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Step 2 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What does severe proteinuria mean?
What can increase urinary protein excretion?
What protein does urine dipstick check?
What is normal protein in 24 hours?

A

Glomerular damage
Standing, physical activity
Albumin

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2
Q

What is the initial test for proteinuria?
What is the accurate test?
What is faster and easier - P/Cr or 24hr urine

A

UA
P/Cr ratio
P/Cr

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3
Q

What is done to determine the cause of proteinuria?

A

Biopsy

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4
Q

What is the best initial therapy for proteinuria in a DM patient?

A

ACEi/ARB

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5
Q

How is Bence Jones protein detected?

A

Immunoelectrophoresis

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6
Q

How do you detect eosinophils in urine?

What disease do these tests diagnose?

A

Wright and Hansel stains

Allergic interstitial nephritis

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7
Q

If you see mild recurrent hematuria, what disease should you be thinking?

A

IgA nephropathy

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8
Q

What would give you a false positive for hematuria?

A

Hemoglobin or myoglobin

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9
Q

What renal disease is suggested by dysmorphic red cells?

A

Glomerulonephritis

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10
Q

What is the most accurate test of the bladder?

When is this test utilized (2)?

A

Cystoscopy
No trauma/infection + hematuria + imaging does show issue
No trauma/infection + hematuria + possible mass in bladder

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11
Q 
What is indicated by red cell casts?
White?
Eosinophils?
Hyaline?
Broad waxy?
Granular muddy brown?
A 
Glomerulonephritis
Pyelonephritis
AIN
Dehydration
CKD
ATN (dead tubular cells)
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12
Q

How do you define an AKI?

A

Decrease in CrCL resulting in sudden rise in BUN/Cr

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13
Q

How many kidneys must be obstructed for the creatinine to rise?

A

Both

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14
Q

What is the best initial test for AKI?
What do the results suggest?
What is the best imaging test initially?
What is the next step (and then next 3 after that)?

A

BUN:Cr
>20:1 is pre or post renal –> 10:1 is intrinsic
U/S
UA > UNa = FeNA > Urine osmolality

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15
Q

What is the best advice for someone with sickle cell trait?

A

Remain hydrated b/c of defect in concentrating urine

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16
Q

Best initial tests in urology (2)

A

UA

BUN + Cr

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17
Q

How do you determine the cause of ATN?

A

Acute renal failure with a toxin in the history

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18
Q

What has a very rapid onset in producing an AKI?
How long does it take?
How can it be prevented?

A

Contrast media
1 day
Saline hydration (1-2Ls prior and during)

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19
Q 
How does a patient with contrast induced renal failure present on lab values?
Urine sodium
FENa
Urine specific gravity
Why?
A

Very low

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20
Q

What causes a creatinine rise 2 days after starting chemotherapy?
Prevention?

A

Hyperuricemia due to tumor lysis syndrome

Allopurinol + H2O + Rasburicase

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21
Q

Ethylene glycol ingestion is associated with what electrolyte abnormality?
Why?
When does it occur?

A

Low Ca
Oxalate crystals precipitate with Ca
3 days after ingestion

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22
Q

What electrolyte deficiency can increase the risk of aminoglycoside or cisplatin toxicity?

A

Magnesium

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23
Q

What are 3 things that a urine dipstick cannot tell the differences between?

A

Hemoglobin
Myoglobin
RBCs

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24
Q 
What is the most specific test for Rhabdo?
What are 3 major electrolyte changes?
What other test needs to be ordered?
How do you treat?
What does not need to be treated?
A 
Urine myoglobin
HyperK, HyperUric, HypoCa
EKG
Saline + Mannitol + Bicarb 
Low Ca
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25
Q

What are 4 INeffective ways to manage ATN?

A

Low dose Dopamine
Diuretics
Mannitol
Steroids

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26
Q

When should you dialyze an ATN patient?

When do you NOT dialyze and what do you do instead?

A 
Fluid overload
Encephalopathy
Pericarditis
MetAcid
HyperK
HypoCa --> VitD/Ca
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27
Q

What are treatments for hepatorenal syndrome? (3)

A

Midodrine
Octreotide
Albumin

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28
Q

What are hints at atheroemboli?

What is the most accurate test?

A

Eosinophilia/eosinophils in urine/high ESR

Biopsy of a purplish lesion on fingers/toes

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29
Q

The same meds that cause AIN also cause ____ (4)

A

Drug allergy/rash
SJS
TEN
Hemolysis

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30
Q

How do you treat an AIN?

A

Resolves spontaneously with the removal of the drug

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31
Q

Papillary necrosis is usually caused by _____ + ______ (4)

A

NSAIDs

SCD/DM/urinary obstruction/chronic pyelo

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32
Q

What is the most accurate test for papillary necrosis?

A

CT scan showing abnormal kidney

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33
Q 
Tubular diseases occur \_\_\_\_
They are usually caused by \_\_\_\_\_
They never cause \_\_\_\_\_\_ syndrome
They are not usually diagnosed with \_\_\_\_\_\_\_
They are not treated with \_\_\_\_ or \_\_\_\_\_\_
They are treated with \_\_\_\_ + \_\_\_\_\_\_\_\_
A 
Acutely
toxins
Nephrotic
Biopsy
Steroids, immunotherapy
Correcting hypoperfusion, removing the toxin
34
Q

Glomerular diseases are _____
The most accurate test?
Typical treatment?
Sometimes you also treat with _____ such as __ ____

A

Chronic
Biopsy
Steroids
Immunosuppressives –> cyclophosphamide, mycophenolate

35
Q

Name 5 characteristics of all forms of glomerulonephritis

A 
Hematuria on UA
Dysmorphic red cells
Red cell casts
Na/FeNa low
Proteinuria
36
Q

What additional features are in Goodpasture?
Initial test?
What is seen on biopsy?
Treatment?

A

Lung involvement as well but no UR
AntiGBM test
Linear deposits
Plasmapheresis and steroids

37
Q

what is the most common cause of acute GN in US?
How does it present?
Most accurate test?
What corresponds to severity of the disease?

A

IgA nephropathy
Hematuria 1-2 days after URI
Biopsy
Increased protein = worse disease

38
Q 
When does PSGN occur?
How does it present?
How can you confirm?
What is the most accurate test?
How do you treat?
A 
1-3 weeks after throat or skin infection
Dark urine, periorbital edema, HTN, oliguria
ASO or antiDNAse titers
Biopsy (but not actually done often!)
Abx + diuretics
39
Q

What is Alport syndrome due to?

What else is affected?

A

Congenital collagen defect

Hearing loss + visual disturbance

40
Q

What organ tends to be spared by polyarteritis Nodosa?
What is it associated with?
What 2 findings are suggestive of a vasculitis (specifically PAN)
Why are neurological complications possible?
What is the best initial test?
What is the standard of care?

A 
Lungs
HepB
Stroke or MI in young person
Damaged blood vessels that surround the nerves
Angiography
Prednisone + Cyclophosphamide
41
Q

What is the most accurate test for lupus nephritis?

What is it used for?

A

Biopsy

Guiding intensity of therapy

42
Q

What are 4 diseases that cause large kidneys on CT and U/S?

A

Amyloid
HIV nephropathy
PCOD
DM

43
Q 
What are the symptoms of nephrotic syndrome?
What are the disease associations (5)?
What is the best initial test?
What is the more accurate test?
What is the most accurate test?
Treatment?
A

PEaL
Cancer (membranous), kids (MCD), drugs/AIDS (FSGS), NSAIDs (MCD/MN), SLE (all)
UA –> shows Maltese crosses (lipid deposits from tubular cells)
Albumin:Cr ratio
Renal biopsy
Glucocorticoids + ACEi + Na restriction + diuretic + station

44
Q 
What is the definition of ESRD?
What are the 2 most common causes?
What is the most common cause acutely?
How do you define uremia? (5)
What are the manifestations + their treatments? (10)
A

Kidney failure necessitating dialysis
DM, HTN
RPGN
MetAcid, Fluid overload, Encephalopathy, HyperK, Pericarditis
Anemia (EPO, Fe) + HypoCa/Osteodystrophy (VitD, Ca) + Bleeding/Infection (DDAVP) + Pruritis (UV light) + HyperP (Sevelamer, Lanthanum) + HyperMg (restriction) + Atherosclerosis (dialyze) + Endocrinopathy (E/T replacement)

45
Q

What is the only necessary finding to establish a dx of TTP or HUS?
How do you treat HUS?
Treat TTP?

A

Intravascular hemolysis
Usually spontaneous resolution
Plasmapheresis > FFP infusion

46
Q

If you are concerned for a complex cyst what do you do?

Why?

A

Remove

CA risk

47
Q

What is the most common death from PKD

A

Renal failure

48
Q

What is the first clue to the presence of DI?

A

High volume nocturia

49
Q

What is the best initial test for DI?

What is the most accurate test?

A

Water deprivation –> urine volume decrease = psychogenic polydipsia
ADH administration –> urine volume decrease = CDI

50
Q

How do you manage mild hypoNa?
Moderate?
Severe?

A

Restrict fluids
Saline + loop
Hypertonic saline + Conivaptan/Tolvaptan

51
Q

What are causes of pseudohyperK?

What is the next step?

A

Hemolysis, leukocytosis, thrombocytosis

Repeat the sample

52
Q

What is the most urgent test for HyperK?
What might it show if positive?
What are the next steps? (3)

A 
EKG
Peaked T waves, wide QRS, PR prolongation
1) CaCl or Ca gluconate 
2) Insulin + glucose
3) Bicarb (especially if due to MetAcid)
53
Q

How does low K present?
What is found on EKG?
How do you treat?
What must be corrected first?

A

Weakness/paralysis –> rhabdo if severe
U waves, flat T waves
IV K but must go slow!
Mg

54
Q

How do you calculate anion gap?
What is normal?
What are the 2 most common causes of normal AG MetAcid?

A

Na-Cl-HCO3
6 to 12
RTA, diarrhea

55
Q 
RTA type 1 occurs where?
Is due to?
Initial test?
Accurate?
Treatment?
A

Distal tubule
Drugs (amphotericin), AI (SLE, sjogrens): HCO3 not generated
pH >5.5
Infuse with NH4Cl and see if acid is secreted
Replace HCO3

56
Q

What is proximal RTA due to?
What can cause this?
What is the most accurate test?
How do you treat?

A

Damage to the proximal tubule –> decreased HCO3 absorption
Amyloid, Myeloma, Fanconi, Acetazolemide, heavy metals
Give HCO3 and see if it is absorbed
Thiazides diuretics –> decreased V –> enhance bicarb resorption

57
Q

What is type 4 RTA?
What is it due to?
What is a major clue?
How do you treat?

A

Decreased amount or effect of aldosterone
Typically DM
High K
Fludrocortisone (aldosterone like steroid)

58
Q

What is the urine anion gap?

What is it used for?

A 
=Na-Cl
distinguishes RTA (+) from Diarrhea (-)
59
Q

What compensates for metabolic acidosis?

A

RespAlk from hyperventilation

60
Q

What are the 6 causes of MetAcid with AG?

A 
Lactate (HypoTN, Hypoperfusion)
Ketoacids (DKA, starvation)
Oxalic acid (Ethylene glycol)
Formic Acid (Methanol)
Uremia (renal failure)
Salicylates (ASA OD)
61
Q

Diagnose and treat lactate AGMA

A

Blood lactate level

Correct hypoperfusion

62
Q

Dx and tx for Ketoacids

A

Acetone level

Insulin + fluid

63
Q

Dx + tx for oxalic acid OD

A

Crystals on UA

Fomepizole + dialyze

64
Q

Dx + tx for formic acid

A

Inflamed retina

Fomepizole + dialysis

65
Q

Dx + tx for uremia

A

BUN/Cr

Dialysis

66
Q

Dx + tx for Salycilates

A

ASA level

Alkalinize urine

67
Q

What 3 findings are always seen on the ABG in MetAcid

A

Decreased pH

68
Q

What is the compensation for MetAlk?

A

RespAcid = hypoventilation to increase pCO2

69
Q

What 3 things are always seen on ABG in MetAlk?

A

Increased pH >7.4
Increased pCO2 indicates RespAcid compensation
Increased HCO3

70
Q

What is minute ventilation?

A

RespRate x Tidal V

71
Q

What is the most common cause of kidney stones?
What kind of urine does it form in?
What is the most common risk factor?

A

CaOxalate
Alkaline
Over excretion of Ca

72
Q

What disease causes kidney stones because it increases oxalate absorption?

A

Crohns

73
Q

What is the most accurate test for nephrolithiasis?

What stones are not detectable on one test but are on another?

A

CT

Uric acid is not seen on X-ray but seen on CT

74
Q

What is the best initial therapy for acute renal colic?

A

Analgesics (i.e. Ketoralac) + hydration
CT + U/S to detect hydronephrosis
Stones

75
Q

When is a lithotripsy performed?

What is used to relieve hydronephrosis?

A

.5-2cm (2-3 will fragment into big pieces)

Stent placement

76
Q

How are cysteine stones managed?

How are struvite stones formed and managed?

A

Alkalinize the urine

UTI - surgical

77
Q

How many people with a stone will have them again in 5 years?
What are 2 ways to reduce this risk?

A

1/2

Hydrate + HCTZ

78
Q

What acid base disorder increases the risk of stones?

A

MetAcid –> removes Ca from bones and increases stone formation + decreases citrate (Ca binder) levels

79
Q

What is the goal BP in a diabetic patient?
What is the goal BP in a >60 patient?
What is the most effective treatment?
How long should you trial it?

A

140/90
150/90
Weight loss –> 3-6 months

80
Q

What is the best initial drug therapy for HTN?
When do you use 2?
What are safe in pregnancy?

A

Thiazides/CCB/ACEi/ARB all work equally
Use 2 if pressure >160/100
BB > CCB/Hydralazine/Methyldopa

81
Q 
What is the best HTN drug if you have CAD?
DM?
BPH?
Depression/asthma?
Hyperthyroidism?
Osteoporosis?
A 
BB/ACEi/ARB
ACEi/ARB
Alpha blocker
NOT BB
BB
Thiazides
82
Q

What is the best initial therapy in HTN crisis?
What is a caveat with one of the choices?
What do you want to avoid doing?

A

Labetolol or Nitroprisside > Enalapril/Dilt/Verapamil/Esmolol/Hydralazine
Nitroprusside needs to be monitored with an ART line
Do not bring BP to normal –> can cause a stroke

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