Nephrology Flashcards
how do you calculate the anion gap?
NA - (HCO3 + CL) 4-12 nl range
Causes of Respiratory acidosis?
COPD, myesthenia gravis, hypercapnia
In the blood gas- what signifies respiratory acidosis?
decreased pH, Increased PCO2
In the blood gas, what signifies Respiratory alkalosis?
increased pH, decreased PCO2
Causes of respiratory alkalosis?
hyperventilation/ anxiety, pregnancy, Salicyclate overdose
in the blood gas what signifies Metabolic acidosis?
decreased pH and decreased HCO3 (bicarb)
Causes of metabolic acidosis?
starvation, lactic acidosis, renal failure, methanol overdose, salicylate intoxication
In a blood gas, what results indicate metabolic alkalosis?
increase pH and increase HCO3(bicarb)
What causes metabolic acidosis?
vomiting and diarrhea, NG suctioning
causes of hypokalemia?
diuretics, renal tubular acidosis, GI loss
What are the EKG changes found in severe hypokalemia?
flattened T waves ad U waves.
Treatment for hypokalemia?
K+ >2.5 - po supplementation
K+ < 2.5 IV supplementation followed by PO
Causes of hyperkalemia?
renal failure, ACE inhibitors, hypoalsotreonism, metabolic acidosis
Neurosymptoms of hyperkalemia?
numbness/tingling/weakness/flaccid paralysis
What cardia symptoms can be found with hyperlakemia?
dysrthymias, cardia arrest
What are EKG findings in hyperkalemia?
Peaked T waves(K+ > 6.5)
Treatment of hyperkalemia
discontinue K+ sparing diurectics, dc K supplementation/vitamins, give sodium bicarb(D50) and Kayexelate.
What is diabetes insipidius?
hypernatriumia but with decrease urinary sodium ad polyuria. Usually due to a posterior pituitary issue causing decrease secretion of ADH
What can happen if you attempt to correct hypernatremia too quickly?
pulomonary/cerebra edema - chances are increased in a diabetic patient.
What is SIADH?
hypotonic hypernatriemia in a patient with normal cardiac/liver/adrenal/renal function
Check a CT scan to rule out a CNS disorder
How do you treat SIADH
free water restriction, give isotonic saline.
What can happen if you correct a hyponatriemia too quickly?
Central Pontine mylenolysis - permanent neurologic damage.
Define Nephrotic syndrome
> 3.5 gm of protein/24 hour urine.
Causes of Nephrotic syndrome.
Primary renal - IgA nephropathy, congential, focal GN
Secondary renal- post strep GN, SLE, malignancy, toxemia of pregnancy
Discuss auto somal dominant polycystic kidney disease
Most common, found males onset 4th decade of life. present in bilateral kidneys. no treatment - just supportive until it gets bad enough for kidney transplan
What is the most common type of stone in nephroliathiasis?
calcium - 75-85% present - they are radiopague - can be seen on plain film
What type of stone has Psuedomonas/Proteus as a causative agent?
Struvite.
treamtent for a kidney stone <5mm
will pass on its own. Hydrate/ pain management. Alpha blockers and CCBs can help it to pass.
you have a patient with a kidney stone at 8mm - how would you treat/ counsel?
stone 5-10 mm may pass on own. Hydrate and manage pain. Consider early elective lithotripsy / ureteroscoic basket retrieval if signs of obstruction.
Treatment of a kidney stone > 10mm?
Ureteral stent or percutaneous nephorstomy (gold standard or treatment) there is increase risk of complications with stones of this size.
who is more common to have glomerulonephritis, kids or adults?
most common in ages 2-12, if adult onset - worse prognosis
Describe the urine found in glomerular nephritis.
hematuria that is tea or cola in color.
what type of casts are found in the urine of a patient diagnosed with glomerular nephritis?
red blood cell casts
what significance is the finding of broad waxy casts in a urinalysis?
chronic kidney failure.
what should you think of if a UA microscopic shows granular or muddy brown casts?
acute tubular necrosis
urine microscopy has maltese crosses in it. what should you think of?
nephrotic syndrome
What is the most common cause of glomerular nephritis?
post streptococcal infection. should had a + ASO titer
how would you treat glomerular nephritis?
prednisone and dietary managment
what are causes of glomerular nephritis?
post infectious, henoch-schlein purport, IgA nephropathy, SLE, vasculitis
What are common causes of acute renal failure?
pre renal (60-70% of cases)- and acute tubular necrosis (intrinsic renal)
List pre-renal causes of ARF .
hypovolemia, hypotension, CHF/cirrhosis/early sepsis, abdominal aortic aneurysm, renal artery stenosis (RAS)
What are intrinsic renal causes of acute kidney failure?
ATN, nephrotoxins, acute interstitial nephritis, SLE, glomerular nephritis, vascular disease
What are post renal causes of ARF?
tubular obstruction, obstructive uropathy (nephrolithiasis, BPH, etc)
What is nephrotic syndrome?
nephorisis is a histopathologic term for renal disease without inflammation.
Causes of nephrotic sydrome
Primary renal disease, SLE, post infection, DM, NSAIDS, lithium, toxins, pregnancy
what are the labs found in nephrotic syndrome
Proteinuria> 3.5 gm / day
hypercholesterolemia/yperlipidemia
ascitis/edema
UA has oval fat bodies/maltese crosses and fatty casts
Treatment for nephritic syndrome
diet - elevate protein to match protein loss, slat restriction, diuretics, ACEI/ARB, steroids
What are reasons to consider short term dialysis in an ARF patient?
creatinine >5-10, unresponsive acidosis, fluid overload, uremic complications
what is the normal range of PCO2
35-45 mmHg
What is the normal range of bicarb (HCO3)
22-26mEq/l
what is the most predictive factor for loss of kidney function?
albumenuria ( followed by tubular proteinuria and renal tubular cell constuituents
acuteglomerular nephritis will demonstrate what on UA?
hematuria, microsopy will reveal red blood cell casts
how do ACE inhibitors work to control blood pressure?
It blocks conversion of angiotensin I to angiotensin 2 which results in greater dilation of the efferent renal arteriole and reduces intraglomerular pressure by lowering resistance.
what is the level of album first noted in the first stage of diabetic nephropathy?
Albumenuria > 30 mg/24hours
what level does a serum glucose need to reach to be excreted in the urine?
180-200 is the renal glucose threshold
what are screening tests for chronic kidney disease?
Blood pressure, serum creat level, spot urine albumen
describe the most frequent presentation of IgA nephroplathy in kids (< 21 yo)
An episode of gross hematuria during or immediately after (1-3 days ) after URI
describe the blood flow through the glomerulus
Renal artery, afferent arterioles, glomerulus, efferent arterioles
What does the acronym RIFLE criteria stand for in AKI
risk, injury, failure, loss and end stage.
What is the most common cause of nephrotic syndrome in children? in
Minimal change disease
