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Step 2 Study > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Urinalysis measures?

A 
Protein
WBC or Leuk esterase
RBCs
Specific gravity and pH
Nitrites
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2
Q

Pyuria +Nitrates=

A

UTI

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3
Q

3 UTI organisms not measured on nitrates

A

Enterococcus
Staph saprophyticus
Group B Strep

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4
Q

1+ proteinuria = g/day

A

1 g/day

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5
Q

less than

is normal protein loss in 24 hours

A

30-50 mg

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6
Q

work up for proteinuria?

A

UA/Dip
Urine protein: creatinine or 24 hour urine
Renal biopsy

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7
Q

Dipstick only measures what kind of protein?

A

albumin

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8
Q

Dipstick is important for what patient?

A

the Diabeetus pt

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9
Q

What detects eosinophils in urine?

A

Wright and hansel stains

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10
Q

Dysmorphic RBCs

A

glomerulonephritis

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11
Q

Hematuria w/o infection w/o trauma

tests to order?

A

Ultrasound/CT if it shows nothing order

cystoscopy is the most accurate

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12
Q

Red cell think?

A

glomerulonephritis

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13
Q

White cell think?

A

Pyelonephritis

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14
Q

Eosinophils think?

A

Acute interstitial nephritis

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15
Q

Hyaline think?

A

Dehydration

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16
Q

Broad, waxy think?

A

Chronic renal disease

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17
Q

Granular, “muddy-brown”

A

Acute tubular necrosis (are dead tubular casts)

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18
Q

AKI

A

Acute Kidney injury
decrease in creatinine clearance
sudden rise in BUN and creatinine

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19
Q

Prerenal Azotemia

A

Decreased perfusion

Hypotension (sepsis, anaphylaxis, bleeding, dehydration)
Hypovolemia (Diuretics, burns, pancreatitis, dec. in pump function, low albumin, cirrhosis)

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20
Q

Postrenal Azotemia

A

Obstruction

BPH/Prostate cancer
Ureteral stone
Cervical cancer
urethral stone
Neurogenic bladder
Retroperitoneal fibrosis (chemo or XRT)
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21
Q

Intrinsic Renal disease

A

ischemia and toxins

ATN: Toxins (NSAIDs, AG, ampho, CIsplastin, cyclophosphamide), Prolonged ischemia

AIN: PCN, sulfa
Rhabdo/hemoglobinuria
Contrast
Crystals
Bence Jones protein
Post Strep Infection
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22
Q

AKI tests?

A

Initial? BUN/Creat
image?
unclear: U/A, UNa, FEUrea, Urine osmolality

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23
Q

Prerenal Azotemia Labs will show??

A 
BUN/creat: >20:1
low UNa (below 20)
Low FENa (500 mOsmo/kg
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24
Q

Acute Tubular Necrosis Labs will show?

A

BUN/creat: 1%)

Urine osmolality

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25
Q

Increase risk of toxic/insult ATN

A

hypoperfusion of kidney
Renal insuff (HTN, diabetes)
older age

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26
Q

ATN causes by time
(5-10 days)
(24-48 hrs)

A

5-10 days: Drugs related injury–aminoglycosides, amphotericin, cisplatin, vancomycin, acyclovir, cyclosporine

24-48 hrs: Contrast media- prevent with saline

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27
Q

Rhabdomyolysis

Causes

A

trauma, prolonged immobility, snake bites, seizures, crush injuries

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28
Q

Rhabdo initial test?

A

UA (dipstick and microscopic analysis)

Blood positive no RBCs seen

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29
Q

rhabdo most specific test?

A

urine myoglobin

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30
Q

Rhabdo other lab findings on CMP?

A 
Increased cpk
hyperkalemia
hyperuricemia
hyperphosphatemia
hypOcalcemia
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31
Q

Tx Rhabdomolysis

A

Saline hydration
mannitol
bicarbonate

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32
Q

Txs THAT DO NOT HELP WITH ATN

A

low dose dopamine
diuretics
mannitol
steroids

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33
Q

Dialysis Indications

A 
Acidosis
Electrolytes
Intoxications
Overload
Uremia
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34
Q

Furosamide SE

A

SE damages inner hair cell

35
Q

Hepatorenal syndrome

A

Sever liver disease
new onset renal failure with no other explanation
very low urine sodium (>10-15 mEq/dL)
FeNa 20:1)

36
Q

Acute Interstitial Nephritis

A

antibodies and eosinophils attack cell linings

Reaction to drugs, infection and autoimmune disorders

37
Q

Papillary Necrosis

A 
onset a few hours
necrotic material in urine
Urine culture: negative
CT scan : bumby contour of kidney interior
Tx: no treatment
38
Q

Glomerular disease all have

A 
UA with hematuria
Dysmorphic red cells
Red cell casts
urine sodium and FENA are low
Proteinuria
39
Q

Goodpasture

A

Lung and kidney only
ANA antibodies
best test : lung or kidney biopsy: linear deposits

40
Q

Goodpasture tx

A

plasmapheresis, steroids,cyclophosphamide

41
Q

IgA Nephropathy (Berger Disease)

A

MCC of acute glmoerulonephritis
1 to 2 days after URI
increased IgA levels (>50%)
no tx unless severe and you give steroids and ACEI

42
Q

Postinfectious Glomerulonephritis

A

MC infection is streptococcus
follows throat infection or skin infection by 1-3 weeks

Presentation:
cola colored urine, edema, HTN, Oliguria

Test: UA, ASO titers, anti-DNAse antibody titers, biopsy

43
Q

Postinfectious glomerulonephritis

A

tx: antibiotics, diuretics to control fluid overload

44
Q

Alport syndrome

A

Type 4 collagen defect
Hearing loss, visual problems, glomerular problems
No treatment

45
Q

Polyarteritis Nodosa

A

systemic vasculitis of small and medium sized arteries
spares the lung
associated with Hep B

46
Q

Polyarteritis Nodosa

Labs and treatment

A 
anemia and leukocytosis
Increased ESR and c-reactive protein
biopsy most accurate
Tx: Prednisone, cyclophosphamide
treat the Hep B
47
Q

Lupus Nephritis

A

any degree of renal involvement: membraneous glomerulonephritis, glomerulosclerosis “scars kidney”
Biopsy
tx: steroids, cyclophosphamide, mycophenolyate

48
Q

Amyloidosis

A

Abnormal protein produced by

myeloma, chronic inflammatory disease, rheumatoid arthritis, inflammatory bowel disease, chronic infections

49
Q

Accurate test for Amyloidosis

tx?

A

apple-green birefringence with congo-red staining
tx: control underlying disease
2nd line: melphalan and prednisone

50
Q

Nephrotic Syndrome

definition

A

protein >3.5g/24 hr
edema
hyperlipidemia
thrombosis

51
Q

Nephrotic syndrome
most common cause
pt & associations

A 
diabetes and HTN
assoc.
cancer: membranous
children: minimal change
IVDU/AIDS: focal segmental
NSAID: minimal change disease and membranous
SLE: any of them
52
Q

Nephrotic Syndrome Tx:

A

1st: Glucocorticoids
2nd: cyclophosphamide
ACEI or ARB
salt restriction/ diuretics
Statins

53
Q

End Stage Renal Disease

A

Loss of renal function defined by symptoms and abnormalities that are collectively known as uremia.

54
Q

Uremia signs

A 
Metabolic acidosis
Fluid overload
encephalopathy
hyperkalemia
Pericarditis
55
Q

Treatment of hyperphosphatemia

A

calcium acetate
calcium carbonate

Use the following when Ca is high:
sevelamer
lanthanum

56
Q

Aluminum causes dementia which is why

A

you never use aluminum containing phosphate binders to lower hyperphosphatemia

57
Q

HLA-identical, related donor kidneys last 24 yrs on average

A

Kidney transplant

58
Q

TTP and HUS

A

TTP is assoc with HIV, cancer, drugs

HUS is assoc w/E coli

59
Q

TTP

A

Tx: plasmapheresis
if not an option treat with FFP

Steroids don’t help and you don’t give platelets (b/c it is consumptive problem)

60
Q

Simple Cyst

A

echo free
smooth, thin walls
sharp demarcation
transmission good through to back

61
Q

Complex Cyst

A

mixed echogenicity
irregular, thick walls
lower density on back wall
debris in cyst

62
Q

Polycystic Kidney Disease

Autosomal dominant disorder

A

Pain, hematuria, stones, infection, HTN

63
Q

Central DI

A

loss of ADH production

CNS disorders: stroke, tumor, trauma, hypoxia, infection

64
Q

Nephrogenic DI

A

Loss of ADH effect

Lithium, demeclocycline, chronic kidney disease, hypokalemia, hyperkalemia

65
Q

CDI Treatment

A

ADH replacement

66
Q

NDI Treatment

A

Correct the potassium and calcium
stop lithium or demeclocycline
Given HCTZ or NSAID

67
Q

Cerebral edema

A

sodium levels brought down too rapidly

68
Q

Addison disease

A

loss of adrenal function –> loss of aldosterone

69
Q

hypervolemia hyponatremia

A

CHF
Nephrotic syndrome
cirrhosis

70
Q

Euvolemic hyponatremia

A

Pseudohyponatremia
psychogenic polydipsia
hypothyroidism
SIADH

71
Q

Hyponatremia symptoms

A

confusion, lethargy, disorientation, seizures, coma

72
Q

Central pontine myelinolysis

A

if the sodium level is brought up to normal too rapidly

73
Q

Hyperkalemia

3 types

A

Pseudohyperkalemia
decreased excretion
increased release from tubules

74
Q

Hyperkalemia order which test first

A

EKG

peaked Twaves, wide QRS, PR interval prolongation

75
Q

Treatment Hyperkalemia

A 
Calcium chloride or calcium gluconate
Bicarb/beta agonist
Insulin
Glucose
Kayexalate
D
76
Q

Hypokalemia presentation

A

weakness, paralysis, loss of reflexes

77
Q

Hypokalemia EKG findings

A 
U waves
ventricular ectopy (PVC), flattened t waves and ST depression
78
Q

Anion gap calculation

A

Na - ( CL+ HCO3)

normal gap is 6-12

79
Q

Nonanion gap calculation

causes

A

RTA and diarrhea

80
Q

Nephrolithiasis most common type

A

calcium oxalate

forms in alkaline urine

81
Q

Nephrolithiasis most common risk factor

A

overexcretion of calcium in urine

82
Q

Diagnostic test for nephrolithiasis

A

CT scan

83
Q

how do you manage cystine stones?

A

alkalinze the urine

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