Nephrology Flashcards by M P

What Lab values are associated with Prerenal Azotemia?

BUN/Cr: >20:1

FeNa: 500

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What Lab Values are associated with Intrarenal causes of acute renal Failure?

BUN/Cr: ~10:1
FeNa: >1%
Urine Na: >40
Urine Osm:

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What lab values are associated with Post renal causes of Acute renal failure?

BUN/Cr: >20:1

FeNa:

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Which pt should avoid/limit NSAID use d/t interference with prostaglandin-mediated Afferent arteriolar vasodilation?

Elderly
HTN
DM
Baseline renal disease

(people with these conditions have less baseline renal reserve)

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What drug causes retroperitoneal fibrosis?

Bleomycin
Methotrexate
Methylsergide

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What medications are commonly associated with allergic reactions?

Penicillins
Rifampin
Sulfa drugs
Allopurinol
Cephalosporins
Quinolones
Phenytoin

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What is the best initial test in managing a pt suspected of extensive muscle damage?

EKG and Chemistries (K+, Ca2+, BUN, Cr, Phosphate)

AND get

Urinalysis

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What lab findings can be associated with rhabdomyolysis?

Urinalysis: High Blood but NO RBCs seen
Urine Myoglobin (most accurate)
Hyperkalemia
Hypocalcemia
Hyperphosphatemia
Low Bicarb
Elevated CPK

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What is the most common way to develop Uric Acid Crystals that acutely cause Renal Damage?

Tumor Lysis Syndrome (lots of proteins being released and metabolized)

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What is the consequence of untreated Ethylene Glycol intoxication?

Calcium-oxalate Stones

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What is the consequence of untreated Methanol Intoxication?

Visual Disturbances/blindness

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What is done for pt prior to chemothrapy for Lymphoma/leukemia?

Hydration and Allopurinol

to prevent uric acid stone formation

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What is the largest size of a stone that can be allowed to pass on its own?

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What is the treatment for uric acid nephrolithiasis (esp in tumor lysis syndrome)?

Hydration
Allopurinol
Rasburicase (breaks down uric acid)

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What should be done to prevent Contrast-induced renal toxicity?

Hydration (12 hrs prior)
N-acetyl Cystein (NAC)
Bicarbonate

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What conditions are associated with Papillary Necrosis?

Chronic NSAID use
Sickle Cell Disease
Diabetes Mellitus

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What are two key differences between pyelonephritis and papillary necrosis?

Papillary Necrosis:
    No serum WBCs
    Sudden onset
    "Bumpy" renal pelvis             
     contours on spiral CT

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What are typical findings associated with all glomerular diseases?

Hematuria 
Dysmorphic RBCs
RBC casts
Hypertension
Proteinuria (mild)
Edema

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What organ is spared in Polyarrteritis Nodosa?

Lung

(No lung involvement in PAN)

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What Glomerularnephritic diseases require a Bx for diagnosis prior to treatment?

Churg-Straus
Wegener's 
IgA Nephropathy (Berger's)
Good Pasture's 
Polyarteritis Nodosa (PAN) (w/Angiography first)

SLE needs renal Bx for treatment

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What is the treatment for severe TTP and HUS?

Plasmapharesis

Do not give Abs, platelets

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What is the treatment for a pt with SLE who has proliferative findings on Bx?

Steroids + Mycophenolate Mofetil

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What is the next step in management for a pt who has an incidental finding of mild proteinuria without symptoms?

Repeat Urinalysis

What is the most likely dx in a pt who presents with 2 findings of mild proteinuria, is on their feet often for work, and does NOT have fever/Infection, CHF, nor exercises much?

Orthostatic Proteinuria

What is the next step to confirm Orthostatic Proteinuria?

Split the urine (test am and pm collections)

If a pt presents with proteinuria on repeat urinalysis and Orthostatic Proteinuria has been r/o, what is next step in management?

Protein:Cr Ratio (or 24 hr urine) If P:C is high, do Renal Bx

What are three causes of Nephrogenic Diabetes Insipidus?

Hypokalemia Hypercalcemia Lithium Toxicity

What is the goal BP for a pt with Diabetes or on Dialysis secondary to renal failure?

What are three causes of Hypervolemic Hyponatremia?

CHF Cirrhosis Nephrotic Syndrome (These represent appropriate increases in ADH)

What are some common causes of Hypovolemic Hyponatremia?

``` Diuretics Vomiting Diarrhea Sweating Burns ```

What are some common causes of Euvolemic Hyponatremia?

``` SIADH Addison's Disease Hypothyroidism Psychogenic Polydypsia Hyperglycemia (pseudohyponatrmia) ```

What are some common causes of SIADH?

``` Any Lung pathology Any CNS abnormality SSRIs Carbamazepine Sulfonylureas Cancer ```

What are typical lab findings associated with SIADH?

``` High Urine Na High Urine Osm Low Serum Na Low Serum Osm (all in the context of Hyponatrmia) ```

What are two main causes of Pseudohyperkalemia?

Prolonged Tourniquet placement on blood draw RBC lysis in lab

What is the treatment for symptomatic hyperkalemia?

1) Calcium Gluconante 2) Insulin with Glc and Bicarb 3) Kayexalate (last, to rid body of K+)

What formula is used to calculate the Urine Anion Gap?

Urine Na+ - Urine Cl- if positive in pt with acidosis, renal func is NOT normal)

What is problematic in RTA type I

Distal tubule cannot Excrete H+-->Urine pH>5.4

What is problematic in RTA type II?

Proximal tubule cannot Reabsorb Bicarb --> Urine pH

What is problematic in RTA type IV?

Low Aldosterone/Effect

How can Diarrhea be distinguished from RTA as a cause for Normal anion gap metabolic Acidosis?

Calculate the Urine Anion Gap (UAG)

What is the treatment for RTA I?

Bicarbonate

What is the treatment for RTA type II?

Thiazide Diuretic | Lg amts of Bicarb

What is the mechanism by which Thiazide aids in treatment of RTA type II?

Volume Contraction--> increase in Bicarb Concentration

What is the treatment for RTA type IV?

Fludrocortisone

What is the effect of serum alkalosis on serum Potassium level?

Alkalosis--> Decrease K+

What is the effect os Hypokalemia on serum acid/base status?

Alkalosis (d/t shift of K+ out and H+ in --> increased extracellular pH)

What type of crystals are associated with Ca-oxalate stones?

Envelope-shaped Crystals on Urinalyisis

What are the routine tests to assess a pt with new onset HTN that persists on repeat reading?

Urinalysis EKG Cardiac Exam Eye Exam (retinopathy)

What is the target BP in pt >60yo with HTN?

What class of anti-HTN drug should not be used in pt with asthma and/or depression?

B-Blockers

What is the next step in dx'ing a pt. with sx of Pheochromocytoma, elevated plasma free catecholamines, metanephrines, and VMA's with a NEGATIVE CT scan?

MIBG Test (to detect occult Pheochromocytoma)

What is the effect of cortisol on vasculature?

Increased response to epinephrine/norepinephrine

What is the standard treatment for Pheochromocytoma?

Alpha-blockers (Phentolamine or Phenoxybenzamine)

What is the best initial test to screen dx Cushing Disease?

Overnight Dexamethasone Suppression test (1mg) If Negative--> no Cushings If Positive (Cortisol still high)--> need to find Etiology

What is next step in management for a pt. with cushingoid features and a Positive overnight Dexamethasone suppression test?

ACTH levels (If ACTH high: pituitary adenoma. if ACTH low: Adrenal adenoma or Ectopic secretion)