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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
isoniazid toxicity
stop medication, move the clock forward
26
electrolyte disturbances with diarrhea
metabolic acidosis -- increased loss of HCO3 from colon hypokalemia hyperchloremia - increased Cl- absorption
27
distal RTA (type 1)
inability to excrete H+ ions in distal tubule - serum K+ low (K+ is cation that is excreted instead) - serum HCO- low - alkaline urine
28
test for distal RTA
``` IV acid (ammonium chloride) - should lower urinary pH secondary to H+ formation; in RTA, the pts urine stays basic ```
29
Tx distal RTA
Bicarb
30
proximal RTA (type 2)
inability to reabsorb bicarb in proximal tubule - low urine pH - osteomalacia
31
how do you test for proximal RTA
give bicarbonate | - urine pH will rise because unable to absorb the bicarb
32
Tx. proximal RTA
thiazide diuretic | large amts of bicarb
33
type IV RTA
decreased aldosterone production or effect - hyperkalemia - urine pH low test: urine Na loss
34
Tx. type IV RTA
fludrocortisone
35
how do you distinguish from metabolic acidosis caused by diarrhea vs RTA
UAG = Urine Na - Urine Cl- negative UAG = diarrhea positive UAG = RTA
36
volume contraction
metabolic alkalosis --> secondary hyperaldosteronism (increased loss of urinary acid)
37
routine tests for HTN cases on CCS
EKG urinalysis eye exam for retinopathy cardiac exam for murmur and gallop
38
most effective lifestyle modification for HTN
weight loss
39
first line therapy for HTN if lifestyle mods dont work
1. thiazides | 2. if diabetic - ACEI
40
coexisting conditions that you tx HTN with a BB
CAD CHF migraine hyperthyroidism
41
in which conditions should you avoid BB for tx of HTN
asthma | depression
42
when should you investigate for 2ndary HTN
young 60 yo failure to control pressure with 2 meds specific findings on physical exam
43
you begin treating a pt with an ACEI, and on labs, their CR level rises - what should you suspect
renal artery stenosis
44
best initial test for renal artery stenosis
renal doppler usg
45
most accurate test for renal artery stenosis
renal angiogram
46
pt with varicocele with any of: bilateral, right sided or does not go away with supine position
needs further evaluation for obstruction of IVC | - order CT abdo
47
who gets tx for asymptomatic bacteriuria
pregnant pts urologic intervetions hip arthroplasty pts
48
clues that renal failure is short duration
normal size normal hematocrit normal calcium level
49
diagnostic features of prerenal failure
1. BUN/Cr > 20:1 2. U sodium LOW 3. FE na < 1% 4. Uosm >500 5. hyaline casts
50
on CCS, all renal cases should have what three tests
urinalysis chemistries renal usg
51
Dx. postrenal azotemia
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
diagnostic features: intrarenal causes of RF
BUN/Cr ~ 10:1 U na > 40 U osm < 350 UA: muddy brown or granular casts
53
common toxins that cause renal failure
aminoglycosides - hypomagnesemia is suggestive amphotericin contrast agents chemotherapy - cisplatin
54
pt on penicillin, develops rise in BUN/Cr with fever and rash - dx? best initial test?
allergic interstitial nephritis | best initial test: UA - increased WBCs
55
most accurate test for allergic interstitial nephritis
wright stain or hansel's stain of urine
56
effect of cyclophosphamide on kidney
hemorrhagic cystitis - it does NOT cause renal failure
57
best initial test for rhabdo
UA - will see blood but no cells
58
most accurate test for rhabdo
urine myoglobin level
59
Dx. findings in rhabdo
``` UA - blood but no cells urine myoglobin + CPK elevated hyperkalemia hypocalcemia low serum bicarb ```
60
Tx. rhabdo
bolus NS mannitol and diuresis alkalinization of urine
61
first test to order in pt who you suspect has rhabdo
EKG - to r/o any arrhythmia secondary to hyperkalemia
62
envelope shaped urine crystals
calcium oxalate crystals | - ethylene glycol poisoning
63
best method to prevent contrast induced nephropathy
1. IVF with NS | 2. possibly bicarb, N acetylcysteine or both
64
best initial test: Goodpasture's syndrome
anti-basement mb abs
65
most accurate test: Goodpasture's syndrome
renal biopsy - shows linear deposits
66
Tx. goodpasture's syndrome
plasmaphoresis | steroids
67
best initial test: churg strauss
CBC for eosinophil count
68
best initial therapy: churg strauss
steroids - prednisone
69
best initial test: Wegener's
c-ANCA
70
best initial therapy: wegeners
cyclophosphamide | steroids
71
most accurate test for dx. polyarteritits
biopsy of sural N or kidney
72
best diagnostic test for dx. IgA nephropathy
biopsy | - no specific blood test or physical exam findings
73
Tx. IgA nephropathy
1. steroids - for acute episodes 2. ACEI 3. fish oil - may delay progression
74
best initial test for Henoch Schonlein purpura
clinical presentation
75
Tx. Henoch Schonlein purpura
resolves spontaneously over time
76
best initial test for post-strep GN
ASLO, anti-DNAase B, antihyaluronidase | complement low
77
when should you do a biopsy with post-strep GN
1. atypical course 2. normal complement level 3. sx > 2 months 4. acute renal failure
78
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?
cryoglobulinemia
79
best initial test for cryoglobulinemia
serum cryoglobulin component levels | decreased C3, C4 and CH50
80
Tx. cryoglobulinemia
alpha interferon - alone, if renal dysfxn + ribavirin, if no renal dysfxn and bocepravir or telaprevir

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