Nephrology Flashcards
Biochemical levels of hypercalcemia of malignancy due to bone mets
high Ca, low PTH, high phos (low PTH-rp)
Name 6 causes of hyperkalemia
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)
Chvostek sign, Trousseau sign, dx?
hypocalcemia
Chvostek - facial tapping twitch; Troussaeu - bp cuff twitch
Giving __ mEq of K increases serum K by __ mEq
10; 0.1
Paraneoplastic syndrome associated with renal cell carcinoma?
Polycythemia (tumor secretes EPO)
What does pancreatitis do to calcium?
Sequesters it causing low calcium
What is the differential for anion gap metabolic acidosis?
MUDPILES: methanol, uremia, DKA, propylene glycol, isopropranol/isoniaizid/iron, lactate, ethylene glycol, salicylates
What are the indications for dialysis?
AEIOU: acidosis, electrolytes (Na/K), Ingestion (toxins), Overload (CHF, edema), Uremia (pericarditis)
What do you do about a low K?
Give K
What lab do you check in suspected vit D deficiency? What lab do you check in suspected hypervitaminosis D?
25 Vit D; 1, 25 vit D
What are two common toxins that cause ATN?
contrast and rhabdomyolysis
Labs for pre-renal failure (4)?
BUN/Cr greater than 20, FeNa less than 1%, UrineNa less than 10, FeUrea less than 35%
If you have a metabolic acidosis, what is the next thing you look at?
Anion gap
What happens to PTH, Ca, and Phos in CKD? Name 3 treatments
increased PTH, decreased Ca, increased PTH; 1) calcimimetics (cinacalcet to decreased PTH release); 2) phosphate binders (sevelamer to decrease phosphate); 3) Ca + VitD3
How do you tx post-renal failure?
catheter relieves bladder outlet, nephrostomy relieves ureteral obstruction
Eosinophils in the urine, dx?
AIN
What test do you get to look for obstructive uropathy?
Ultrasound (or non con CT)
What is the tx for symptomatic hypercalcemia? What are the symptoms (4)?
Fluid fluid fluid!! (dilute!); kidney STONES, painful BONES, abdominal GROANS, psychiatric MOANS/OVERTONES
What is the radiographic test of choice for kidney stones?
non-contrast abdominal CT (not xray)
How fast can you replete K through a peripheral IV? through a central line?
PIV = 10mEq/hr
Central line = 20mEq/hr (faster could cause hyperkalemic sxs to heart through central line)
(po is preferred over IV)
Next step in NON anion gap metabolic acidosis and what it means?
urine anion gap (Urine Na + K - Cl)
+ = renal tubular acidosis
- = diarrhea
Name two ways to lose potassium in body, and specifics of each (2 and 3)
GI loss (vomiting or diarrhea) Renal loss (hyperaldosteronism (RAS, FMD, Conns), diuretics (loops/thiazides), large volume infusion)
Stone that is greater than 5mm and less than 3cm, tx?
Lithotripsy
Asterixis, pericardial friction rub, nausea, altered mental status, dx?
Uremia
First test for kidney stone?
U/A (no blood = no stone)
If trying to replete K and it won’t go up, what should you do?
Check Mg and give along with K
Name two overlapping symptoms of hyper and hypokalemia. Name an additional one of hypokalemia
Both: weakness, paralysis
Hypo: loss of reflexes
Renal failure in the setting of penicillin antibiotic, dx?
AIN (also seen with TMP-SMX and cephs)
RBC casts in the urine, dx?
glomerulonephritis
WBC casts, dx?
Pyelonephritis (most likely)
Radially oriented cysts in kidneys, dx?
Autosomal recessive polycystic kidney disease (newborns)
What is the radiographic test of choice for kidney stones in pregnancy?
U/S
Patient has a metabolic alkalosis and a urine chloride less than 10 - name 3 dx and next step
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)
Asymptomatic patient with a midly elevated calcium, next step?
check a urine (might be familial hypocalciuric hypercalcemia)
Muddy brown casts?
ATN
HTN, renal failure, lots of cysts on kidney, diagnosis?
Autosomal dominant PKD
Which stones are radioopaque and which are lucent?
Opaque: calcium oxalate and Struvite (Mg, ammonium, phosphate)
Lucent: uric acid and cystine
How do you reduce total body K in a normal person (aka stable with no EKG changes) (2)?
Diuretics, kayexalate
You get a CT scan for pancreatitis and find a simple cyst on the kidney, next step?
reassurance
How do you dx a pre-renal AKI if the patient is on a natriuretic medication?
FeUrea less than 35% (instead of FeNa less than 1%)
If you have ADPKD, what non-renal findings might you have?
Berry aneurysms, cysts in pancreas, cysts in liver, heart valve abnormalities (mitral valve prolapse)
T wave peaking, QRS widening, dx? Next first step?
hyperkalemia; IV calcium
How do you reduce total body K in ESRD (2)?
kayexalate, hemodialysis
Stone that is less than 5mm, tx?
fluids + analgesia
There is euvolemic hyponatremia, what is the first test?
TSH
What is the diagnostic step to diagnose a renal cell carcinoma?
Nephrectomy (not biopsy!!!)
Old person bed bound in nursing home with hypercalcemia, dx and next step?
Hypercalcemia of immobilization; mobilize!
Flank pain, flank mass, hematuria, dx? Next step?
Renal cell carcinoma; CT scan
If you see an elevated K, what should you do?
Recheck the K, get an EKG
Medications that help the stone pass?
Tamsulosin or amlodipine (good for stone btwn 5mm-7mm)
Colicky flank pain that radiates to the groin, dx?
Kidney stone
Next step in a metabolic alkalosis?
Urine chloride (or give volume and reassess)
What are the causes of respiratory acidosis (4)?
hypoventilation - opiates, asthma/COPD, OSA (obstructive sleep apnea), OHS (obesity hypoventilation syndrome)
Patient has metabolic alkalosis and a urine chloride greater than 10 - what’s the next question and the diagnoses based on it (4 total)
HTN or no?
HTN = RAS or Conn’s
no HTN = Bartter, Gitelman
The sodium is 123 and the glucose is 600. What is the corrected sodium
131 (600-100 = 500 (5 100s over 100) 5x1.6 = 8, 123+8 = 131)
What is the tx of hypercalcemia of malignancy?
Fluid fluid fluid!!! and bisphosphonates (not lasix!)
Differential for hypervolemic hyponatremia?
cirrhosis, nephrotic syndrome, CHF (cirrhosis, nephrosis, cardosis)
In addition to IV fluids in a symptomatic pt with a very high calcium, what else can you give?
Immediate: calcitonin; long term: bisphosphonates
You get a CT scan for pancreatitis and find a large loculated renal cyst, next step?
Nephrectomy (if it were non loculated with no septations, it’s a simple cyst and do nothing)
Flank pain and hematuria, diagnosis?
kidney stone
T-wave flattening and U waves, dx?
hypokalemia
If you correct hyponatremia too fast, what do you do?
give free water (D5W)
What happens to phosphate, parathyroid hormone, and calcium in CKD? What do you give to control symptoms?
hyperphosphatemia, (which leads to) hyperparathyroidism; hypocalcemia; give sevelamer (phosphate binder); give cinacalcet (calcimimetic which acts as calcium causing parathyroid to release less PTH
What are the causes of respiratory alkalosis (3)?
hyperventilation - pain, anxiety, hypoxemia
Altered mental status, abdominal pain, and bone pain, diagnosis?
Hypercalcemia
36 yo black woman with hypercalcemia and bilateral hilar lymphadenopathy, dx and next step?
Sarcoid, get a 1,25 vit D level and biopsy the sarcoid
Nephrotic syndrome, define it (3)
greater than 3.5g/day proteinuria, edema, elevated cholesterol (HTN too)
Most common cause of hypercalcemia (2)?
Malignancy and hyperparathryoidism
When do you give 3% saline (hypertonic)?
severe hyponatremia with seizure, coma
You diagnose hyperparathyroidism, what do you do next?
Sestamibi scan (nuclear scan) to check if primary hyper PTH (adenoma) or tertiary hyper PTH (multiple adenomas)
How do you tx hypernatremia?
give free water D5W or oral water
Perioral tingling and paresthesias after a thyroidectomy, dx and next step?
hypocalcemia, check iCa
Cr 1.5; gets IV contrast. Creatinine goes up. Dx?
Contrast induced nephropathy = ATN
Stone that is greater than 3 cm, tx?
Nephrostomy and surgery
Name 3 ways to eliminate K from the body
kayexalate (through stool), diuretics (through urine), dialysis (through blood)
What is the fastest sodium should be corrected in hyponatremia?
No faster than 0.25 mEq/hour except if seizing or in coma (risk of central pontine myelinolysis)
Most common type of kidney stone?
Calcium oxalate
Biochemical levels of hypercalcemia of malignancy due to PTHrp
High Ca, low Phos, Low PTH, High PTHrp
If the pt has a hypovolemic hyponatremia, what do you do?
IVF
What lab should you look at first with disorders of calcium?
Albumin
What is winter’s formula and when do you do it?
CO2 = 1.5(HCO3) + 8 +/- 2
To see if CO2 is appropriate in metabolic acidosis
Which stones form in increased pH? Which is caused by proteus? Which is caused by tumor lysis?
Struvite (Mg, Ammonium, Phosphate); Struvite; Uric Acid
Name 3 ways to shift K from serum into cells
Insulin + D50
B-agonist
Na Bicarb
