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Foundations II Exam 5 (Jess) > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What are the MC ways to get imaging on kidneys?

A

US and CT

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2
Q

What is the benefit of US?

what is is not good at identifying?

A
  • safe/easy to use
  • initial test MCly used
  • choice for obstructive dz

less sensitive to renal masses

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3
Q

US with doppler is used for what?

A

assess vascular flow

MR/CT more sensitive

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4
Q

What are benefits of CT?

A

Gold standard for renal stones

  • locate ureteral obstruction
  • higher sensitivity for PKD
  • Evaluate tumor
  • dx RVT
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5
Q

Who can you not give gadolinium to? why

A

in moderate to advanced kidney disease (GFR < 30)

leads to nephrogenic systemic fibrosis

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6
Q

What are ateriorgraphy and venography used for?

A

arterial and venous occlusions

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7
Q

What is intravenous pyelogram (IVP)?

A

used for caliceal anatomy, size of kidney, shape of kidney

high sensitivity and specificity for stones

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8
Q

Indications for renal biopsy?

Not indicated?

A

Indicated:
Nephrotic syndrom
acute nephrotic syndrome
unexplained ARF

NOT:
Isolated glomerular hematuria
low grade proteinuria

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9
Q

What is hydronephrosis?

how does it present?

A

Unilateral or bilateral edema of the collecting system

almost always asymptomatic
possible pain or change in UOP

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10
Q

What are causes of obstructive hydrogenphrosis? What do you do for dx?
Tx?

A

-bladder outlet obstruction consider GI and GYN masses, stones, BPH

US

stent

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11
Q

What are causes of non obstructive hydrogenphrosis? What do you do for dx?
Tx?

A

Large diuresis can distend intrarental collecting system (EX. Diabetes insipidus)

-CT if US is not indicative

stent

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12
Q

What is AKI? Is it reversible/not?

A

abrupt (w/in 48 hrs) decline in renal filtration function

usually reversible

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13
Q

What are lab values for acute renal failure?

A
  • decrease in GFR
  • UOP less than 0.5 ml/kg/hr for > 6 hrs
  • increase in Urea and creatinine (azotemia)
  • serum creatinine increases abruptly by more than 50% of baseline
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14
Q

What are the levels of kidney failure? (RIFLE)

A

R- risk of renal dysfunction
GFR decrease more than 25% and UOP less than .5 mL x6 hrs

I- injury to kidney
GFR decrease more than 50% and UOP less than .5 x 12 hrs

F-failure of kidney function
GFR decrease more than 75% and UOP less than .5 x24 hrs

L- loss of kidney function
for more than 4 weeks

E- end stage Renal dz
more than 3 months

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15
Q

Examples of pre-renal AKI?

A

Anything before the kidneys

renal hypo perfusion, hypovolemia, shock, GI fluid loss, poor fluid intake

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16
Q

Examples of intrinsic AKI?

A

damage to the glomeruli, tubular or interstitial, glomerularnephritis, acute tubular necrosis

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17
Q

Examples of post-renal AKI?

A

Obstruction nephrology: prostatic hyperplasia, neoplasia, nephrolithiasis, tumors

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18
Q

MC type of AKI?

A

Prerenal

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19
Q

Causes of Prerenal AKI

A

hypo perfusion leading to decrease in renal perfusion:

  • decrease in intravascular volume (hemorrhage, gI losses, burns, dehydration)
  • change in vascular resistance (cirrhosis, sepsis, anaphylaxis)
  • low CO (CHF, PE, tamponade)
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20
Q

What will the BUN/Cr ratio be in prerenal AKI?

A

upper limit of nl 20:1

increase ratio in prerenal dz

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21
Q

Tx for prerenal AKI? Avoid?

A

Tx: maintain envolemia

Avoid: nephrotoxic drugs (NSAIDS, ACEI, Digoxin)

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22
Q

Intrinsic causes of AKI? (types)

A
  • acute tubular necrosis (ATN)
  • interstitial (AIN)
  • glomerular (GN)
  • vascular
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23
Q

Acute tubular necrosis is causes by?

characteristic KEY WORDS?

A

muddy brown casts;
ischemia, nephrotoxin, sepsis

  • tubular damage due to ischemia or nephrotoxins (ahminoglycosides, vancomycin, contrast)
  • prolonged hypotension/hypoxemia
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24
Q

Tx of Acute tubular necrosis?

Avoid?

A

avoid volume overload
avoid hyperK
protein restrict
+/- diuretics

-Give N-acetylcystine/IVF w/ bicarb to renal protect from radiographic contrast

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25
Q

What is AIN? causes of AIN?

A

Inflammatory response leading to edema and possible tubular cell damage

70% caused by nephrotoxic drugs
(others= strep infections)

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26
Q

What will UA show in AIN? how do you treat?

A

Eosinophiluria

steroids +/- dialysis

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27
Q

What is GN caused by?

A

Immune complex deposition/etiology:

  • IgA nephropathy (Berger dz)
  • postinfectious strep GN
  • MPGN, Goodpastures, Wegeners
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28
Q

What does UA in GN show? Tx?

A

UA: RBC casts (bleeding from kidneys)

Tx: steroids, plasma exchange

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29
Q

What type of Intrinsic AKI is MC?

A

ATN- 85%

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30
Q

What are causes of post renal AKI?

A

Obstruction:

BPH, urolithiasis, bladder dysfunction, bladder CA

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31
Q

What is a common sx of pt w/ postrenal AKI?

DX? Tx?

A

Lower abd pain

Dx: bladder US, elevated BUN/Cr ration

Tx: catheter, stent, surgery depending on etiology
(key point= fix whatever is causing obstruction)

32
Q 
Again,
What is tx:
Prerenal
intrarenal
Postrenal

Tx for all?

A

prerenal: IVF w/ goal to nl hemodynamics
intrarenal: avoid nephrotoxic agents

Postrenal: removal of obstruction

For all: consider short-term dialysis

33
Q

What should be considered when debating to dialyze or not? (Who should have dialysis)

A
  • weight
  • Physical exam/ fluid overload
  • UOP/uremic complications
  • unresponsive acidosis pH < 7.1
34
Q

What are the stages of Chronic Kidney Disease?

A

1-5
1, 2, 3a, 3b, 4, 5

5= ESRD

35
Q

What does GFR tell you?

A

Degree of impairment

varies by age, gender, body size

36
Q

What is creatinine?

What is it dependent on?

A

Waste product of creatinine phosphate from muscle which passes in the blood through kidneys

*Dependent on muscle mass

37
Q

What is Azotemia? What is it measured by?

A

Nitrogen in the blood

Measured by BUN and Cr (markers of nitrogen accumulation)

38
Q

Why does Azotemia occur? What does it lead to?

A

Occurs when renal fxn can no longer efficiently clear metabolites

results from renal parenchymal damage

Leads to uremia

39
Q

Uremia is monitored by what? What stages is it in?

A

Monitored w/ blood urea nitrogen (BUN), urea produced by liver excreted by urine

stages 3-5

40
Q

Sx of Uremia

A

lotssssss some are:

malaise
N/V
insomnia
cardiac arrest
weight loss
HTN
ecchymosis
Kussmaul respirations
41
Q

Dx studies for CKD?

A

GFR= gold standard!

BUN and Cr elevated, proteinuria, microalbuminuria may be present in early stages, Abnormal hgb, hct, lytes, UA

42
Q

Tx for CKD?

A
  • slows progression: ACE/ARB
  • Epo, Fe, antiplatelet therapy (goal hgb 11-12)
  • low protein diet, fluid restriction, Ca/VitD supplementation
  • dialysis/transplant
43
Q

Hypervolemia causes what and is seen in what?

A

Causes hyponatremia w/ hypervolemia

seen in CHF, nephrotic syndrome, ESRD

44
Q

In Hypervolemia, what happens to HgB and Hct?

Tx?

A

Decreased

fluid restrict
consider diuretic therapy or dialysis

45
Q

Hypovolemia is caused by?

what happens to HgB and Hct?

A

lost from extracellular compartment > intake
-usually GI tract, kidneys

Hgb and Hct increase, urine Na down, Urea increases

46
Q

Tx of hypovolemia

A

Give isotonic IVFs

rapid correction can lead to central pontine myelinoysis

47
Q

What is polycystic kidney disease? Signs/sx?

A

multiple b/l cysts, (autosomal dominant MC 75%)

hematuria, infection, pain from rupture, nephrolithiasis, nocturia

weight loss, early satiety, N/V

48
Q

Dx tool for Polycystic kidney dz? Tx

A

US is choice method

Tx: pain management, ACE/ARB, aggressive abx if symptomatic, transplantation

49
Q

Diabetes Mellitus causes…

A

1/2 of ESRD cases!

50
Q

What should be avoided in pts w/ Cr greater than 1.4 in women and 1.5 in men?

how many days after scan do you hold it?

A

Metformin

2 days

51
Q

MC cause of renal artery stenosis?

A

atherosclerosis

52
Q

Dx and tx of renal artery stenosis

A

Dx: renal angiogram is gold standard
however, Doppler US is good start

Tx: angioplasty, +/- stenting

53
Q

DX and Tx of renal htn?

A

Dx: 2 episodes of SBP > 140 or DBP > 90

Lifestyle modifications then medications
-thiazide diuretic, ACE/ARB, Ca chan blockers

54
Q

MC sx of HTN?

A

Trick-

usually asymptomatic

55
Q

SLE is MC in? What does it cause

A

young female 9x more likely than males

Nephritis w/ proteinuria

56
Q

Types of stones in Nephrolithiasis?

are they radiopaque or radiolucent

A
  1. Calcium 75-85%- - radiopaque
  2. Uric acid- radiolucent
  3. Cystine- radiolucent
  4. Stuvite- radiopaque. Pts w/ UTIs and recurrent caths
57
Q

Most of Glomerulonephropathies are seen in?

A

kids ages 2-12 60%

58
Q

Signs of Nephritic syndrome?

Tx?

A

hematuria, RBC casts, mild proteinuria, hTN

RBC casts present!

Tx: diuretics, salt/water restrict, dialysis

59
Q

Sx of nephrotic syndrome?

A

Hypoalbumunemia
heavy proteinuria
hyperlipidemia
edema

60
Q

Major causes of death for dialysis pts?

A

CV disease, infection, withdrawal from dialysis

61
Q

What is KDRI? Explain

A

Kidney Donor risk Index summarizes risk of graft failure

KDPI 80% has higher expected risk of graft failure t

62
Q

Antibodies in recipient blood can cause reaction resulting in a positive crossmatch

A

previous tip
pregnancy
blood transfusions

63
Q

What do you need to watch for post transplant?

A
  • new meds and drug-drug interactions
  • hyper/hypoglycemia
  • HTN/hypotension
  • N/V/D
  • wound complications
  • anemia
  • watch for hyper/hypovolemia
64
Q

Hyperkalemia:
sign on ekg
tx

A

Sx: peaked T waves

hemodialysis, sodium bicarbonate, D50 + insulin, Kayexalate

65
Q

Hypercalcemia:

sx

A

sx: bones, stones, and groans

common in hyperparathyroid and malignancies

66
Q

Hypocalcemia:

sx

A

Trousseau sign (carpal tunnel spasm)

Chevostek sign (spasm of facial muscles)

67
Q

hyperphosphatemia cause?

hypophosphatemia?

A

Hyper: MC 2/2 CKD

hypo: EtOH

68
Q

Hypomagnesemia sign on EKG?

A

widening of QRS

69
Q

HbA1C is ___ or great to dx DM?

A

6.5%

70
Q

Type 1 DM characteristics, sx

A

autoimmune, early onset, risk of DKA

sx: polydipsia, polyuria, nocturia, gastroparesis

71
Q

Type 2 DM characteristics

A

later onset, +FH, obesity, hyperinsulinemia

72
Q

What dz is a risk factor in pts who have kidney/pancreas tx?

A

Gastroparesis

tx: metoclopramide, domperidone, erythromycin

73
Q

What is key in preventing rejection after transplant?

A

Always steroids

74
Q

What is Cytomegalovirus?
sx?
tx?

A

CMV MC viral infection found in immunocompromised pts

most prominent 1st 3 months

fevers, malaise, arthralgias, lymphocytes, thrombocytopenia

gastroenteritis, myocarditis, pneumonitis, fatality

tx= antivirals

75
Q

EBV and BK virus causes what?

A

mononucleosis

45-50% reactivation after kidney transplant

76
Q

What is the 2nd leading cause of death in liver transplant recipients?

A

Malignancy

Foundations II Exam 5 (Jess) (7 decks)

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