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Nephrology Flashcards

1
Q

causes of nephrogenic DI

A

hypokalemia
hypercalcemia
lithium toxicity

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2
Q

Tx. of central DI

A

Desmopressin

- prompt decrease in urine volume and increase in urine osmolality

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3
Q

tx. nephrogenic DI

A

correct underlying cause

thiazide diuretics

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4
Q

causes: hypervolemic hyponatremia

A

CHF
cirrhosis
nephrotic syndrome

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5
Q

causes: hypovolemic hyponatremia

A

GI losses - diarrhea, vomiting
skin loss of fluids - burns, sweating
diuretics

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6
Q

Tx. hypervolemic hyponatremia

A

fluid restriction

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7
Q

Tx. hypovolemic hyponatremia

A

NS

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8
Q

hyponatremia + hyperkalemia and mild metabolic acidosis

A

Addison’s disease

- tx. fludrocortisone

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9
Q

causes: euvolemic hyponatremia

A

SIADH
psychogenic polydipsia
hyperglycemia

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10
Q

effect of glucose on na level

A

every 100 mg increase in glucose drops Na by 1.6 points

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11
Q

Tx. hyponatremia 125-135

A

no tx or tx the cause

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12
Q

tx. hyponatremia 115-125

A

water restriction, if asymptomatic

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13
Q

Tx. mod -severe hyponatremia <115 or symptomatic hyponatremia

A

saline infusion

loop diuretics

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14
Q

appropriate rate of rise of Na in correction of hyponatremia

A

no more than 0.5 mEQ/L/hour (12 mEQ/L/day) in first 24 hours, no more than 18 in 48 hours

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15
Q

Tx. chronic SIADH ex from malignancy

A

demeclocycline

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16
Q

EKG changes in hyperkalemia

A

1) peaked T waves
2) loss of P waves
3) wide QRS complex

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17
Q

Tx. severe hyperkalemia

A

calcium gluconate - cardioprotective

insulin + glucose

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18
Q

causes of hypokalemia

A 
diuretics
Conns syndrome
vomiting - metabolic alkalosis w/ cellular shifts
proximal and distal RTA
amphotericin
Barter syndrome
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19
Q

Bartter syndrome

A

inability of the loop of henle to absorb NaCl which causes secondary hyperaldosteronism and renal potassium wasting

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20
Q

Tx. hypokalemia

A

replace K+ = no max rate on oral K+ replacement as bowel regulates absorption; you should avoid glucose containing fluids, which may worsen hypokalemia from cellular shifts

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21
Q

causes: hypermagnesemia

A

Mg containing laxatives
iatrogenic administration
rare unless underlying renal insufficiency

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22
Q

Tx. hyperMg

A

restrict intake
saline administration to promote diuresis
occasionally, dialysis

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23
Q

causes: hypomagnesemia

A

loop diuretics
alcohol withdrawl
gentamycin
cisplatin

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24
Q

fastest, single test to tell if patient’s hyperglycemia is life threatening

A

low serum bicarb

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25
Q

isoniazid toxicity

A

stop medication, move the clock forward

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26
Q

electrolyte disturbances with diarrhea

A

metabolic acidosis – increased loss of HCO3 from colon
hypokalemia
hyperchloremia - increased Cl- absorption

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27
Q

distal RTA (type 1)

A

inability to excrete H+ ions in distal tubule

  • serum K+ low (K+ is cation that is excreted instead)
  • serum HCO- low
  • alkaline urine
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28
Q

test for distal RTA

A 
IV acid (ammonium chloride)
- should lower urinary pH secondary to H+ formation; in RTA, the pts urine stays basic
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29
Q

Tx distal RTA

A

Bicarb

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30
Q

proximal RTA (type 2)

A

inability to reabsorb bicarb in proximal tubule

  • low urine pH
  • osteomalacia
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31
Q

how do you test for proximal RTA

A

give bicarbonate

- urine pH will rise because unable to absorb the bicarb

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32
Q

Tx. proximal RTA

A

thiazide diuretic

large amts of bicarb

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33
Q

type IV RTA

A

decreased aldosterone production or effect

  • hyperkalemia
  • urine pH low
    test: urine Na loss
34
Q

Tx. type IV RTA

A

fludrocortisone

35
Q

how do you distinguish from metabolic acidosis caused by diarrhea vs RTA

A

UAG = Urine Na - Urine Cl-
negative UAG = diarrhea
positive UAG = RTA

36
Q

volume contraction

A

metabolic alkalosis –> secondary hyperaldosteronism (increased loss of urinary acid)

37
Q

routine tests for HTN cases on CCS

A

EKG
urinalysis
eye exam for retinopathy
cardiac exam for murmur and gallop

38
Q

most effective lifestyle modification for HTN

A

weight loss

39
Q

first line therapy for HTN if lifestyle mods dont work

A
  1. thiazides

2. if diabetic - ACEI

40
Q

coexisting conditions that you tx HTN with a BB

A

CAD
CHF
migraine
hyperthyroidism

41
Q

in which conditions should you avoid BB for tx of HTN

A

asthma

depression

42
Q

when should you investigate for 2ndary HTN

A

young 60 yo
failure to control pressure with 2 meds
specific findings on physical exam

43
Q

you begin treating a pt with an ACEI, and on labs, their CR level rises - what should you suspect

A

renal artery stenosis

44
Q

best initial test for renal artery stenosis

A

renal doppler usg

45
Q

most accurate test for renal artery stenosis

A

renal angiogram

46
Q

pt with varicocele with any of: bilateral, right sided or does not go away with supine position

A

needs further evaluation for obstruction of IVC

- order CT abdo

47
Q

who gets tx for asymptomatic bacteriuria

A

pregnant pts
urologic intervetions
hip arthroplasty pts

48
Q

clues that renal failure is short duration

A

normal size
normal hematocrit
normal calcium level

49
Q

diagnostic features of prerenal failure

A
  1. BUN/Cr > 20:1
  2. U sodium LOW
  3. FE na < 1%
  4. Uosm >500
  5. hyaline casts
50
Q

on CCS, all renal cases should have what three tests

A

urinalysis
chemistries
renal usg

51
Q

Dx. postrenal azotemia

A
  1. obstruction of kidney (must be b/l)
  2. elevated BUN/Cr > 15:1
  3. clues:
    - distended bladder
    - large volume diuresis after cath
    - b/l hydronephrosis on us
52
Q

diagnostic features: intrarenal causes of RF

A

BUN/Cr ~ 10:1
U na > 40
U osm < 350
UA: muddy brown or granular casts

53
Q

common toxins that cause renal failure

A

aminoglycosides - hypomagnesemia is suggestive
amphotericin
contrast agents
chemotherapy - cisplatin

54
Q

pt on penicillin, develops rise in BUN/Cr with fever and rash - dx? best initial test?

A

allergic interstitial nephritis

best initial test: UA - increased WBCs

55
Q

most accurate test for allergic interstitial nephritis

A

wright stain or hansel’s stain of urine

56
Q

effect of cyclophosphamide on kidney

A

hemorrhagic cystitis - it does NOT cause renal failure

57
Q

best initial test for rhabdo

A

UA - will see blood but no cells

58
Q

most accurate test for rhabdo

A

urine myoglobin level

59
Q

Dx. findings in rhabdo

A 
UA - blood but no cells
urine myoglobin +
CPK elevated
hyperkalemia
hypocalcemia
low serum bicarb
60
Q

Tx. rhabdo

A

bolus NS
mannitol and diuresis
alkalinization of urine

61
Q

first test to order in pt who you suspect has rhabdo

A

EKG - to r/o any arrhythmia secondary to hyperkalemia

62
Q

envelope shaped urine crystals

A

calcium oxalate crystals

- ethylene glycol poisoning

63
Q

best method to prevent contrast induced nephropathy

A
  1. IVF with NS

2. possibly bicarb, N acetylcysteine or both

64
Q

best initial test: Goodpasture’s syndrome

A

anti-basement mb abs

65
Q

most accurate test: Goodpasture’s syndrome

A

renal biopsy - shows linear deposits

66
Q

Tx. goodpasture’s syndrome

A

plasmaphoresis

steroids

67
Q

best initial test: churg strauss

A

CBC for eosinophil count

68
Q

best initial therapy: churg strauss

A

steroids - prednisone

69
Q

best initial test: Wegener’s

70
Q

best initial therapy: wegeners

A

cyclophosphamide

steroids

71
Q

most accurate test for dx. polyarteritits

A

biopsy of sural N or kidney

72
Q

best diagnostic test for dx. IgA nephropathy

A

biopsy

- no specific blood test or physical exam findings

73
Q

Tx. IgA nephropathy

A
  1. steroids - for acute episodes
  2. ACEI
  3. fish oil - may delay progression
74
Q

best initial test for Henoch Schonlein purpura

A

clinical presentation

75
Q

Tx. Henoch Schonlein purpura

A

resolves spontaneously over time

76
Q

best initial test for post-strep GN

A

ASLO, anti-DNAase B, antihyaluronidase

complement low

77
Q

when should you do a biopsy with post-strep GN

A
  1. atypical course
  2. normal complement level
  3. sx > 2 months
  4. acute renal failure
78
Q

pt with hepatitis C presents with joint pain and purpuric skin lesions. Exam shows LAD, hepatosplenomegaly and peripheral neuropathy. labs show hematuria, proteinuria and increased Cr. - Dx?

A

cryoglobulinemia

79
Q

best initial test for cryoglobulinemia

A

serum cryoglobulin component levels

decreased C3, C4 and CH50

80
Q

Tx. cryoglobulinemia

A

alpha interferon - alone, if renal dysfxn
+ ribavirin, if no renal dysfxn
and bocepravir or telaprevir

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