Nephrology Flashcards
1
Q
hypervolemic hyponatremia
A
CHF
nephrotic
cirrhotic
2
Q
hypovolemia hyponatremia
A
diruetics
vomiting
psychogenic polydypsia
3
Q
euvolemic hyponatremia
A
SIADH
Addisons
hypotheyroidism
4
Q
hypovolemic hyponatremia tx
A
NS fluids
3% saline if seizures or Na < 120
5
Q
hypervolemic or euvolemic hyponatremia tx
A
fluid restriction
diruetics
6
Q
Don’t correct hyponatremia faster than…
A
12 - 24 mEq/day
0.5 - 1 mEq/hr
or else… central pontine myelinolysis
7
Q
low to high…
high to low…
A
pons will die (central pontine myelinolysis)
brain will blow (cerebral edema)
8
Q
hyponatremia means…
A
gain of water
9
Q
hypernatremia means…
A
loss of water
10
Q
hypernatremia tx
A
replace water with D5W or other hypotnic fluid
11
Q
Don’t correct hypernatremia faster than…
A
12 - 24 mEq/day
0.4 - 1 mEq/hr
or else… cerebral edema
12
Q
numbness + Chvostek or Trousseau + prolonged QT interval
A
hypocalcemia
13
Q
bones + stones + groans + psychiatric overtones + short QT interval
A
hypercalcemia
14
Q
paralysis + ileus + ST depression + u waves
A
hypokalemia
15
Q
Tx hypokalemia
A
K+ (make sure pt can pee)
max 40 mEq/hr
16
Q
peaked T waves + prolonged PR + wide QRS + sine waves
A
hyperkalemia
17
Q
hyperkalemia tx
A
Ca+ gluconate insuline D50 kayexalate albuterol sodium bicarb
last resort…hemodialysis
C my big k drop
18
Q
Check pH, if acidotic or alkalotic…check
A
HCO3 and pCO2
19
Q
If HCO3 is high and pCO2 is high…
A
metabolic alkalosis
20
Q
metabolic alkalosis, check…
A
urine chloride
- if Cl > 20 + HTN –> hyperaldosterone (Conn’s)
- if normotensive think Barter’s or Gittlemans
- if Cl < 20 –> think vomiting/NG sucktion, antacids, diuretics
21
Q
If HCO3 is low and pCO2 is low…
A
respiratory alkalosis
22
Q
respiratory alkalosis from…
A
hyperventilation: anxiety increased ICP fever pain ASA
23
Q
respiratory acidosis from…
A
hypoventilation:
opioid OD
brainstem injury
ventilation probs
24
Q
nL anion gap metabolic acidosis from…
A
diarrhea
diuretic
RTAs (I, II and IV)
25
renal tubular acidosis (RTA) cause...
NAGMA
26
Type I RTA
```
distal
Lithium/amoph B
SLE
analgesics
Sjogrens
sickle
hepatitis
```
27
Type I RTA sx
urine pH >5.4
hypokalemia
cannot excrete H+
28
Type I RTA tx
replete K
| orla bicarb
29
Type II RTA
```
proximal
Fanconi's syndrome
myeloma
amyloid
vit D deficiency
ai dz
```
30
Type II RTA dx
hypokalemia
osteomalacia
cannot reabsorb HCO3
31
Type II RTA tx
replete K
mild diuretic
bicarb won't help
32
Type IV RTA
```
hyper-renin
hypoaldo
>50% caused by T2DM
Addisons
sickle cell
any cause of aldo def
```
33
Type IV RTA sx
HYPERkalemia
hypercholemia
high urine Na conc even with salt restriction
34
Type IV RTA tx
fludrocortisone
35
Fanconi's anemia
hereditary or acquired proximal tubule dysfunction
| defective transport of gluc, AA, Na, K, PO4, uric acid, and bicarb
36
ARF
> 25% or 0.5 rise in Cr over baseline
37
ARF/AKI workup
```
BUN
Cr
UA
urine Na
urine Cr
measure FENa
```
38
Prerenal AKI workup
BUN/Cr > 20
FENa < 1%
if on diruetic, measure FENurea < 35%
39
ARF/AKI tx
prerenal: fluids to perfuse kidney
40
Causes prerenal AKI
```
HYPOPERFUSION
CHF
GN
cirrhosis
RAS
hypovolemia
```
41
Muddy brown casts in pt w/ ampho, AG, cisplatin or prolonged ischemia
ATN
fluids, avoid nephrotox
maybe HD
42
protein, blood, and eos in urine + fever + rash + recent bactrim
AIN
stop offending agent
add steroids if no improvement
43
army recruit or crush victim w/ CPK > 50K + blood on dipstick + no RBCs
rhabdomyolysis
check k+ and EKG
bicarb to alkalinize urine to prevent precipitation
44
enveloped shaped crystals on UA
ethylene glycol intox
HD
if pH < 7.2, NaHCO3
45
bump in cr 48-72 h s/p cardiac cath or CT scan
contrast nephropathy
hydrate before
OR
give bicarb or NAC
46
Indications for acute hemodialysis
AEIOU
```
A: acidosis
E: electrolyte imbalance, esp. K+ > 6.5
I: intoxication, esp. antifreeze, Li+
O: overload of volume, hypoxic pulmonary edema
U: uremia, esp. pericarditis, AMS
```
NOT high cr or oliguria
47
#1 cause CKD
1. DM
| 2. HTN
48
#1 COD in CKD
cardiovascular dz
| so, want LDL < 100
49
CKD complications
HTN 2/2 aldo, fluid retention --> CHF
normochromic normocytic anemia --> loss of EPO
hyperk, hyperPHOS, hypoCA --> 2* HTN
hyperPHOS --> precip Ca2+ in tissues --> renal osteodystrophy and calciphylaxis (skin necrosis)
uremia --> confusion, pericarditis, itchiness, incr bleeding bc PLT dysfxn
50
So you patient is peeing blood... 1st test?
urinalysis
51
So you patient is peeing blood... painless...think
bladder or kidney cancer until proven otherwise
52
So you patient is peeing blood... "terminal hematuria" + tiny clots...
bladder cancer or hemorrhagic cystitis (cyclophosphamide)
53
So you patient is peeing blood... dysmorphic RBCs or RBC casts?
glomerular
54
definition of nephitic syndrome
proteinuria (but < 2 g/24h)
hematuria
edema
azotemia
55
So you patient is peeing blood...1-2 days after runny nose, sore throat, and cough
Berger's dz
| Iga nephropathy
56
So you patient is peeing blood...1-2 weeks after sore throat of skin infection
PSGN
smokey/cola urine
subepithelial IgG humps
57
Suspect PSGN...best test
ASO titer
58
So you patient is peeing blood...and hemoptysis
Goodpasture's syndrome
Abs to collagen IV
OR
Wegeners
59
So you patient is peeing blood...and deaf
Alport syndrome
XLR mutation in collagen IV
60
Kid s/p viral URI with renal railure + abd pain + arthralgia + purpura
HSP
supportive tx +/- steroids
61
kid s/p hamburger + diarrhea + renal failure + MAHA + petechiae
HUS, e. coli O157H7 OR shigella
DON'T TREAT WITH ABX (releases more toxin)
62
cardiac pt s/p ticlopidine + renal failure + MAHA + thrombocytopenia + fever + AMS
TTP
plasmapheresis
DON"T GIVE PLTs
63
How tell DIC from TTP?
PT and PTT are normal in HUS/TTP
64
c-ANCA + kidney + lung + sins involvement
Wegener's grnaulomatosis
Bx
steroids OR cyclophosphamide
65
p-ANCA + renal fialure + asthma + eosinophilia
Churg Strauss
lung bx
cyclophosphamide
66
p-ANCA + NO lung involvement + hep B
polyarteritis nodosa
affects small/med arteries of every organ except lung!
cyclophosphamide
67
flank pain radiating to groin + hematuria...get
CT
kidney stones
68
MC type kidney stone
calcium oxalate
tx HCTZ
69
kid with fhx stones type
cysteine
can't resorb certain AA
70
chronic indwelling foley and alkaline pee stones
Mg/Al/PO4 = struvite
proteus, staph, pseudomonas, klebsiella
71
leukemia being treated w/ chemo and stones?
uric acid
alkalinize urine
hydrate
72
s/p bowel resection for volvulus with stones?
pure oxylate stone
Ca2+ not reabsorbed by gut (pooped out)
73
stones < 5 mm...tx
will pass spontaneously
| hydrate
74
stones > 2 cm...tx
open or endoscopic surgical removal
75
stones 5 mm - 2 cm...tx
extracorporal shock wave lithotripsy
76
So your patient is peeing protein... best test?
repeat etst in 2 weeks, then quantify w/ 24 hr urine
77
So your patient is peeing protein... MC in kiddos
minimal change dz
fusion of foot processes
'roids
78
So your patient is peeing protein... MC in adults
membranous
thick capillary walls with SUBepi spikes
79
definition nephortic syndrome
> 3.5 g protein/24 h
hypoalbuminemia
edema
hyperlipiedemia (fatty/waxy casts)
80
So your patient is peeing protein... assoc. with heroin use and HIV
focal segmental GN
mesangial IgM deposits
try 'roids
81
So your patient is peeing protein... assoc with chronic hepatitis and low complement
membranoproliferative GN
tram-track BM with SUBendo deposits
82
So your patient is peeing protein... and suddenly developes flank pain...think and get
suspect renal vein thrombosis!
2/2 peeing out ATIII, protein C and S
CT or US STAT!
83
So your patient is peeing protein... other random causes
```
orthostatic
bence jones (MM)
UTI
pregnant
fever
CHF
```
