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MS3 Year > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Biochemical levels of hypercalcemia of malignancy due to bone mets

A

high Ca, low PTH, high phos (low PTH-rp)

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2
Q

Name 6 causes of hyperkalemia

A

hypoaldo (Ace, arb, spironolactone), artifact (repeated fist clenching when drawing blood), iatrogenic, ESRD, ingestion + CKD, acidosis (albumin binds acid and releases K)

(also see it in rhabdo, tumor lysis syndrome)

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3
Q

Chvostek sign, Trousseau sign, dx?

A

hypocalcemia

Chvostek - facial tapping twitch; Troussaeu - bp cuff twitch

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4
Q

Giving __ mEq of K increases serum K by __ mEq

A

10; 0.1

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5
Q

Paraneoplastic syndrome associated with renal cell carcinoma?

A

Polycythemia (tumor secretes EPO)

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6
Q

What does pancreatitis do to calcium?

A

Sequesters it causing low calcium

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7
Q

What is the differential for anion gap metabolic acidosis?

A

MUDPILES: methanol, uremia, DKA, propylene glycol, isopropranol/isoniaizid/iron, lactate, ethylene glycol, salicylates

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8
Q

What are the indications for dialysis?

A

AEIOU: acidosis, electrolytes (Na/K), Ingestion (toxins), Overload (CHF, edema), Uremia (pericarditis)

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9
Q

What do you do about a low K?

A

Give K

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10
Q

What lab do you check in suspected vit D deficiency? What lab do you check in suspected hypervitaminosis D?

A

25 Vit D; 1, 25 vit D

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11
Q

What are two common toxins that cause ATN?

A

contrast and rhabdomyolysis

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12
Q

Labs for pre-renal failure (4)?

A

BUN/Cr greater than 20, FeNa less than 1%, UrineNa less than 10, FeUrea less than 35%

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13
Q

If you have a metabolic acidosis, what is the next thing you look at?

A

Anion gap

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14
Q

What happens to PTH, Ca, and Phos in CKD? Name 3 treatments

A

increased PTH, decreased Ca, increased PTH; 1) calcimimetics (cinacalcet to decreased PTH release); 2) phosphate binders (sevelamer to decrease phosphate); 3) Ca + VitD3

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15
Q

How do you tx post-renal failure?

A

catheter relieves bladder outlet, nephrostomy relieves ureteral obstruction

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16
Q

Eosinophils in the urine, dx?

A

AIN

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17
Q

What test do you get to look for obstructive uropathy?

A

Ultrasound (or non con CT)

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18
Q

What is the tx for symptomatic hypercalcemia? What are the symptoms (4)?

A

Fluid fluid fluid!! (dilute!); kidney STONES, painful BONES, abdominal GROANS, psychiatric MOANS/OVERTONES

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19
Q

What is the radiographic test of choice for kidney stones?

A

non-contrast abdominal CT (not xray)

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20
Q

How fast can you replete K through a peripheral IV? through a central line?

A

PIV = 10mEq/hr
Central line = 20mEq/hr (faster could cause hyperkalemic sxs to heart through central line)

(po is preferred over IV)

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21
Q

Next step in NON anion gap metabolic acidosis and what it means?

A

urine anion gap (Urine Na + K - Cl)
+ = renal tubular acidosis
- = diarrhea

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22
Q

Name two ways to lose potassium in body, and specifics of each (2 and 3)

A 
GI loss (vomiting or diarrhea)
Renal loss (hyperaldosteronism (RAS, FMD, Conns), diuretics (loops/thiazides), large volume infusion)
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23
Q

Stone that is greater than 5mm and less than 3cm, tx?

A

Lithotripsy

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24
Q

Asterixis, pericardial friction rub, nausea, altered mental status, dx?

A

Uremia

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25
Q

First test for kidney stone?

A

U/A (no blood = no stone)

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26
Q

If trying to replete K and it won’t go up, what should you do?

A

Check Mg and give along with K

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27
Q

Name two overlapping symptoms of hyper and hypokalemia. Name an additional one of hypokalemia

A

Both: weakness, paralysis
Hypo: loss of reflexes

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28
Q

Renal failure in the setting of penicillin antibiotic, dx?

A

AIN (also seen with TMP-SMX and cephs)

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29
Q

RBC casts in the urine, dx?

A

glomerulonephritis

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30
Q

WBC casts, dx?

A

Pyelonephritis (most likely)

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31
Q

Radially oriented cysts in kidneys, dx?

A

Autosomal recessive polycystic kidney disease (newborns)

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32
Q

What is the radiographic test of choice for kidney stones in pregnancy?

A

U/S

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33
Q

Patient has a metabolic alkalosis and a urine chloride less than 10 - name 3 dx and next step

A

volume depleted - 1) diuretics; 2) dehydration; 3) emesis - give fluids! (urine chloride is low because kidney is retaining sodium and chloride due to low volume state)

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34
Q

Asymptomatic patient with a midly elevated calcium, next step?

A

check a urine (might be familial hypocalciuric hypercalcemia)

35
Q

Muddy brown casts?

A

ATN

36
Q

HTN, renal failure, lots of cysts on kidney, diagnosis?

A

Autosomal dominant PKD

37
Q

Which stones are radioopaque and which are lucent?

A

Opaque: calcium oxalate and Struvite (Mg, ammonium, phosphate)
Lucent: uric acid and cystine

38
Q

How do you reduce total body K in a normal person (aka stable with no EKG changes) (2)?

A

Diuretics, kayexalate

39
Q

You get a CT scan for pancreatitis and find a simple cyst on the kidney, next step?

A

reassurance

40
Q

How do you dx a pre-renal AKI if the patient is on a natriuretic medication?

A

FeUrea less than 35% (instead of FeNa less than 1%)

41
Q

If you have ADPKD, what non-renal findings might you have?

A

Berry aneurysms, cysts in pancreas, cysts in liver, heart valve abnormalities (mitral valve prolapse)

42
Q

T wave peaking, QRS widening, dx? Next first step?

A

hyperkalemia; IV calcium

43
Q

How do you reduce total body K in ESRD (2)?

A

kayexalate, hemodialysis

44
Q

Stone that is less than 5mm, tx?

A

fluids + analgesia

45
Q

There is euvolemic hyponatremia, what is the first test?

A

TSH

46
Q

What is the diagnostic step to diagnose a renal cell carcinoma?

A

Nephrectomy (not biopsy!!!)

47
Q

Old person bed bound in nursing home with hypercalcemia, dx and next step?

A

Hypercalcemia of immobilization; mobilize!

48
Q

Flank pain, flank mass, hematuria, dx? Next step?

A

Renal cell carcinoma; CT scan

49
Q

If you see an elevated K, what should you do?

A

Recheck the K, get an EKG

50
Q

Medications that help the stone pass?

A

Tamsulosin or amlodipine (good for stone btwn 5mm-7mm)

51
Q

Colicky flank pain that radiates to the groin, dx?

A

Kidney stone

52
Q

Next step in a metabolic alkalosis?

A

Urine chloride (or give volume and reassess)

53
Q

What are the causes of respiratory acidosis (4)?

A

hypoventilation - opiates, asthma/COPD, OSA (obstructive sleep apnea), OHS (obesity hypoventilation syndrome)

54
Q

Patient has metabolic alkalosis and a urine chloride greater than 10 - what’s the next question and the diagnoses based on it (4 total)

A

HTN or no?
HTN = RAS or Conn’s
no HTN = Bartter, Gitelman

55
Q

The sodium is 123 and the glucose is 600. What is the corrected sodium

A

131 (600-100 = 500 (5 100s over 100) 5x1.6 = 8, 123+8 = 131)

56
Q

What is the tx of hypercalcemia of malignancy?

A

Fluid fluid fluid!!! and bisphosphonates (not lasix!)

57
Q

Differential for hypervolemic hyponatremia?

A

cirrhosis, nephrotic syndrome, CHF (cirrhosis, nephrosis, cardosis)

58
Q

In addition to IV fluids in a symptomatic pt with a very high calcium, what else can you give?

A

Immediate: calcitonin; long term: bisphosphonates

59
Q

You get a CT scan for pancreatitis and find a large loculated renal cyst, next step?

A

Nephrectomy (if it were non loculated with no septations, it’s a simple cyst and do nothing)

60
Q

Flank pain and hematuria, diagnosis?

A

kidney stone

61
Q

T-wave flattening and U waves, dx?

A

hypokalemia

62
Q

If you correct hyponatremia too fast, what do you do?

A

give free water (D5W)

63
Q

What happens to phosphate, parathyroid hormone, and calcium in CKD? What do you give to control symptoms?

A

hyperphosphatemia, (which leads to) hyperparathyroidism; hypocalcemia; give sevelamer (phosphate binder); give cinacalcet (calcimimetic which acts as calcium causing parathyroid to release less PTH

64
Q

What are the causes of respiratory alkalosis (3)?

A

hyperventilation - pain, anxiety, hypoxemia

65
Q

Altered mental status, abdominal pain, and bone pain, diagnosis?

A

Hypercalcemia

66
Q

36 yo black woman with hypercalcemia and bilateral hilar lymphadenopathy, dx and next step?

A

Sarcoid, get a 1,25 vit D level and biopsy the sarcoid

67
Q

Nephrotic syndrome, define it (3)

A

greater than 3.5g/day proteinuria, edema, elevated cholesterol (HTN too)

68
Q

Most common cause of hypercalcemia (2)?

A

Malignancy and hyperparathryoidism

69
Q

When do you give 3% saline (hypertonic)?

A

severe hyponatremia with seizure, coma

70
Q

You diagnose hyperparathyroidism, what do you do next?

A

Sestamibi scan (nuclear scan) to check if primary hyper PTH (adenoma) or tertiary hyper PTH (multiple adenomas)

71
Q

How do you tx hypernatremia?

A

give free water D5W or oral water

72
Q

Perioral tingling and paresthesias after a thyroidectomy, dx and next step?

A

hypocalcemia, check iCa

73
Q

Cr 1.5; gets IV contrast. Creatinine goes up. Dx?

A

Contrast induced nephropathy = ATN

74
Q

Stone that is greater than 3 cm, tx?

A

Nephrostomy and surgery

75
Q

Name 3 ways to eliminate K from the body

A

kayexalate (through stool), diuretics (through urine), dialysis (through blood)

76
Q

What is the fastest sodium should be corrected in hyponatremia?

A

No faster than 0.25 mEq/hour except if seizing or in coma (risk of central pontine myelinolysis)

77
Q

Most common type of kidney stone?

A

Calcium oxalate

78
Q

Biochemical levels of hypercalcemia of malignancy due to PTHrp

A

High Ca, low Phos, Low PTH, High PTHrp

79
Q

If the pt has a hypovolemic hyponatremia, what do you do?

A

IVF

80
Q

What lab should you look at first with disorders of calcium?

A

Albumin

81
Q

What is winter’s formula and when do you do it?

A

CO2 = 1.5(HCO3) + 8 +/- 2

To see if CO2 is appropriate in metabolic acidosis

82
Q

Which stones form in increased pH? Which is caused by proteus? Which is caused by tumor lysis?

A

Struvite (Mg, Ammonium, Phosphate); Struvite; Uric Acid

83
Q

Name 3 ways to shift K from serum into cells

A

Insulin + D50
B-agonist
Na Bicarb

MS3 Year (18 decks)

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