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Fun Med Renal Urology > Nephrology > Flashcards

Nephrology Flashcards

1
Q

what is the gold standard test for diagnosing renovascular disease?

A

Renal arteriography

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2
Q

Although arteriography is gold standard for diagnosing renovascular disease, what are some better options that are NONINVASIVE?

A

Duplex Doppler US
Computed Tomographic angiography (CTA)
Magnetic Resonance Angiography (MRA)

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3
Q

What is the risk of performing renal arteriography on a patient with renal dysfunction?

A

performing arteriography may precipitate atheroembolism

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4
Q

you do workup on a patient with suspected renovascular disease, and initial noninvasive test (US Doppler) is inconclusive. What is the next best option?

A

renal arteriography

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5
Q

what is the substance used in radiocontrast that can be nephrotoxic to patients with kidney dysfunction?

A

Gadolinium

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6
Q

noninvasive diagnostic kidney tests are best for _________ disease (proximal, distal, or systemic?)

A

proximal. Does a poor job of picking up plaque due to FMD

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7
Q

Which noninvasive test provides information on both structure and function of the kidneys?

A

Duplex Doppler US

preferred over CTA and MRA, because there is no contrast so it is safer!

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8
Q

which diagnostic test for kidney dysfunction still uses gadolinium?

A

MRA

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9
Q

What is the benefit of using MRA for imaging of the kidneys?

A

provides excellent view of the PROXIMAL renal artery stenosis

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10
Q

kidney noninvasive imaging ranked from most preferred to least preferred

A

Doppler US –> CTA –> MRA

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11
Q

what percentage of stenosis in one or both renal arteries is needed to DIAGNOSE renal artery stenosis by CTA/MRA

A

> 75% (or 50% with post-stenotic dilation)

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12
Q

what percentage of stenosis is needed to diagnose renal artery stenosis via DOPPLER US?

A

> 60% (peak systolic velocity >200 cm/sec)

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13
Q

Treatment unilateral/bilateral Renal artery stenosis?

A

ACE-I/ARBs first line (before considering revascularization)

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14
Q

Which is favored in percutaneous transluminal renal angioplasty (PTRA)?

A

STENT is preferred over surgery

only perform surgery in pt who have complex anatomic lesions where stenting is not possible

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15
Q

what is the limitation of management WITHOUT revascularization in FMD?

A

stenosis and kidney dysfunction may progress despite good BP control

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16
Q

treatment for FMD?

A

ACE-I/ARBs are first line

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17
Q

Is PTRA with stenting preferred as FMD treatment?

A

PTRA is preferred over surgery, but WITHOUT STENT PLACEMENT!

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18
Q

do you place a stent via PTRA in FMD?

A

NO!

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19
Q

True or false: start a patient w/ FMD on a statin with their antihypertensives

A

FALSE! - these patients do not have atherosclerosis in their lumen, they have connective tissue replacing normal epithelium, so statins WONT HELP

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20
Q

How often does BP and serum creatinine levels need to be monitored in patients with FMD who are only treated with medication?

A

every 3 months

if stabilizes, then annually.

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21
Q

what is the new ACC/AHA target BP for all patients?

A

130/80

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22
Q

New guidelines for treating patient with 130-139/80 BP?

A

nonpharmacologic therapy

“elevated”

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23
Q

what is the disorder called when a stenotic lesion in the renal artery increases the SVR, increasing BP?

A

Renal artery stenosis

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24
Q

what are the 2 major causes of renal artery stenosis?

A

Atherosclerosis

Fibromuscular dysplasia

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25
Q

Which is more common, unilateral renal artery stenosis or bilateral stenosis?

A

unilateral

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26
Q

True or false: patients with renal artery stenosis are assumed to have coronary artery disease until proven otherwise

A

TRUE

treat like you would CAD:
statin, ASA, BP control, smoking cessation

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27
Q

Atherosclerosis in the renal arteries is commonly distal or proximal?

A

proximal

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28
Q

This renal disorder is considered non-inflammatory, non-atherosclerotic disorder that leads to arterial stenosis, occlusion, dissection

A

Fibromuscular dysplasia (FMD)

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29
Q

you may see a string of beads on imaging with this renal disorder

A

FMD

30
Q

young patient is having recurrent episodes of flash pulmonary edema and an acute rise in serum creatinine of >30%, AFTER initiating an ACE-I. what is your most likely dx?

A

Renovascular disease, most likely FMD.

31
Q

Considering a CKD diagnosis requires decreased kidney function for how long?

A

> 3 months

32
Q

What is the most frequently assessed marker of kidney damage?

A

Albuminuria

33
Q

what imaging abnormalities might you find while looking at the kidneys of someone with CKD?

A

hydronephrosis, echogenic kidneys, polycystic kidneys

34
Q

What is used to measure decreased kidney function?

A

GFR/eGFR

Threshold <60

35
Q

The G-stages of CKD begin to accompany SYMPTOMATIC disease at which stage?

A

G3a (<60)

36
Q

True or false: those with CKD should also be assumed to have Coronary artery disease until proven otherwise

A

TRUE

37
Q

How to treat volume overload in someone with CKD

A

sodium restriction

Loop diuretics

38
Q

what is the caution regarding handling a CKD patient with metabolic acidosis?

A

bicarb supplements need to include CLOSE monitoring of volume status.

39
Q

How do you handle mineral and bone disorders in a CKD patient?

A

phosphate restriction and administration of CALCITROL

40
Q

how to manage a CKD patient with HTN

A

begin with ACE/ARB + diuretic + thiazide diuretic.

Then add Loop diuretic for volume overload

41
Q

is it ok to add a loop diuretic to the thiazide?

A

YES - they have an additive effect and it is safe

42
Q

True or False: anemia of CKD is normocytic and normochromic

A

True

43
Q

What are the characteristics of RBCs in someone with CKD

A

Reduced production of erythropoietin and shortened RBC survival

44
Q

True or false: the triglycerides in a CKD patient are NORMAL while the total cholesterol is HIGH

A

FALSE - hypertriglyceridemia, and normal total cholesterol

45
Q

Which vaccines should you give a patient with CKD?

A

influenza
pneumococcal
Hep B

46
Q

In AKI, what is the hallmark amount you will see creatinine increase?

A

1-1.5 mg/dL daily

47
Q

patient with suspected AKI is experiencing a 2.2-fold increase in serum creatinine, and you check the time frame, noting that it has been 16 hours since admission. What stage AKI are you suspecting?

A

stage 2

48
Q

what is the 3rd leading cause of new-onset AKI in hospitalized patients?

A

Radiographic contrast media

49
Q

most common cause of post-renal AKI in MEN?

A

BPH

post renal is likely due to obstruction

50
Q

Your hospitalized patient is on Vancomycin, is a diabetic, and needs repeat imaging for further assessment of kidney function. You notice she has had radiographic contrast media 20 hours ago. Should you undergo the imaging with contrast?

A

NO! assess patient’s risk for AKI as radiocontrast is directly nephrotoxic

diabetes + kidney dysfunction are at higher risk for contrast nephropathy

51
Q

What will serum creatinine levels look like in “abnormal” kidney function?

A

Elevated - unhealthy kidneys cannot filter creatinine effectively so it gets reabsorbed into the serum

52
Q

after obtaining a urinalysis, you see “muddy brown casts” on urinalysis. What is your most likely diagnosis?

A

ATN (acute tubular necrosis)

53
Q

what is the most common cause of AKI?

A

Pre-renal causes (renal hypoperfusion)

54
Q

if your diabetic patient absolutely NEEDS the imaging study with the contrast, what do you administer?

A

1 Liter 0.9% IV saline over 10-12 hours BEFORE AND AFTER contrast is administered

(also tell patient to avoid other nephrotoxic agents the day before and after)

55
Q

treatment for ATN (acute kidney injury subcategory)

A 
avoid volume overload
avoid hyperkalemia
Adjust doses that are renally cleared
ACUTE DIALYSIS
(nephrology referral)
56
Q

What are the 3 phases of ATN?

A

initial injury
maintenance (1-3 weeks)
recovery

57
Q

what do you need to be cautious of after treating Post-renal AKI?

A

post-obstructive diuresis

monitor volume status so patient isn’t losing too much

58
Q

Your patient has AKI, and it is suspected that it is post-renal causes. They need to undergo which procedure first?

A

Bladder catheterization!

DO NOT cath anyone with cancer

59
Q

What is the imaging study of choice for a patient with suspected post-renal AKI?

A

Ultrasound

+/- CT scan if needed

60
Q

What causes 70% of acute interstitial nephritis?

A

DRUGS (medications!)

NSAIDs penicillin, cephalosporin allopurinol, PPIs

61
Q

Describe acute interstitial nephritis

A

interstitium is inflamed, the edema causes cell damage to kidney.

62
Q

A patient presents with Fever, rash, and arthalgias. What is your FIRST plan of action regarding tests/imaging?

A

GET A KIDNEY PANEL FIRST!

to assess for acute interstitial nephritis

63
Q

Pathophysiologic disorder where acute or chronic deterioration of one organ causes acute/chronic deterioration of the other (ex: heart and kidneys)

A

Cardiorenal syndrome

64
Q

what are the subtypes of interstitial AKI?

A

Acute tubular necrosis (ATN)
Acute interstitial Nephritis
Glomerulonephritis
Cardiorenal syndrome

65
Q

difference between volatile acid and nonvolatile acid

A

volatile: readily evaporates (carbs and fat)
nonvolatile: must be excreted by kidney (amino acids)

66
Q

which takes longer, compensation by kidneys or lungs?

A

kidneys take days (lungs take minutes)

67
Q

potassium is controlled by ______ at what part of the nephron?

A

Aldosterone; collecting duct

68
Q

altered sensorium is commonly seen in patients with ___?

A

acute kidney injury - build-up of materials causes confusion

69
Q

what can be seen in labs several days prior to AKI?

A

platelet dysfunction - you’ll see a steady decline = red flag

70
Q

“muddy brown casts” on UA is suggestive of what?

A

Acute tubular necrosis AKI

71
Q

if patient has fever + rash + arthralgias what are you thinking (kidney-wise)

A

do a workup! could be intersitital necrosis

Fun Med Renal Urology (2 decks)

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