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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
Q

AKI definition

A

abrupt (w/in 48hr) reduction in kidney fxn

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26
Q

AKI reduction in kidney fxn definition

A

up serum Cr > 0.3 in 2 weeks
up serum Cr > 50%
down urine:

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27
Q

anuria #s

A
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28
Q

oliguria #s

A

100-400 cc/24hr

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29
Q

non-oliguric

A

> 400cc/24 hr

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30
Q

polyuria #s

A

> 3000 cc/24hrs

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31
Q

AKI i hospital

A

50% of hospital ARF is iatrogenic

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32
Q

uremic milieu (gen)

A

n/v, malaise, altered taste/ sensorium

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33
Q

uremic mileau (CV)

A

pericardial effusion

tamponade

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34
Q

uremic mileau (pulm)

A

rales w/ hypervolemia

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35
Q

uremic mileau (abd)

A

diffuse abd pain and ileus

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36
Q

uremic mileau (neuro)

A 
encephalopathic changes
asterixis
confusion
seizures
nerve irritation (hiccups)
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37
Q

ways to reduce renal perfusion

A

intravascular vol depletion
inadequate cardiac output
systemic vasodilation
renal vasoconstriction

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38
Q

which SLE classes do you treat aggressively

A

III, IV, V

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39
Q

aggressive tx for SLE kidney issues

A

Steroids (prednisone) and IV Cytoxan (cyclophosphamide)
Current: cellcept (mycophenolate mofetil) + low dose steroids
Or Rituximad

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40
Q

PSA confounders

A

infection/prostatitis/UTI
catheterization
ejaculation (48hrs)
medication (down)

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41
Q

low risk prostate Ca

A

T1c-2a
Gleason 2-6
PSA 0-10

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42
Q

intermediate risk prostate Ca

A

T2b
G 7
PSA 10.1-20

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43
Q

high risk prostate Ca

A

T2c
G 8-10
PSA > 20

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44
Q

UTI clues

A

pyuria

dysuria

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45
Q

GN clues

A

recent URI

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46
Q

calculus clues

A

unilat flank pain

radiation

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47
Q

BPH clues

A

hesitancy

dribbling

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48
Q

hematuria imaging

A 
(after exclusion of glom bleeding)
IVP (intravenous pyelogram)
renal US (cysts)
helical CT scan (stones) 
biopsy (GN)
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49
Q

nephritic syndrome sx

A 
HTN
edema
azotemia
oliguria
coca-cola or tea colored urine
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50
Q

nephritic syndrome dipstick

A

(+) blood

maybe trace protein

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51
Q

nephritic syndrome urine sediment

A

dysmorphic RBCs

RBC casts

52
Q

causes of hematuria

A 
UTI
GN
PCKD
renal calculus
BPH
malignancy
exercise/trauma
53
Q

limits to protein:Cr ratio

A

DM nephropathy

extreme BMIs

54
Q

AIN features

A

delayed hypersensitivity
not dose dependent
recurs w/ re-exposure
extra-renal manifestations

55
Q

extra renal AIN sx

A

fever
maculopapular rash
arthralgia

56
Q

things that cause ED

A 
DM
HTN
dyslipidemia
CAD
malignancy
57
Q

oral ED meds

A

PDE-5 inhibitors

sildenafil

58
Q

1st line ED tx

A

oral meds
penis pump
counseling

59
Q

2nd line ED tx

A

alprostadil injections

60
Q

3rd line ED tx

A

prosthesis surgery

61
Q

cause of prerenal AKI

A

down renal blood flow
(down volume, CO, renal vasoconstriction or sepsis)
kidney is normal

62
Q

thrombotic microangiopathy causes

A 
hemolytic uremic syndrome
TTP
scleroderma
mal HTN
HELLP syndrome
63
Q

types of intrarenal injury

A

vascular
glomerular
interstitial
tubular

64
Q

immune complex GN w/ low C3/4

A 
SLE
SBE
MPGN
PIGN
cryoglobulinemia
65
Q

immune complex GN w/ normal C3/4

A

IgA nephropathy

66
Q

ATN nephrotoxic agents

A 
aminoglycosides
heavy metals
myoglobinuria (rhabdo)
ethylene glycol
radiocontrast dye
urate (tumor lysis syndrome)
67
Q

causes of post-renal AKI

A

obstruction:

stones, clots, neo, preg, BPH

68
Q

causes of increased BUN

A 
vol depletion
up prt
GI bleed
steroids, tetracycline
tissue trauma
69
Q

causes of decreased BUN

A

liver disease
down prt
pregnancy
malnutrition

70
Q

diabetic nephropathy treatment (#1)

A

BP control
type I: ACE-I
type II: ARB

71
Q

conditions a/w CKD

A 
anemia
HTN, CVD
mineral bone disease
hyperkalemia 
met acidosis
72
Q

normal GFR

A

130 (M)

120 (W)

73
Q

top 3 causes of CKD

A

DM
HTN
GN

74
Q

proteinuria tx

A 
limit diet prt to ~1/kg
ACE-Is
ARBs
spironolactone
diltiazem
75
Q

anemia goals in CKD

A

get to 10-11 (procrit, aranesp)

normal risks stroke, thrombosis

76
Q

indications for dialysis

A 
Acidosis
Electrolytes
Ingestions/intoxications
Overload (volume)
Uremia
77
Q

complications of uremia

A 
pericarditis
pleuritis
encephalopathy
bleeding diathesis
n/v/malnutrition
hiccups
pruritis
78
Q

prevention of diabetic nephropathy

A

glycemic control
BP control
lifestyle
prevent CV morbidity

79
Q

complicated vs uncomplicated UTI

A

structural or functional impairment

MSR orgs

80
Q

UTI RFs for women

A 
previous UTI
condom use
diaphragm use
ABs in past month
frequency of sex
81
Q

pyelonephritis tx (mild, compliant)

A

12-24 hr observation
Quinolone
TMP/SMP
amox/clav or amox

82
Q

pyelonephritis tx (mod/severe, non-compliant)

A

inpatient
parenteral quinolone, aminoglycoside + ampicillin
extended: cephalosporin +/- aminoglycoside

83
Q

extended spectrum beta lactamase tx

A

nitrofurantoin
sulfas
fosfomycin

84
Q

2 MC renal diseases

A

FSGS

membranous nephropathy

85
Q

kidney diseases a/w SLE

A

lupus assoc GN (classes, IV is DPGN)
tubulointerstitial nephritis
antiphospholipid antibody syndrome

86
Q

DOC in scleroderma renal crisis

A

ACE-Is

87
Q

how to calculate intravascular space

A

total H2O = 0.6 x kg (M) (0.5 x kg F)
2/3 ICF, 1/3 ECF
1/4 ECF is intravascular

88
Q

hyponatremia w/ normal/high osm plasma due to

A

translocational: gluc, mannitol, glycine, maltose
pseudo: prts, lipids, lab error

89
Q

hyponatremia w/ low plasma osm + normal urine (

A 
polygenic polydipsia
dilute formula (infants)
low Na intake
90
Q

hyponatremia w/ low plasma osm + high osm urine (>100) due to

A

vasopressin things

91
Q

body volume for SIADH

A

euvolemia

92
Q

hyponatremia, low plasma osm, hypovolemic = ?

A

less water

even less Na

93
Q

hyponatremia, low plasma osm, hypervolemic = ?

A

lots of water
more Na (but not lots)
(cirrhosis, CHF, nephro)

94
Q

hyponatremia, low plasma osm, euvolemic = ?

A

more water

no change in Na

95
Q

things that inhibit vasopressin action

A

lithium

demeclocycline

96
Q

vasopressin antagonists

A

colicaptan

tolvaptan

97
Q

acute hyponatremia sx

A

seizures, herniation, coma, resp dep

98
Q

chronic hyponatremia sx

A

n/v
crqamps/weakness
confusion, seizures

99
Q

max fixing hyponatremia

A

dont exceed 12 mM in 24 hrs

100
Q

DI tx (non-Li)

A

thiazides

101
Q

DI tx (Li)

A

amiloride

102
Q

Liddle syndrome (action)

A

gain of fxn mutation

up activity of ENaC channel in CD (up Na reabsorption)

103
Q

Liddle syndrome (sx)

A

HTN

hypoK

104
Q

hyperkalemia effect on kidney

A

cant secrete NH4 (acidic)

acidosis

105
Q

kayexalate complications

A

can cause ischemic colitis + colonic necrosis

106
Q

anion gap (how + normal)

A

Na - (Cl + HCO3)

8 - 12

107
Q

causes of anion gap acidosis

A 
methanol
uremia
DKA
propylene glycol
iron or isoniazid
lactic acid
ethylene glycol
salicyclates
108
Q

causes of non-anion gap acidosis

A

RTA

diarrhea

109
Q

winter’s formula

A

pCO2 = (bicarb x 1.5) + 8 +/- 2

110
Q

HELLP

A

preg complication
hemolysis
elevated liver enzymes
low platelets

111
Q

caths can –> ? (+ time frame)

A 
cholesterol emboli (2-3 weeks)
contrast induced nephropathy (24-48 hrs)
112
Q

which stage needs dialysis

A

5

113
Q

complications of CKD

A 
HK
HP (--> hypocalciuria)
uremia
2ndary HPTH
\+ CVD, proteinuria, anemia, met acidosis
114
Q

nephron part more susceptible to hypoxia

A

PCT

ALoH

115
Q

UTI tx time

A

10-14 days

116
Q

pyelonephritis tx time

A

7-14 days

117
Q

gold standard bladder cancer screening

A

cytoscopy

118
Q

psych vs organic ED

A

ask about morning wood

119
Q

gold standard BPH surgery

A

transurethral resection of prostate (TURP)

120
Q

BPH therapy

A

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
Q

BPH prostate zone

A

central

122
Q

kidney stone sx

A

flank pain w/ LQ radiation
n/v
colic
no fever!

123
Q

kidney stone (not) sx

A

rarely contralateral
mvmt doesnt increase pain
doesnt radiate down LE

124
Q

kidney stone tx (broad)

A 
decompress system (+ drainage)
take out stone
125
Q

stone tx options

A

extracorporeal shock wave lithotripsy
uretoscopy
uretorenoscopy
percutaneous nephrolitotomy

Clinical Medicine (9 decks)

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