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Step 3 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What Lab values are associated with Prerenal Azotemia?

A

BUN/Cr: >20:1

FeNa: 500

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2
Q

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

A

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

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3
Q

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

A

BUN/Cr: >20:1

FeNa:

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4
Q

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

A

Elderly
HTN
DM
Baseline renal disease

(people with these conditions have less baseline renal reserve)

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5
Q

What drug causes retroperitoneal fibrosis?

A

Bleomycin
Methotrexate
Methylsergide

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6
Q

What medications are commonly associated with allergic reactions?

A 
Penicillins
Rifampin
Sulfa drugs
Allopurinol
Cephalosporins
Quinolones
Phenytoin
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7
Q

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

A

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

AND get

Urinalysis

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8
Q

What lab findings can be associated with rhabdomyolysis?

A 
Urinalysis: High Blood but NO RBCs seen
Urine Myoglobin (most accurate)
Hyperkalemia
Hypocalcemia
Hyperphosphatemia
Low Bicarb
Elevated CPK
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9
Q

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

A

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

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10
Q

What is the consequence of untreated Ethylene Glycol intoxication?

A

Calcium-oxalate Stones

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11
Q

What is the consequence of untreated Methanol Intoxication?

A

Visual Disturbances/blindness

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12
Q

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

A

Hydration and Allopurinol

to prevent uric acid stone formation

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13
Q

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

A
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14
Q

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

A

Hydration
Allopurinol
Rasburicase (breaks down uric acid)

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15
Q

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

A

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

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16
Q

What conditions are associated with Papillary Necrosis?

A

Chronic NSAID use
Sickle Cell Disease
Diabetes Mellitus

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17
Q

What are two key differences between pyelonephritis and papillary necrosis?

A 
Papillary Necrosis:
    No serum WBCs
    Sudden onset
    "Bumpy" renal pelvis             
     contours on spiral CT
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18
Q

What are typical findings associated with all glomerular diseases?

A 
Hematuria 
Dysmorphic RBCs
RBC casts
Hypertension
Proteinuria (mild)
Edema
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19
Q

What organ is spared in Polyarrteritis Nodosa?

A

Lung

(No lung involvement in PAN)

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20
Q

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

A 
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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21
Q

What is the treatment for severe TTP and HUS?

A

Plasmapharesis

Do not give Abs, platelets

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22
Q

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

A

Steroids + Mycophenolate Mofetil

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23
Q

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

A

Repeat Urinalysis

24
Q

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?

A

Orthostatic Proteinuria

25
Q

What is the next step to confirm Orthostatic Proteinuria?

A

Split the urine (test am and pm collections)

26
Q

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

A

Protein:Cr Ratio (or 24 hr urine)

If P:C is high, do Renal Bx

27
Q

What are three causes of Nephrogenic Diabetes Insipidus?

A

Hypokalemia
Hypercalcemia
Lithium Toxicity

28
Q

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

A
29
Q

What are three causes of Hypervolemic Hyponatremia?

A

CHF
Cirrhosis
Nephrotic Syndrome

(These represent appropriate increases in ADH)

30
Q

What are some common causes of Hypovolemic Hyponatremia?

A 
Diuretics
Vomiting
Diarrhea
Sweating
Burns
31
Q

What are some common causes of Euvolemic Hyponatremia?

A 
SIADH
Addison's Disease
Hypothyroidism
Psychogenic Polydypsia
Hyperglycemia (pseudohyponatrmia)
32
Q

What are some common causes of SIADH?

A 
Any Lung pathology
Any CNS abnormality
SSRIs
Carbamazepine
Sulfonylureas
Cancer
33
Q

What are typical lab findings associated with SIADH?

A 
High Urine Na
High Urine Osm
Low Serum Na
Low Serum Osm
 (all in the context of Hyponatrmia)
34
Q

What are two main causes of Pseudohyperkalemia?

A

Prolonged Tourniquet placement on blood draw

RBC lysis in lab

35
Q

What is the treatment for symptomatic hyperkalemia?

A

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

36
Q

What formula is used to calculate the Urine Anion Gap?

A

Urine Na+ - Urine Cl-

if positive in pt with acidosis, renal func is NOT normal)

37
Q

What is problematic in RTA type I

A

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

38
Q

What is problematic in RTA type II?

A

Proximal tubule cannot Reabsorb Bicarb –> Urine pH

39
Q

What is problematic in RTA type IV?

A

Low Aldosterone/Effect

40
Q

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

A

Calculate the Urine Anion Gap (UAG)

41
Q

What is the treatment for RTA I?

A

Bicarbonate

42
Q

What is the treatment for RTA type II?

A

Thiazide Diuretic

Lg amts of Bicarb

43
Q

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

A

Volume Contraction–> increase in Bicarb Concentration

44
Q

What is the treatment for RTA type IV?

A

Fludrocortisone

45
Q

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

A

Alkalosis–> Decrease K+

46
Q

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

A

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

47
Q

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

A

Envelope-shaped Crystals on Urinalyisis

48
Q

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

A

Urinalysis
EKG
Cardiac Exam
Eye Exam (retinopathy)

49
Q

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

A
50
Q

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

A

B-Blockers

51
Q

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?

A

MIBG Test (to detect occult Pheochromocytoma)

52
Q

What is the effect of cortisol on vasculature?

A

Increased response to epinephrine/norepinephrine

53
Q

What is the standard treatment for Pheochromocytoma?

A

Alpha-blockers (Phentolamine or Phenoxybenzamine)

54
Q

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

A

Overnight Dexamethasone Suppression test (1mg)

If Negative–> no Cushings

If Positive (Cortisol still high)–> need to find Etiology

55
Q

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

A

ACTH levels

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

Step 3 (12 decks)

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