; DRE; UA/UC; Cr; Not recommended for BPH PSA & cystoscopy
272
Q272. BPH Tx
A272. Mild reassurance; mod to severe surgery, terazosin, finasteride, TURP, open prostatectomy
273
Q273. Prostate Cancer What is it; Risk factors
A273. MC cancer in men; second cause of cancer death in men; risk factors age, family History
274
Q274. Prostate Cancer History/PE
A274. Usually asymp; rarely causes Sxs until advanced; urinary retention; decreased force of urine stream; lymphedema; constitutional Sxs; back pain; DRE palpable nodule, area of induration; early Ca usually not detectable; tender prostate = prostatitis
275
Q275. Prostate Cancer Dx
A275. Clinical; markedly elevated PSA; US guided transrectal Biopsy; Gleason grade; CXR; bone scan; Gleason grade based on histology; grades 1 5 on two features level of differentiation, structural architecture, the two scores are added; Poorly differentiated tumors score 8 10, worst prognosis
276
Q276. Prostate Cancer Tx
A276. Tx based on aggression of tumor, pt's risk of dying; watchful waiting elderly & low grade; radical prostatectomy & RT increased risk of incontinence, increased risk of impotence; PSA use to evaluate post Tx, check for disease recurrence; metastasis chemo & androgen ablation: GnRH agonists, flutamide, orchiectomy
277
Q277. Prostate Cancer Prevention
A277. Annual DRE > 50 y/o; > 45 y/o if Black; > 45 y/o if positive family History; also screen with PSA
278
Q278. Bladder Cancer What is it; Risk factors
A278. 2nd MC urologic cancer; MC malignant tumor urinary tract; transitional cell Ca; men 60s & 70s risk factors:; smoking; chronic bladder infections; calculous disease; aniline dye; hair dye
279
Q279. Bladder Cancer History/PE
A279. Asymptomatic in early stages; gross hematuria; freq. urgency; dysuria
280
Q280. Bladder Cancer Dx
A280. UA; cytology; IVP; cystoscopy with Biopsy diagnostic; may also US, MRI, pelvic CT
281
Q281. Bladder Cancer Tx
A281. superficial transurethral resection or intravesicular chemo with mitomycin C or BCG; CIS intravesicular chemo; large, hi grade recurrent intravesicular chemo; invasive without mets aggressive surgery, RT; distant mets chemo
282
Q282. Testicular Cancer What is it; Risk factors
A282. Heterogenous group; 95% derive from germ cells; almost all are malignant; MC malignancy in 15 35 y/o; seminomas peak at 40 50 y/o; Klinefelter's risk factor; cryptorchidism increased risk of neoplasia in both testes
283
Q283. Testicular Cancer History/PE
A283. Painless enlargement of testis
284
Q284. Testicular Cancer Dx
A284. B hCG increased in choriocarcinomas, increased in 10% of seminomas; AFP increased in endodermal sinus, (yolk sac) tumors
285
Q285. Testicular Cancer Tx
A285. Seminomas very radiosensitive, also respond to chemo; nonseminomatous germ cell platinum based chemo
286
Q286. SIADH What is it; What is it associated with
A286. Euvolemic hyponatremia from nonosmotically stimulated ADH release associated with:; CNS disease; pulmonary disease; ectopic tumor/ paraneoplastic syndromes; drugs; surgery
287
Q287. SIADH Dx
A287. Urine osmolality > 50 100 mOsm/kg; concurrent serum hyposmolarity; no physio reason for increased ADH; urinary sodium > 20 mEq/L
288
Q288. SIADH; Tx
A288. Tx underlying cause; mild restrict fluids; moderate NS and furosemide; severe (Sxs) hypertonic saline, then furosemide; if chronic demeclocycline or lithium ADH antag
289
Q289. Diabetes Insipidus What is it; What is it caused by
A289. Central or nephrogenic Central:; post pit. doesn't secrete ADH; causes tumor, ischemia (Sheehan's), trauma, infection, autoimmune disorder Nephrogenic:; kidneys don't respond to ADH; causes renal disease, drugs (lithium, demeclocycline)
290
Q290. Diabetes Insipidus History/PE
A290. Polydipsia; polyuria; persistent thirst; dilute urine; if don't have unlimited access to water dehydration, hypernatremia
291
Q291. Diabetes Insipidus Dx
A291. Water deprivation test; DDAVP challenge desmopressin mimics ADH; if central DDAVP challenge => decreased urine output, increased urine osmolarity; thus, MRI (to check for mass); if nephrogenic DDAVP challenge will not decreased urine output
292
Q292. Diabetes Insipidus Tx
A292. central DDAVP subcutaneously; nephrogenic thiazide diuretics (HCTZ), amiloride, chlorthalidone
293
Q293. Acetazolamide Site of Action; Mechanism
A293. Proximal convoluted tubule; inhibits carbonic anhydrase
294
Q294. Acetazolamide Clinical Use
A294. Glaucoma; urinary alkalinization; metabolic alkalosis; altitude sickness; cysteinuria
295
Q295. Acetazolamide Toxicity
A295. Hyperchloremic metabolic acidosis; sulfa allergy
296
Q296. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid Site of Action; Mechanism
A296. Ascending loop of Henle; Inhibits Na/K/2 Cl cotransport
297
Q297. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid Clinical Use
A297. HTN; hypercalcemia; edematous states CHF; cirrhosis; nephrotic syndrome; pulmonary edema
298
Q298. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid Toxicity
A298. OH DANG; Ototoxicity; Hypokalemia; Dehydration; Allergy sulfa (not ethacrynic acid); Nephritis interstitial; Gout
299
Q299. Hydrochlorothiazide Site of Action; Mechanism
A299. Distal convoluted tubule; inhibits Na+/Cl cotransporter
300
Q300. Hydrochlorothiazide Clinical Use
A300. HTN; CHF; idiopathic hypercalciuria; nephrogenic diabetes insipidus
301
Q301. Hydrochlorothiazide Toxicity
A301. HyperGLUC; hyperGlycemia; hyperLipidemia; hyperUricemia; hypercalcemia and; hypokalemic metabolic alkalosis; hyponatremia; sulfa allergy
302
Q302. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride Site of Action; Mechanism
A302. Cortical collecting tubule; Spironolactone aldosterone receptor antag; triamterene & amiloride block Na+ channels
303
Q303. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride Clinical Use
A303. Hyperaldosteronism; K+ depletion; CHF
304
Q304. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride Toxicity
A304. Hyperkalemia; gynecomastia; antiandrogen effects
305
Q305. Mannitol Site of Action; Mechanism
A305. Entire tubule; sorbitol stereoisomer; osmotic diuretic; filtered by glomerulus; can't be reabsorbed; increased tubular fluid osmolarity => decreased water reabsorption => increased urine flow
306
Q306. Mannitol Clinical Use
A306. Shock; drug overdose; decreased intracranial or intraocular pressure
307
Q307. Mannitol Toxicity
A307. Pulmonary edema; dehydration; contraindicated in anuria, CHF
308
Q308. Renal Tubular Acidosis What is it
A308. Failure of kidneys to acidify urine; net decreased in tubular H+ secretion or HCO3 reabsorption => nonanion gap metabolic acidosis
309
Q309. RTA Type I What is it
A309. Distal tubule H+/K+ pump is broken => failure to secrete H+; serum K+ stays low; urinary pH > 5.3
310
Q310. RTA Type I Causes; Complications
A310. Causes usually sporadic; lithium; amphotericin; analgesics; collagen vascular disease; cirrhosis; chronic urinary tract obstruct; sickle cell; nephrocalcinosis also a consequence complication nephrolithiasis; secondary hyperaldosteronism
311
Q311. RTA Type I Tx; Dx/Test
A311. Tx potassium citrate; Dx/Test acid load
312
Q312. RTA Type II What is it
A312. Proximal tubule cells don't reabsorb HCO3; urinary pH initial > 5.3; distal tubular cells work OK => urinary pH < 5.3 when serum gets acidic
313
Q313. RTA Type II Causes; Complications
A313. Causes:; hereditary; carbonic anhydrase inhibitors; Fanconi's syndrome; multiple myeloma; complications rickets, osteomalacia
314
Q314. RTA Type II Tx; Dx/Test
A314. Tx potassium citrate; Dx/Test bicarb load
315
Q315. RTA Type IV What is it
A315. Adrenal insensitivity to angiotensin 2; aldosterone deficient; serum K+ is high; usually asymptomatic hyperkalemia, hyperchloremic metabolic acidosis (nonanion/normal metabolic acidosis)
316
Q316. RTA Type IV Causes; Complications
A316. Causes; hyporeninemic hypoaldosterone:; DM (infarcts JG); ACEIs; NSAIDs; addison's; sickle cell; renal insufficiency; complication hyperkalemia
317
Q317. RTA Type IV Tx; Dx/Test
A317. Tx fludrocortisone, furosemide if HTN, kayexelate; Dx/Test restrict salt
318
Q318. Acute Renal Failure What is it
A318. Rapid decreased in renal function over days to weeks => accum of nitrogenous products, fluid & electrolyte disorder develop. prerenal caused by decreased renal plasma flow (inadequate renal perfusion); renal caused by intrinsic renal disease or damage; postrenal caused by obstruction of urinary outflow, both kidneys must be obstructed to cause significant azotemia
319
Q319. Acute Renal Failure History/PE
A319. History uremia, malaise, oliguria, fatigue, anorexia, n/v; PE asterixis, HTN, decreased urinary output, increased RR, pericardial friction rub if uremic pericarditis,; prerenal hypovolemia, orthostasis, oliguria; postrenal anuria, distended bladder; acute interstitial nephritis fever; rash
320
Q320. Acute Renal Failure Dx
A320. CBC; BUN/Cr; electrolytes; FE(Na) if oliguric; urine sediment RBC, WBC casts, eosinophils; urinary catheter; renal US
321
Q321. Acute Renal Failure Tx
A321. Balance fluid & electrolytes; dialysis if indicated; acute/allergic nterstitial nephritis adjust/discontinue offending meds; glomerulonephritis corticosteroids, cytotoxics
322
Q322. Acute Renal Failure Complications
A322. Chronic renal failure => dialysis; dialysis prevent buildup of: K+, H+, toxic metabolites; increased risk for CAD
323
Q323. Acute Renal Failure What is Prerenal % for FE(Na); What is Prerenal No. for U(Na); What is Prerenal Ratio; for BUN/Cr
A323. FE(Na) is < 1%; U(Na) is < 20; BUN/Cr is > 20
324
Q324. Acute Renal Failure FE(Na) How do you calculate it
A324. U/P Na divided by U/P Cr
325
Q325. Dialysis What are the indications
A325. AEIOU; Acidosis; Electrolyte abnormalities (hyperkalemia); Ingestions; Overload of fluid; Uremic Sxs pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus
326
Q326. Hyponatremia What is it
A326. Serum sodium < 135 mEq/L
327
Q327. Hyponatremia History/PE
A327. May be asymptomatic; confusion; lethargy; muscle cramps; nausea; can progress to seizures, status epilepticus, coma
328
Q328. Hyponatremia Dx
A328. Classified by:; serum osmolality; volume status (by PE); urinary Na+
329
Q329. Hyponatremia What are the types; of osmolalities
A329. High > 295 mEq/L: hyperglycemia, hypertonic infusion (mannitol); Normal 280 295 mEq/L: hyperlipidemia, hyperproteinemia, pseudohyponatremia; Low < 280 mEq/L: hypervolemic hyponatremia, euvolemic hyponatremia, hypovolemic hyponatremia
330
Q330. Hyponatremia Tx
A330. Chronic hyponatremia should be corrected slowly to prevent central pontine myelinolysis
331
Q331. Hypervolemic Hyponatremia What is it; Etiologies; Tx
A331. Increased in Na+ & total body weight, Increased greater in TBW etiologies edematous states:; renal failure; nephrotic syndrome; cirrhosis; CHF; Tx restrict salt and water
332
Q332. Euvolemic Hyponatremia What is it; Etiologies; Tx
A332. Total body Na+ normal, total body water has increased Etiologies:; SIADH; hypothyroidism; renal failure; drugs; psychogenic polydipsia; adrenal insufficiency; Tx restrict salt and water
333
Q333. Hypovolemic Hyponatremia What is it; Etiologies; Tx
A333. Decreased in total body Na+ and total body water, more Na+ than water is lost etiologies; diuretics; vomiting; diarrhea; third spacing; dehydration; Tx replete volume with normal saline
334
Q334. Hypernatremia What is it
A334. Serum Na+ > 145 mEq/L
335
Q335. Hypernatremia History/PE
A335. Thirst; oliguria or polyuria (depends on etiology); mental status changes; weakness; focal neuro deficits; seizures; "doughy" skin
336
Q336. Hypernatremia Dx
A336. Measure urine volume; measure urine osmolality; hypervolemic hyperNa+ increased aldosterone or excess Na+ (IV saline); min vol (500 mL/day) of max concentrated urine (> 400 mOsm/kg) adequate renal response; inadequate free water replaced; fluid loss from decreased intake, diuretics, glycosuria, 3rd spacing; large volume of dilute urine diabetes insipidus
337
Q337. Hypernatremia Tx
A337. Tx underlying causes; replace free water deficit isotonic fluids; correct gradually over 48 72 hrs (to prevent neuro damage secondary to cerebral edema)
338
Q338. Hypercalcemia What is it; What causes it
A338. Serum Ca2+ > 10.2 mg/dL, > 15 mg/dL = medical emergency; MCC hyperparathyroidism, malignancy common causes CHIMPANZEES:; Calcium supplementation; Hyperparathyroidism; Iatrogenic (thiazides); Immobility; Milk alkali syndrome; Paget's disease; Addison's; Acromegaly; Neoplasm; Zollinger Ellison syndrome; Excess vitamin A; Excess vitamin D; Sarcoidosis; and other granulomatous disease
339
Q339. Hypercalcemia History/PE
A339. "Bones, stones, abdominal groans, psych overtones ( fracture, kidney stones, n/v ,constipation, anorexia, Weakness, Fatigue and altered mental status"
340
Q340. Hypercalcemia Dx
A340. EKG short QT; total Ca2+; ionized Ca2+; albumin; phosphate; PTH; PTHrP; vit D; TSH; serum immunoelectrophoresis
341
Q341. Hypercalcemia Tx
A341. IV hydration; then furosemide; if severe or refractory calcitonin, bisphosphonates (pamidronate), glucocorticoids, dialysis
342
Q342. Hypocalcemia What is it; What causes it
A342. Serum Ca2+ < 8.5 mg/dL caused by: hypoparathyroidism (postsurgery, idiopathic); malnutrition; hypomagnesemia; acute pancreatitis; medullary thyroid cancer (excess calcitonin); vit D def. pseudohypoparathyroidism; renal insufficiency; serum Ca2+ may be falsely low in hypoalbuminemia
343
Q343. Hypocalcemia History/PE
A343. Abdominal muscle cramps; tetany; perioral & acral paresthesias; convulsions; dyspnea; Chvostek's sign; Trousseau's sign; EKG prolonged QT
344
Q344. Hypocalcemia Dx
A344. Ionized Ca2+; Mg2+; PTH; albumin; calcitonin; if post thyroidectomy check operative note to determine number of parathyroid glands removed
345
Q345. Hypocalcemia Tx
A345. Tx underlying disorder; oral calcium supplements; if severe IV calcium
346
Q346. Hypomagnesemia What is it; What is it caused by
A346. Serum Mg2+ < 1.5 mEq/L causes:; decreased intake: malnutrition, alcoholism, malabsorption, short bowel syndrome, TPN; increased loss: diuretics, diarrhea, vomiting; miscellaneous: DKA, pancreatitis
347
Q347. Hypomagnesemia History/PE
A347. Sxs usually related to concurrent hypocalcemia and hypokalemia; anorexia, n/v; muscle cramps, weakness; if levels very low paresthesias, irritability, confusion, lethargy, seizures, arrhythmias
348
Q348. Hypomagnesemia Dx
A348. Check for concurrent hypocalcemia & hypokalemia; EKG prolonged PR & QT
349
Q349. Hypomagnesemia Tx
A349. IV or oral Mg2+; hypokalemia & hypocalcemia; won't correct if Mg2+, not corrected also
350
Q350. Hyperkalemia What is it; What is it caused by
A350. Serum K+ > 5 mEq/L Causes:; spurious hemolyzed blood draw, fist clenched during blood draw; extreme leukocytosis; extreme thrombocytosis; rhabdomyolysis; decreased excretion renal insufficiency, mineralocorticoid def., RTA type 4, drugs heparin, spironolactone, triamterene, ACEIs, trimethoprim, NSAIDs; cellular shifts tissue injury, insulin def., drugs succinylcholine, digitalis, arginine, B blockers; iatrogenic
351
Q351. Hyperkalemia History/PE
A351. Muscle weakness starts > 6.5; MCC of death abnormal cardiac conduction; May be asymptomatic; n/v; intestinal colic; areflexia; weakness; flaccid paralysis; paresthesias
352
Q352. Hyperkalemia Dx
A352. Verify with repeat blood draw (if need to); EKG tall peaked T, prolonged PR, wide QRS, loss of P can => sine waves,; ventricular fibrillation,; cardiac arrest
353
Q353. Hyperkalemia Tx
A353. Emergent Tx if > 6.5 mEq/L or prolonged PR or wide QRS C BIG K:; Calcium gluconate or CaCl: immediate but short lived; Bicarb: not in same IV line as Ca (forms CaCO3 precipitate); Insulin and Glucose takes 30 60 min. to work; Kayexalate and loop diuretics; give sorbitol to prevent constipation; If RF or severe, refractory dialysis
354
Q354. Hypokalemia What is it; What is it caused by
A354. Serum K+ < 3.5 mEq/L causes:; transcellular shifts insulin, B2 agonists, alkalosis, periodic paralysis; GI losses diarrhea, chronic laxative abuse, vomiting, NG suction; renal K+ losses diuretics, primary mineralocorticoid, excess secondary hyperaldosteronism, drugs, DKA, hypomagnesemia, RTA Types 1&2; licorice; clay
355
Q355. Hypokalemia History/PE
A355. Sxs start when K+ <2.5 3.0; muscle weakness; cramps; ileus; fatigue; hyporeflexia; paresthesias; if severe flaccid paralysis, cardiac arrhythmia
356
Q356. Hypokalemia Dx
A356. 24 hour or spot urine K to distinguish renal from GI losses; EKG flattened T, U wave, ST depression followed by AV block and cardiac arrest
357
Q357. Hypokalemia Tx
A357. Tx underlying disorder; oral or IV K+; too fast => fatal arrhythmia; max 10 meq/hr; use 1/2 NS or NS; replace Mg2+; monitor EKG and plasma K+; freq. during replacement
358
Q358. MCC dysuria 25 yo male
A358. urethritis
359
Q359. Prehn's sign
A359. elevate testicles relieves pain in epididymitis (sp?)
360
Q360. torsion evaluation
A360. ultrasound
361
Q361. renal stone evaluation
A361. CT
362
Q362. pre renal azotemia; BUN:creatinine
A362. >20:1 <30:1; BUN:creatinine
363
Q363. CHF in ESRD treatment
A363. Furosemide (Lasix)
364
Q364. Renal stone size threshholds for surgery
A364. 6 mm will not likely pass; 5 mm will likely pass
365
Q365. GI bleed; BUN:creatinine
A365. >30:1; BUN:creatinine
366
Q366. Why is the left kidney taken during transplantation?
A366. It has a longer renal vein
367
Q367. Water breakdown?
A367. Water is 60% of body weight; 2/3 is intracellular; 1/3 is extracellular; 1/4 of extracellular volume is plasma; 3/4 of extracellular volume is interstitial
368
Q368. How can you measure plasma volume?
A368. Radiolabeled albumin
369
Q369. Formula for clearance
A369. Cx = UxV/Px
370
Q370. What does the glomerular filtration barrier block, and how?
A370. Large, negative particles; 1. Fenestrated capillary (size); 2. Heparin on basement membrane (charge); 3. Podocyte foot processes
371
Q371. Calculation for free water clearance
A371. C = V (Uosm*V/Posm); it is the volume of water per unit time that is cleared by the kidneys. you get at it by taking the urine flow rate and subtracting out the volume of osmole containing fluid.
372
Q372. What is the renal threshold for glucose?
A372. around 200 mg/dL; this is when you start to see symptoms
373
Q373. Why does acidosis decrease K secretion?
A373. It causes a shift of K outside the cell; (thus decreasing the amount of K available for transport to the lumen)
374
Q374. Actions of AII
A374. Vasoconstriction; Aldosterone synthase induction; ADH release; Stimulates hypothalamus for increasing thirst
375
Q375. ANP actions
A375. Decreases renin; Increases GFR
376
Q376. What part of the kidney secretes EPO?
A376. Endothelial cells of peritubular capillaries
377
Q377. What stimulates renin secretion?
A377. Beta 1
378
Q378. Winter's formula
A378. PCO2 = 1.5 (HCO3) + 8 +/ 2
379
Q379. Metabolic alkalosis
A379. PCO2 increases .7 for every 1 mEq/L increase in HCO3
380
Q380. Respiratory alkalosis; acute; chronic
A380. 2 mEq/L decrease for every 10mmHg decrease in PCO2; 5 mEq/L for every 10mmHg decrease in PCO2; You're pretty good at peeing out excess base.
381
Q381. Respiratory acidosis; acute; chronic
A381. 1mEq/L increase for every 10 mmHg increase; 3.5 mEq/L increase
382
Q382. Delta delta; 2
A382. change in AG from normal of 12 / change in HCO2 from normal of 24; 2 = Alk + AG acid
383
Q383. WBC casts
A383. virtually pathognomonic for pyelo, and not seen in cystitis
384
Q384. Granular casts
A384. ATN
385
Q385. What stone is radiolucent
A385. Uric acid
386
Q386. Renal cell carcinoma; Host; Histology; Genetics; Paraneoplastics
A386. Men 50 70; Likes upper pole, originates in renal tubule cells (clear cells); Associated with VHL gene on 3; EPO, ACTH, PTHrP, prolactin
387
Q387. WAGR complex
A387. Wilms' tumor; Aniridia; Genitourinary malformation; mentomotor Retardation
388
Q388. What does Wilms' tumor originate from?
A388. Primitive metanephric tissues
389
Q389. Causes of transitional cell carcinoma
A389. Phenacetin,; Smoking,; Aniline dyes,; Cyclophosphamide,; Schistosomiasis
390
Q390. Where can TCC occur?
A390. Calyces,; pelves,; ureters,; bladder
391
Q391. Chronic pyelonephritis
A391. Coarse,; asymmetric,; corticomedullary scarring,; blunted calyx,; thyroidization of kidney; Usually from chronic UT obstruction
392
Q392. What causes diffuse cortical necrosis?
A392. combination of vasospasm and DIC,; usually in sepsis or obstetric catastrophes
393
Q393. What is the mechanism by which drugs induce interstitial nephritis
A393. Haptenation
394
Q394. Nephrocalcinosis
A394. diffuse deposition of calcium in the kidney parenchyma which can lead to renal failure. Caused by hypercalcemia or hyperphosphatemia (this is associated with renal failure)
395
Q395. Causes of ATN
A395. ischemia,; myoglobinuria,; toxins (mercuric chloride, aminoglycosides, ethylene glycol (oxalosis))
396
Q396. 2 phases
A396. oliguric phase : worry hyperkalemia (deadly arrhythmia); recovery phase : vigorous diuresis
397
Q397. Causes of renal papillary necrosis
A397. DM (infection and vascular disease); Acute pyelonephritis; Chronic phenacetin use (acetaminophen, too); Sickle cell anemia
398
Q398. In what condition can you see bleeding 2/2 platelet dysfunction, skin pigmentation, and fibrinous pericarditis?
A398. uremia
399
Q399. What conditions are associated with dominant mutations of APKD1.
A399. polycystic liver disease,; berry aneurysms,; mitral valve prolapse,; secondary polycythemia
400
Q400. What are dialysis cysts?
A400. cortical and medullary cysts resulting from long standing dialysis. Increased risk of renal cancer.
401
Q401. Which has a better prognosis: medullary cystic disease or medullary sponge kidney?
A401. Medullary sponge kidney;; multiple small cysts in the collecting ducts, associated with moderately impaired tubular function and occasional infection, but otherwise good prognosis. Medullary cystic disease patients have small kidneys. Also known as nephronopthisis.
402
Q402. What do thiazides do to urinary calcium?
A402. They decrease urinary calcium excretion!; They retain calcium!; Good for idiopathic hypercalciuria.
403
Q403. What drug do you use for nephrogenic DI?
A403. THIAZIDES!
404
Q404. enlarged, hypercellular glomeruli, PMNs, lumpy bump EM; subepithelial humps; granular pattern
A404. PSGN
405
Q405. Crescentic GN
A405. RPGN; I: goodpasture's; II: Post strep in 50% of all cases, Lupus IV; III: Pauci immune (ANCA)
406
Q406. subendothelial humps; tram tracking
A406. Membranoproliferative GN; tram tracks are the reduplication of the GBM ("proliferative of the membrane")
407
Q407. mesangial deposits of IgA; no complement
A407. Berger's disease
408
Q408. defect in alpha 5 type IV collagen
A408. Alports; sensorineural deafness,; hematuria,; anterior lenticonus
409
Q409. Membranous GN (nephritis/nephropathy); Associations?
A409. Oddly, this is a NEPHROTIC syndrome. capillary and BM thickening; granular pattern; spike and dome (reactive BM forms spikes); Unknown etiology: lupus, HBV, syphilis, malaria, gold salts, penicillamine, cancers. Often accompanied by azotemia
410
Q410. normal glomeruli, foot process effacement, lipid laden renal cortices
A410. minimal change disease; responds well to steroids
411
Q411. segmental sclerosis and hyalinosis; clinically similar to minimal change
A411. FSGS
412
Q412. subendothelial and mesangial deposits of apple green birefringent material... what diseases are associated?
A412. Amyloidosis. Myeloma; Chronic inflammation; TB; Rheumatoid arthritis
413
Q413. Lupus glomerulonephropathy; I; II; III; IV; V
A413. I: no renal involvement; II: mesangial form (like FSGS); III: focal proliferative; IV: diffuse proliferative (nephrotic and nephritic presentations; crescents, mesangial hypertrophy, endothelial proliferation, subendothelial deposits); V: membranous
