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Nephrology Flashcards

1
Q

Metabolic acidosis- Eti

A
  • pH
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2
Q

Metabolic acidosis- Sx

A
  • low, low, low (pH, HCO3, PCo2)

-

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3
Q

Acute kidney injury- Eti

A
  • Abrupt (>48H) increase in Cr >0.3
  • Cr increased > 50%
  • Increased BUN
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4
Q

Acute kidney injury- Classification

A
  • Pre-renal: Decreased volume, renal vasoconstriction, large vessels
    Intrinsic: Tubular necrosis (ischemia, toxins, contrast), interstitial nephritis (allergy, infection, auto immune), glomerular nephritis
  • Post: Bladder (BPH, prostate), ureteral
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5
Q

Acute kidney injury-Pre-renal- Dx

A
  • FENa 20

- Transparent hyaline casts

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6
Q

Acute kidney injury- Intrinsic- Dx

A
  • ATN: MC Muddy brown casts,

- AIN: RBCs & protein, casts, WBCs

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7
Q

Acute kidney injury- Pre-renal- Tx

A

Isotonic IV fluid, albumin

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8
Q

Acute kidney injury- Intrinsic

A
  • Steroids for AIN

- Monitor volume, electrolytes

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9
Q

CKD- Eti

A

> 3 mo reduced GFR and/ or kidney damage

  • DM MC, HTN 2nd MC
  • Albuminuria associated with worse outcomes
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10
Q

CKD- Sx/ Dx

A
  • Proteinuria = outcome worse
    1: > 90
    2: 60-89
    3: 30-59
    4: 15-29
    Kidney failure
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11
Q

CKD- Tx

A
  • Dialysis GFR
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12
Q

Nephrotic syndrome- Eti

A
  • Proteinuria + hypoalbumin + hyperlipid + edema
  • Idiopathic: Minimal change dz (children)
  • Focal glomerulosclerosis- 2/2 HTN, IVDU
  • Membranous nephropathy- SLE, hep, MC in white males
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13
Q

Nephrotic syndrome- Sx

A
  • Peripheral edema-
  • Periorbital edema, worse in AM
  • Anemia
  • DVTs
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14
Q

Nephrotic syndrome- Dx

A
  • 24 hr urine protein = gold standard
  • Proteinuria >3.5g / day
  • Hypoalbuminemia
  • Hyperlipidemia
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15
Q

Nephrotic syndrome- Tx

A
  • Minimal change dx = steroids
  • Diuretics
  • ACE/ARB
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16
Q

Glomerulonephritis- Eti

A

Immunologic inflammation of glomeruli d/t

  • IgA nephropathy MC post URI or GI infxn
  • Post infectious: GABHS- post infxn
  • Membranoproliferative
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17
Q

Glomerulonephritis- Sx

A
  • Cola colored urine (hematuria)
  • Edema (dependent)
  • HTN
  • Fever, abd/ flank pain
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18
Q

Glomerulonephritis- Dx

A
  • Renal bx = gold standard
    UA: Hematuria, RBC casts, proteinuria
  • Increased BUN, Cr
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19
Q

Glomerulonephritis- Tx

A
  • IgA: ACEI + steroids

- Strep: Supportive,

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20
Q

Rapidly progressive glomerulonephritis- Eti

A
  • Any cause of AGN, poor prognosis
  • Goodpasture- post URI
  • Vasculitis
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21
Q

Rapidly progressive glomerulonephritis- Sx

A
  • End stage renal dz in weeks to months
  • Hemoptysis
  • Hematuria
  • Edema
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22
Q

Rapidly progressive glomerulonephritis- Dx

A
  • Renal bx- immune deposits in GP, none in vasculitis
  • Goodpasture: Anti-GBM abs
  • Vasculitis: + ANCA
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23
Q

Rapidly progressive glomerulonephritis- Tx

A

high dose steroids + cyclophosphamide

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24
Q

Nephritic syndrome- Eti

A
  • Immune mediated glomerular inflammation
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25
Nephritic syndrome- Sx
- Azotemia, oliguria, hematuria with casts
26
Nephritic syndrome- Dx
Proteinuria
27
Nephritic syndrome- Tx
- Steroids
28
Acute interstitial nephritis- Eti
- Inflammatory/ allergic of interstitial - Drug hypersensitivity MC (pen G) - Spares glomeruli, vessels
29
Acute interstitial nephritis- Sx
- Eosinophilia - Maculopapular rash - Fever
30
Acute interstitial nephritis- Dx
- WBC casts, urine eosinophils
31
Acute interstitial nephritis- Tx
-D/c affecting agent
32
SIADH- Eti
- CNS MC, stroke, trauma, meningitis - Non-physiologic excess of ADH, increased H2O, hyponatremia inability to exert dilute urine - Hypoosmolar, euvolemic
33
SIADH- Sx
- Sx only with increased intake - Sx of hyponatremia- neuro manifestation - No edema
34
SIADH- Dx
- Isovolemic hypotonic, hyponatremia - Low serum osm, increased urine osm - High urine Na, sodium Na
35
SIADH- Tx
H2O restriction | - IV hypertonic saline with furosemide
36
Diabetes insipidus- Eti
- Central: No ADH production, idiopathic MC | - Nephro: insensativity to ADH- Hypercalemia, hypokalemia
37
Diabetes insipidus- Sx
- Large amounts of dilute urine - Polydipsia - Nocturia - Hyponatremia
38
Diabetes insipidus- Dx
- Fluid deprivation test- continued production of dilute urine - Desmopressin stimulation test: nephrogenic = continue production of dilute urine
39
Diabetes insipidus- Tx
Central: DDAVP/ desmopressin | - Nephrogenic: Na/ protein restriction
40
Hyponatremia- Eti
- Hypertonic: Hyperglycemia, mannitol. Shift to extracellular space - Isotonic: Error- hypertriglyceride, proteniemia - Hypotonic: True hyponatremia
41
Hypotonic hyponatremia: Eti
Hypovolemic- impaired free water excretion- diuretics, bleeds, diarrhea - Euvolemic: SIADH, hypothyroid, tea & toast, water intoxication - Hypervolemic: CHF, nephrotic
42
Hyponatremia- Sx
- Neuro: fatigue, HA, nausea, cramps lethargy | - Seizures, coma
43
Hyponatremia- Dx, Tx
Serum Na
44
Hypernatremia- Eti
- Net water loss | - Diuretics
45
Hypernatremia- Sx
Shrinkage of brain cells | - Confusion, lethargy, coma, weakness
46
Hypernatremia- Dx, Tx
Na >145 - Hypotonic fluids, PO - 0.5 NS
47
Hypomagnesia- Eti
GI loss: malabsorbtion, ETOH | Renal loss: Diuretics & PPIs
48
Hypomagnesia- Sx
Increased DTRs, tetany - Seen with Hypocalcemia - Prolonged PR & QT intervals, torsades
49
Hypomagnesia- Dx, Tx
- Low Mag | - IV mag sulfate or oral
50
Hypermagnesia- Eti
Rare, renal insufficiency MC
51
Hypermagnesia- Sx
- Hyporeflexive, decreased DTRs
52
Hypermagnesia- Dx, Tx
- High Mg, Bradyarrythmias | - Fluids & furosemide or calcium gluconate
53
Hypokalemia- Eti
- Urinary/ GI losses - Diuretics, diarrhea, vomiting - Metabolic alk
54
Hypokalemia- Sx
- Severe musc weakness - Rhabdo - Polyuria
55
Hypokalemia- Dx
- R/o hypomagnesemia | - EKG: Flattened T wave, prominent U wave
56
Hypokalemia- Tx
KCL PO | - K sparing diuretics, spironolactone
57
Hyperkalemia- Eti
- Renal failure - Lab error MC - Meds- spironolactone, ACEI/ARB, digoxin, B blockers
58
Hyperkalemia- Sx
- Palpitations, flaccid paralysis, weakness
59
Hyperkalemia- Dx, Tx
K > 5.0 - EKG: Tall, peaked T waves, P wave flattening - Tx: Insulin, IV Ca, kayexalate
60
Hypocalcemia- Eti
- Hypoparathyroid - Chronic renal dz (increased PTH) - HypoMg
61
Hypocalcemia- Sx
- Chvosteck & trousseau sign - Increased DTR - Diarrhea, abd pain
62
Hypocalcemia- Dx, Tx
- EKG: Prolonged QT, low Ca | - Ca PO or IV
63
Hypercalcemia- Eti
- Primary hyperparathyroid, malignancy
64
Hypercalcemia- Sx
Stones, groans- abd pain, constipation bones- fractures psych overtones- decreased DTRs, weak
65
Hypercalcemia- Dx, Tx
- ionized Ca+ high, 24 hr urinary Ca+ - Shortened QT interval - IV saline & furosemide - Bisphosphinates
66
Hypophosphatemia- Eti
- Primary hyperparathyroid
67
Hypophosphatemia- Sx
- Diffuse muscle weakness, flaccid paralysis | - Rhabdo
68
Hypophosphatemia- Dx, Tx
- Repletion
69
Hyperphosphatemia- Eti
- Renal failure - Hypoparathyroid - Vit D intox
70
Hyperphosphatemia- Sx
- Soft tissue calcifications
71
Hyperphosphatemia- Tx
Phosphate binders
72
Renal artery stenosis- Eti
- Atherosclerotic ischemic renal dz
73
Renal artery stenosis- Sx
- HTN refractory to meds | - New onset HTN > 50
74
Renal artery stenosis- Dx
- Renal angiography
75
Renal artery stenosis- Tx
- Medical mgmt | - Angioplasty w/ stenting
76
Thromboembolic dz- Eti
- Emboli to renal artery d/t a fib, infarct etc
77
Thromboembolic dz- Sx
- Abd/ flank pain | - Hematuria or anuria
78
Thromboembolic dz- Dx
- Angiography
79
Thromboembolic dz- Tx
Streptokinase or angioplasty followed by antithrombolytic
80
Atheroembolizm- Eti
- AKI, worsening renal fxn over time leading to chronic renal impairment
81
Atheroembolizm- Sx
- Livedo reticularis. GI sx,
82
Atheroembolizm- Dx, Tx
Renal bx | - Supportive
83
Renal calculi- Eti
- Ca MC
84
Renal calculi- Sx
- Flank pain | - Hematuria, dysuria
85
Renal calculi- Dx
Non-contrast helical CT
86
Renal calculi- Tx
- Alpha blocker to pass stone | - litotripsy or stent
87
Uremic syndrome- Eti
- Advanced kidney failure | - GFR
88
Uremic syndrome- Sx
- Malaise, weakness, insomnia - Organ dysfxn - Anemia of chronic dz
89
Uremic syndrome- Dx, Tx
- Metabolic acidosis, kidney fun studies, lyte abns | - Dialysis or transplant
90
Chronic tubulointerstitial nephropathy- Eti
Obstructive uropathy d/t prostate dz, calculus
91
Chronic tubulointerstitial nephropathy- Sx
- Polyuria, volume depletion - Broad waxy casts - Small kidneys
92
Chronic tubulointerstitial nephropathy- Dx
- Reduced GFR - Decreased urine conc. - Metabolic acidosis
93
Acute pyelonephritis- Eti
- Gram - (E. coli) MC | - Ascends from lower tracts
94
Acute pyelonephritis- Sx
- Fever, flank pain, - Irritative voiding - CVA tenderness
95
Acute pyelonephritis- Dx
- Urine culture- growth | - UA: pyuria, bacteruria, white casts, hematuria
96
Acute pyelonephritis- Tx
- IV ampicillin + aminoglycoside
97
Urinary tract obstruction- Eti
- BPH, cancer, stones
98
Urinary tract obstruction- Sx
- Pain d/t dissension of some aspect of urinary system - Difficult voiding - Change in urinary vol - Azotemiaume
99
Urinary tract obstruction- Dx
UA: hemat, py and bacteruria
100
Urinary tract obstruction- Tx
- Relieve obstruction | - Tx infxn, lytes, acid-base imbalances
101
Crockcroft-Gault equation
(140-age) x wt (kg)/72)/ | 0.815 x Cr

1 Inpt (12 decks)

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