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Clinical Medicine > Nephrology > Flashcards

Nephrology Flashcards

1
Q

causes of primary renal disease

A 
minimal change disease (MCD): 15-20%
focal segmental glom sclerosis (FSGS): 33%
membranous: 33%
membranoproliferative GN (MPGN): 5%
mesangial GN: 3-5%
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2
Q

how to differentiate primary renal disease

A

renal biopsy

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3
Q

renal biopsy procedure

A

light microscopy
immunoflorescence
electron microscopy

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4
Q

nephrotic syndrome causes

A

70% primary**

30% systemic

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5
Q

layers of glomerular capillary

A

endothelium
basement membrane
podocytes

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6
Q

glomerular disease work up

A

Hx, PE
lab/serologies
urinalysis**

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7
Q

glomerular disease tx

A 
prednisone
cytotoxic: cyclophosphamide (cytoxin), chlorambucil
mycophenolate mofetil (MMF)
cyclosporine, tacrolimus 
rituximab
ACE-I or ARBs + statins for all
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8
Q

SLE dx criteria

A 
4/11
malar rash
discoid rash
photosensitivity
oral ulcers
arthritis
serositis
renal (proteinuria)
neuro
heme
immuno
ANA+
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9
Q

types of SLE and kidney disease

A

lupus assoc GN (6 variants)
tubulointerstitial nephritis
anti-phos ab syndrome

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10
Q

lupus nephritis class I

A

normal

mesangial immune deposits but norm light microscopy

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11
Q

lupus nephritis class II

A

mesangial

mesangial hypercellularity

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12
Q

lupus nephritis class III

A

focal

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13
Q

lupus nephritis class IV

A

diffuse

>50% glom w/ endocap or extracap hypercellularity

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14
Q

lupus nephritis class V

A

membranous

subepi deposits or any membranous

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15
Q

lupus nephritis class VI

A

sclerosis

>90% glom are sclerosed

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16
Q

causes of transient proteinuria

A 
fever
exercise
UTI
matignant HTN
CHF
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17
Q

normal albumin excretion

A

up to 30 mg/day

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18
Q

normal protein excretion

A

100 - 150 mg/day

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19
Q

normal protein to creatinine ratio

A

0.1 - 0.15

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20
Q

glomerular proteinuria detection

A

dipstick (only one)

mostly albumin

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21
Q

proteins lost in tubular proteinuria

A

low molecular weight proteins

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22
Q

tubular or overflow proteinuria detection

A 
urine protein electrophor (UPEP)
urine immunofixation (UIF)
serum studies (SPEP or SIF)
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23
Q

nephrotic syndrome

A 
edema (anasarca)
hypoalbuminemia
albuminuria
hyperlipidemia
lipiduria
hypercoagulable states
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24
Q

nephrotic syndrome tests

A

dipstick: high protein, low/no blood
sediment: bland, maybe lipid
polarized: maltese cross

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25
AKI definition
abrupt (w/in 48hr) reduction in kidney fxn
26
AKI reduction in kidney fxn definition
up serum Cr > 0.3 in 2 weeks up serum Cr > 50% down urine:
27
anuria #s
28
oliguria #s
100-400 cc/24hr
29
non-oliguric
>400cc/24 hr
30
polyuria #s
>3000 cc/24hrs
31
AKI i hospital
50% of hospital ARF is iatrogenic
32
uremic milieu (gen)
n/v, malaise, altered taste/ sensorium
33
uremic mileau (CV)
pericardial effusion | tamponade
34
uremic mileau (pulm)
rales w/ hypervolemia
35
uremic mileau (abd)
diffuse abd pain and ileus
36
uremic mileau (neuro)
``` encephalopathic changes asterixis confusion seizures nerve irritation (hiccups) ```
37
ways to reduce renal perfusion
intravascular vol depletion inadequate cardiac output systemic vasodilation renal vasoconstriction
38
which SLE classes do you treat aggressively
III, IV, V
39
aggressive tx for SLE kidney issues
Steroids (prednisone) and IV Cytoxan (cyclophosphamide) Current: cellcept (mycophenolate mofetil) + low dose steroids Or Rituximad
40
PSA confounders
infection/prostatitis/UTI catheterization ejaculation (48hrs) medication (down)
41
low risk prostate Ca
T1c-2a Gleason 2-6 PSA 0-10
42
intermediate risk prostate Ca
T2b G 7 PSA 10.1-20
43
high risk prostate Ca
T2c G 8-10 PSA > 20
44
UTI clues
pyuria | dysuria
45
GN clues
recent URI
46
calculus clues
unilat flank pain | radiation
47
BPH clues
hesitancy | dribbling
48
hematuria imaging
``` (after exclusion of glom bleeding) IVP (intravenous pyelogram) renal US (cysts) helical CT scan (stones) biopsy (GN) ```
49
nephritic syndrome sx
``` HTN edema azotemia oliguria coca-cola or tea colored urine ```
50
nephritic syndrome dipstick
(+) blood | maybe trace protein
51
nephritic syndrome urine sediment
dysmorphic RBCs | RBC casts
52
causes of hematuria
``` UTI GN PCKD renal calculus BPH malignancy exercise/trauma ```
53
limits to protein:Cr ratio
DM nephropathy | extreme BMIs
54
AIN features
delayed hypersensitivity not dose dependent recurs w/ re-exposure extra-renal manifestations
55
extra renal AIN sx
fever maculopapular rash arthralgia
56
things that cause ED
``` DM HTN dyslipidemia CAD malignancy ```
57
oral ED meds
PDE-5 inhibitors | sildenafil
58
1st line ED tx
oral meds penis pump counseling
59
2nd line ED tx
alprostadil injections
60
3rd line ED tx
prosthesis surgery
61
cause of prerenal AKI
down renal blood flow (down volume, CO, renal vasoconstriction or sepsis) kidney is normal
62
thrombotic microangiopathy causes
``` hemolytic uremic syndrome TTP scleroderma mal HTN HELLP syndrome ```
63
types of intrarenal injury
vascular glomerular interstitial tubular
64
immune complex GN w/ low C3/4
``` SLE SBE MPGN PIGN cryoglobulinemia ```
65
immune complex GN w/ normal C3/4
IgA nephropathy
66
ATN nephrotoxic agents
``` aminoglycosides heavy metals myoglobinuria (rhabdo) ethylene glycol radiocontrast dye urate (tumor lysis syndrome) ```
67
causes of post-renal AKI
obstruction: | stones, clots, neo, preg, BPH
68
causes of increased BUN
``` vol depletion up prt GI bleed steroids, tetracycline tissue trauma ```
69
causes of decreased BUN
liver disease down prt pregnancy malnutrition
70
diabetic nephropathy treatment (#1)
BP control type I: ACE-I type II: ARB
71
conditions a/w CKD
``` anemia HTN, CVD mineral bone disease hyperkalemia met acidosis ```
72
normal GFR
130 (M) | 120 (W)
73
top 3 causes of CKD
DM HTN GN
74
proteinuria tx
``` limit diet prt to ~1/kg ACE-Is ARBs spironolactone diltiazem ```
75
anemia goals in CKD
get to 10-11 (procrit, aranesp) | normal risks stroke, thrombosis
76
indications for dialysis
``` Acidosis Electrolytes Ingestions/intoxications Overload (volume) Uremia ```
77
complications of uremia
``` pericarditis pleuritis encephalopathy bleeding diathesis n/v/malnutrition hiccups pruritis ```
78
prevention of diabetic nephropathy
glycemic control BP control lifestyle prevent CV morbidity
79
complicated vs uncomplicated UTI
structural or functional impairment | MSR orgs
80
UTI RFs for women
``` previous UTI condom use diaphragm use ABs in past month frequency of sex ```
81
pyelonephritis tx (mild, compliant)
12-24 hr observation Quinolone TMP/SMP amox/clav or amox
82
pyelonephritis tx (mod/severe, non-compliant)
inpatient parenteral quinolone, aminoglycoside + ampicillin extended: cephalosporin +/- aminoglycoside
83
extended spectrum beta lactamase tx
nitrofurantoin sulfas fosfomycin
84
2 MC renal diseases
FSGS | membranous nephropathy
85
kidney diseases a/w SLE
lupus assoc GN (classes, IV is DPGN) tubulointerstitial nephritis antiphospholipid antibody syndrome
86
DOC in scleroderma renal crisis
ACE-Is
87
how to calculate intravascular space
total H2O = 0.6 x kg (M) (0.5 x kg F) 2/3 ICF, 1/3 ECF 1/4 ECF is intravascular
88
hyponatremia w/ normal/high osm plasma due to
translocational: gluc, mannitol, glycine, maltose pseudo: prts, lipids, lab error
89
hyponatremia w/ low plasma osm + normal urine (
``` polygenic polydipsia dilute formula (infants) low Na intake ```
90
hyponatremia w/ low plasma osm + high osm urine (>100) due to
vasopressin things
91
body volume for SIADH
euvolemia
92
hyponatremia, low plasma osm, hypovolemic = ?
less water | even less Na
93
hyponatremia, low plasma osm, hypervolemic = ?
lots of water more Na (but not lots) (cirrhosis, CHF, nephro)
94
hyponatremia, low plasma osm, euvolemic = ?
more water | no change in Na
95
things that inhibit vasopressin action
lithium | demeclocycline
96
vasopressin antagonists
colicaptan | tolvaptan
97
acute hyponatremia sx
seizures, herniation, coma, resp dep
98
chronic hyponatremia sx
n/v crqamps/weakness confusion, seizures
99
max fixing hyponatremia
dont exceed 12 mM in 24 hrs
100
DI tx (non-Li)
thiazides
101
DI tx (Li)
amiloride
102
Liddle syndrome (action)
gain of fxn mutation | up activity of ENaC channel in CD (up Na reabsorption)
103
Liddle syndrome (sx)
HTN | hypoK
104
hyperkalemia effect on kidney
cant secrete NH4 (acidic) | acidosis
105
kayexalate complications
can cause ischemic colitis + colonic necrosis
106
anion gap (how + normal)
Na - (Cl + HCO3) | 8 - 12
107
causes of anion gap acidosis
``` methanol uremia DKA propylene glycol iron or isoniazid lactic acid ethylene glycol salicyclates ```
108
causes of non-anion gap acidosis
RTA | diarrhea
109
winter's formula
pCO2 = (bicarb x 1.5) + 8 +/- 2
110
HELLP
preg complication hemolysis elevated liver enzymes low platelets
111
caths can --> ? (+ time frame)
``` cholesterol emboli (2-3 weeks) contrast induced nephropathy (24-48 hrs) ```
112
which stage needs dialysis
5
113
complications of CKD
``` HK HP (--> hypocalciuria) uremia 2ndary HPTH + CVD, proteinuria, anemia, met acidosis ```
114
nephron part more susceptible to hypoxia
PCT | ALoH
115
UTI tx time
10-14 days
116
pyelonephritis tx time
7-14 days
117
gold standard bladder cancer screening
cytoscopy
118
psych vs organic ED
ask about morning wood
119
gold standard BPH surgery
transurethral resection of prostate (TURP)
120
BPH therapy
combo best tamulosin (alpha blocker) to see immediate relief start finesteride to stop prostate growth (down the line) maybe remove tam in 6 mo
121
BPH prostate zone
central
122
kidney stone sx
flank pain w/ LQ radiation n/v colic no fever!
123
kidney stone (not) sx
rarely contralateral mvmt doesnt increase pain doesnt radiate down LE
124
kidney stone tx (broad)
``` decompress system (+ drainage) take out stone ```
125
stone tx options
extracorporeal shock wave lithotripsy uretoscopy uretorenoscopy percutaneous nephrolitotomy

Clinical Medicine (9 decks)

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