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Nephrology Flashcards

1
Q

What is the definition of acute renal failure?

A

rapid onset of azotemia (increase BUN and Cr) and oliguria <500mL urine per day

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2
Q

what causes prerenal ARF?

A

hypoperfusion 2/2

vol depletion, heart failure, liver failure, sepsis, burns or bilateral RAS

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3
Q

what causes post renal ARF?

A

OBSTRUCTION
BPH
bladder or pelvic tumors
calculi

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4
Q

what causes intrinsic renal failure?

A

ATN
Allergic interstitial nephritis
glomerulonephritis
nephrotoxin exposure (including myoglobin from rhabdo)
renal ischemia (prolonged prerenal state that progresses to ischemia)

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5
Q

what are signs and symptoms of ARF?

A

oliguria
AGMA
hyperkalemia
arrhythmias

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6
Q

Urinary eosinophils suggest __________

A

allergic nephritis

athero-embolic dz

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7
Q

RBC casts are pathognomonic for ?

A

glomerulonephritis

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8
Q

muddy brown casts suggest ___________

A

ATN

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9
Q

how treat acute renal failure?

A
  • fluids to maintain urine output
  • diuretics to prevent volume overload
  • monitor electrolytes
  • Dialysis if recalcitrant vol overload, electrolyte abnormalities that are critical, unresponsive metabolic acidosis, toxic ingestion, uremia
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10
Q

What can we use in place of FENa if pt is on diuretics?

A

FE urea

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11
Q

Urine osms in prerenal vs. renal/postrenal

A

> 500 because urine is concentrated because body wants to hold onto water

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12
Q

What causes ATN?

A 
persistent prerenal states
rhabdo--> myoglobinuria
direct toxins (ampho, aminoglycosides, contrast dye)
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13
Q

what are the 3 phases of ATN

A

prodromal, oliguric and post-oliguric

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14
Q

how treat ATN?

A

treat precipitating cause
IVF to maintain UOP
monitor lytes
diurese PRN to prevent fluid overload

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15
Q

What can cause drug induced AIN?

A

b-lactams
sulfonamides
diuretics
NSAIDs

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16
Q

Si/Sx AIN?

A 
pyuria
maculopapular rash
eosinophilia
proteinuria
hematuria
oliguria
flank pain
fever
eosinophilia
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17
Q

Dx AIN

A

clinical improvement following withdrawal of offending drug

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18
Q

Tx AIN

A

removal of underlying cause, consider corticosteroids for allergic dz

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19
Q

Type 1 RTA characteristics? pH?

A

distal tubule defect of urinary H+ gradient
ph >5.5
when? ampho toxicity

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20
Q

Type 2 RTA characteristics? pH?

A

prox tubule failure to resorb HCO3
cause? acetazolamide, nephrotic syndrome, mult myeloma, Fanconi’s syndrome
pH >5.5 early then

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21
Q

Type 4 RTA characteristics? pH?

A

decreased aldosterone–> hyperkalemia and hyperchloremia
usually due to decreased secretion
when? diabetics, interstitial nephritis, NSAID/ACE or Heparin use

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22
Q

DI sx

A

polyuria, polydipsia, nocturia, urine spec grav 300

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23
Q

causes of central DI

A

1o -idiopathic

2o - trauma/infection/granulomatous infxn /fungal /TB infxn of pituitary

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24
Q

Tx central DI

A

desmopressin DDAVP (ADH analogue nasal spray)

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25
Nephrogenic DI causes
1o - X linked | 2o usually due to drugs: lithium, demeclocycline, rarely sickle cell, amyloid, multiple myeloma
26
Tx nephrogenic DI
increase water intake, sodium restrict
27
How differentiate central vs. nephrogenic DI?
hold water, administer vasopressin. in central DI, Uosm after deprivation isn't greater than Sosm, but increases 10% after vasopression. (won't change in nephrogenic)
28
Causes of SIADH
CNS dz: trauma, tumor, GBS, hydrocephalus Pulm Dz: pneumonia, SCLC, abscess, COPD Endocrine: hypothyroid, COnn Drugs: NSAIDs, antidepressants, chemotherapy, diuretics, phenothiazine, oral hypoglycemics PAIN
29
How Dx SIADH
hyponatremia with Uosm >300 and clinically NOT hypovolemic
30
How tx SIADH
evolemic: water restrict - -> 3% saline or conivaptan if no response hypovolemic: nml saline * *beware of central pontine myelinolysis w/rapid correction of hyponatremia
31
What is chronic renal failure always associated with?
Azotemia of renal origin
32
What is Uremia?
clinical and biochem syndrome: - Azotemia - Acidosis (accumulate sulfates, phosphates, organic acids) - Hyperkalemia bc cannot excrete K+ in urine - Fluid volume disorder - Hypocalcemia due to lack of Vit D production - Anemia due to lack of Epo production - HTN 2/2 RAASq
33
Sx of uremia?
``` anorexia N/V dementia convulsions coma bleeding due to platelet dysfunction fibrinous pericarditis--> tamponade ```
34
How Dx chronic renal failure?
reanl US--> small kidneys in chronic dz, anemia, diffuse osteopenia (bc decrease vit D since kidneys can't convert it leads to decreased Ca absorption which causes increased PTH which leeches Ca from bones)
35
Tx chronic renal failure?
salt and water restrict diuresis to prevent fluid overload dialysis to correct acid-base or severe electrolye disorders
36
Sx nephrotic syndrome
``` proteinuria >3.5g/day edema lipiduria with hyperlipidemia marked decrease in serum albumin hypercoagulation (due to loss of antithrombin III in urine) ```
37
Minimal change dz: WHO Path Tx
WHO: young kids, Hodgkins PATH: EM shows fusion of podocyte foot processes Tx: Prednisone
38
FSGS Who? Assoc? Tx
MCC hispanics and African American's clinically similar to MCD, but occurs in adults with refractory HTN -usually idiopathic, can be assoc with HIV, heroin, diabetes, sickle cell idiopathic type: young hypertensive males Light micro: focal because only affects some glomeruli, segmental because only affects part of the glomerulus Tx: prednisone and cyclophosphamide **poor prognosis**--> chronic renal failure
39
Membranous Glomerulonephritis Who Cause Tx
MCC in caucasian adults -slowly progressive disorder with decreased response to treatment seen Causes -infxn: HBV/HCV/Syph/Malaria -drugs: gold salts, penicillamine in RA pts -occult malignancy -SLF TX = prednisone and cyclophosphamide, 50% pts--> ESRD **due to immune complex deposition
40
Membranoproliferative glomerulonephritis Types Tx
*thick capillary membrane on H+E with tram track appearance due to immune complex deposition mesangial cell has proliferative cytoplasm TYPE 1: subendothelial deposits, slowly progressive TYPE 2: more aggressive, assoc with C3 nephritic factor--> overactive complement, decreased serum C3 TX: pred _ plasmapheresis or inferferon a, very poor prognosis
41
how dx nephrotic glomerulopathies?
bx
42
What is the general treatment for nephrotic syndrome
``` protein restriction salt restriction diuretic tx for edema statin for hyperlipidemia ```
43
What are the main causes of systemic glomerulopathies
diabetes HIV renal amyloidosis Lupus
44
What is the main manifestation of diabetes nephropathy? tx?
microalbuminuria ACEi--decrease progression to renal failure strict glycemic and hypertensive control bx: Kimmelstiel Wilson nodules as dz progresses only tx is renal transplant
45
HIV nephropathy characteristics
usually seen in HIV acquired from drug use --> FSGS early antiretroviral tx may help kidney dz
46
reanl amyloidosis dx and tx
dx: birefringence with congo red stain tx: transplant bc dz recurs
47
What are the main characteristics and tx for Lupus Nephropathy type 1
no renal involvement by histo
48
What are the main characteristics and tx for Lupus Nephropathy type 2
mesangial dz with FSG pattern, no tx
49
What are the main characteristics and tx for Lupus Nephropathy type 3
focal proliferative dz | tx: aggressive pred and cyclophosphamide
50
What are the main characteristics and tx for Lupus Nephropathy type 4
diffuse proliferative dz, mos severe nephrotic/nephritic presentation LM--> wire loop abnormality tx: pred+ cyclophos maybe transplant
51
What are the main characteristics and tx for Lupus Nephropathy type 5
membranous dz | tx: pred
52
what cuases nephritic syndrome
diffuse glomerular inflammation
53
Sx of nephritic syndrome
``` acute onset hematuria (smoky brown urine) decreased GFR resulting in azotemia oliguria HTN edema ```
54
classic dyad in RAS?
sudden HTN with low K+ in a pt not on diuretics
55
PSGN: presentation
s/p strep (or any infxn) labs: RBCs and RBC casts in urine, azotemia, decreased C3, increased ASO titer immunofluorescence--> coarse granular IgG or C3 deposits
56
PSGN: tx
none, usually self limited
57
Crescentic (rapidly progressive) glomerulonephritis
progresses to renal failure in weeks to months
58
What is the main presentation and immunoflourescence pattern of goodpasture's?
pres: 90% pres w/hemoptysis + anti GBM antibody immunofluorescence--> smooth, linear deposition of IgG
59
Tx of crescentic/goodpastures
prednisone and plasmapheresis
60
Cause and sx of Berger's dz
cause = IgA deposition in mesangium | sx: recurrent hematuria with low-grade proteinuria
61
result of Berger's dz
25% to renal failure
62
tx of Berger's
prednisone for acute flares, won't halt dz progression
63
Henoch schonlein purpura what IgG? who? pres?
IgA Kids ab pain, vomiting, hematuria and GI bleed often after respiratory infxn
64
Henoch schonlein purpura tx
none, usually self limiting
65
multiple myeloma kidney sx
tubular plugging 2/2 Bence jones (light chain) proteins 2o hypercalcemia myeloma cells can directly invade kidney parenchyma
66
what infxns are multiple myeloma patients susceptible to?
encapsulated organisms--> chronic renal failure
67
causes of RAS?
atherosclerosis and fibromuscular dysplasia
68
what is a screening for RAS?
oral captopril--> increase in renin
69
how confirm RAS
angiography
70
tx RAS
surgery vs. angioplasty
71
MCC urinary tract obstruction in kids vs adults
kids: congenital adults: BPH and stones
72
50% of calcium pyrophosphate stones are assoiated with _______
idiopathic hypercalciuria
73
ammonium magnesium aka struvite stones are radio_____
opaque (bc magnesium is heavy)
74
ammonium magnesium aka struvite stones are usually due to which bugs
bugs that produce urease: proteus staph saphrophyticus will cause pH to rise
75
uric acid stones are radio____
lucent
76
uric acid stones due to
gout | increased cell turnover (malignancy)
77
tx uric acid stones
alkalinize urine, treat underlying disorder
78
how does renal cell disseminate
hematogenously, invades renal vein and IVC
79
sx renal cell cancer
hematuria, palpable mass, flank pain, fever, 2o polycythemia
80
tx renal cell
resection systemic IL-2 poor prognosis
81
Wilms tumor: what age group? sx?
incidence peaks 2-4 years (vs. neuroblastoma, echymosis with proptosis, MC metastatic tumor in kids) sx: palpable flank masses
82
what syndrome can Wilms tumor be a part of?
``` WAGR W: Wilms A: aniridia G: genitourinary malformations R: mental retardation ```
83
tx wilms
nephrectomy plus chemo and radiation

Medicine (8 decks)

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