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Step 2 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Urnie Na and FENa consistent with pre-renal causes

A

Urine Na <20

FENa <1%

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2
Q

Urnie Na and FENa consistent with intrinsic renal dysfunction

A

Urine Na >20 (inability to concentrate)

FENa >1%

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3
Q

How is contrast induced nephropathy different than other forms of ATN?

A

Mechanism of action

Contrast induced causes spasm of the afferent arteriole leading to concentrated urine and very low urine Na

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4
Q

What is the timing for ATN caused by medications?

A

5-10d

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5
Q

Shape of oxalate crystals

A

Envelope shaped

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6
Q

Drugs implicated in ATN

A

Aminoglycosides

amphoterocin

Cisplatin

Vancomycin

acyclovir

Cyclosporin

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7
Q

Is medication induced ATN dose dependant?

A

YES

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8
Q

Aminoglycosides and furosemide share this adverse effect

A

Ototoxicity

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9
Q

Kidney dysfunction and rash in a patient who recently underwent cardiac or renal artery cath

A

Livedo reticularis

cholesterol atheroemboli

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10
Q

Hansel or wright stain

A

stain for eosinophils

most accurate test for AIN

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11
Q

Most accurate test in papillary necrosis

A

CT showing anatomic changes to papilla

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12
Q

Classic presentation for IgA nephropathy

A

Gross hematuria in asian american 1-2d after URI

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13
Q

Therapy for polyarteritis nodosa

A

Predisone and cyclophosphamide

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14
Q

What screening test to perform in a patient with polyarteritis nodosa

A

HBV surface antigen

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15
Q

In amyloidosis, HIV nephropathy, polycystic kidney disease and diabetes, the kidneys are….(small or enlarged)

A

enlarged

unlike HTN where they are smaller

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16
Q

Treatment for amyloidosis nephropathy

A

prednisone and melphalan

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17
Q

Nephrotic range proteinuria =

A

>3.5g/24hrs in urine

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18
Q

Nephrotic syndrome leads to this coagulopathy…why

A

Thrombosis

loss of protein C, protein S and antithrombin

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19
Q

Cancer patients more likely have this type of nephrotic syndrome

A

Membranous

20
Q

Children commonly develop this type of nephropathy

A

minimal change disease

21
Q

AIDS and IV drug abusers typically have this type of nephropathy

A

Focal segmental glomerulonephritis

22
Q

NSAID users will typically develop this type of nephropathy

A

minimal change disease and membranous

23
Q

By definition nephrotic syndrome is…

A

Hyperproteinuria (>3.5g/24hrs)

Hypoproteinemia

Hyperlipidemia

Periorbital edema

24
Q

Used to reduce protein loss in nephrotic syndrome

A

ACEi and ARBs

25
Q

Used to manage edema in nephrotic syndrome

A

Salt restriction and diuretics

26
Q

Initial therapy for Nephrotic syndrome includes….second line includes…

A

Glucocorticoids

2nd line– further immune suppression with cyclophosphamide

27
Q

Uremia is defined as

A

Metabolic acidosis

Fluid overload

Encephalopathy

Hyperkalemia

Pericarditis

28
Q

Type of RTA associated with hyperkalemia

A

type IV RTA

29
Q

Type of RTA associated with hypokalemia

A

Type I and II

30
Q

Location of type I, II and IV RTA

A

I- distal

II- Proximal

IV- Hyporeninemia, hypoaldosteronemia– throughout

31
Q

Defect in Type I RTA

A

Distal tubule unable to genernate new HCO3 which means H+ cannot be excreted

Leads to high urine pH

32
Q

People with Type I RTA will commonly suffer from recurrent…

A

Calcium oxylate kidney stones

33
Q

Type I RTA is associated with

A

SLE and Sjogrens

Use of Amphoterocin

34
Q

Test for type I RTA

A

Give Acid and watch urine pH

Inability for urine to decrease pH indicates a Type I RTA

35
Q

Cause of type II RTA

A

Proximal

Inability of tubule to resorb filtered bicarb (fanconi, amyloidosis, myeloma, acetazolamide, heavy metals)

36
Q

Urine findings in type II RTA

A

At first, persistently high urine pH due to increase HCO3 excretion.

When Bicarb is depleted HCO3 will be low

37
Q

Test for Type II RTA

A

Give HCO3

If Urine pH increases= type II RTA

38
Q

Type II RTA has this effect on bones

A

Chronic metabolic acidosis causes leaching of Ca from bones and osteomalacia

39
Q

Treatment for Type II RTA

A

Difficault

Thiazides will help volume deplete and cause distal retention of HCO3

40
Q

Cause of Type IV RTA

A

Hyporeninemia/hyopaldosteronemia

–most often occurs in diabetes

–Loss of aldosterone effect leads to loss of Na+ and retention of potassium and H+

41
Q

Persistently high Na+ despite low Na+ diet is consistent with this type of RTA

42
Q

Treatment for type IV RTA

A

administer fludrocortisone

(high mineralocorticoid effect)

43
Q

Measurement of urine anion gap…why?

A

UAG= Na - Cl

Acid is buffered in urine as ClNH4

Therefore Cl is a measure of acid in the urine

44
Q

Stones <5mm– let pass

Stones 5-7mm get this tx…

A

Nifedipine and tamulosin to help

45
Q

Best initial therapy for hypertensive crisis

A

Lebetolol or nitroprusside

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