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MKSAP > nephrology > Flashcards

nephrology Flashcards

1
Q

normal calcium with high pth

secondary due to CKD with normal phos

A

cannot be primary, has to be secondary

start activated vitamin D

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2
Q

hyponatremia+ normal plasma osmolarity in the presence of lipids/proteins (panc/ multiple myeloma) with no ingested osmoles

A

pseudohyponatremia

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3
Q

minimal change disease (podocyte foot processes) treatment

A

steroids, if contraindicated->cyclosporine

if refractory->cyclophosphamide

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4
Q

Thyrotoxic periodic paralysis

A

2/2 hypokalemia
precipitated by strenous exercise/high carb meal
treat hyperhyroidism

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5
Q

Metabolic alkalosis+ hypokalemia+ normal-low BP

A

Bartter syndrome

autosomal recessive

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6
Q

Preggo htn

A

No ACEI/ARB/direct renin inhibitor

labetalol if >160/105

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7
Q

lithium kidney

diagnosis

A

nephrogenic diabetes insipidus

water restriction test, then desmopressin administration

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8
Q

> 60 yo BP goal

A

150/90. Adding a second agent is more effective than increasing existing dose.

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9
Q

Acute acid-base compensation

chronic

A

for every 10 drop in co2, 2 drop in bicarb
for every 10, 4-5
for every 10 increase, 3-4

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10
Q

CKD with normal anion gap metabolic acidosis

A

oral bicarb, maintain bicarb 23-29

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11
Q

interstitial nephritis urinalysis
cause

membranous glomerulopathy

rapidly progressive glomerulonephritis

A

sterile pyuria and leukocyte casts
drugs (mesalamine)

heavy proteinuria and nephrotic syndrome (primary: anti pla2r, sec: cancer, autoimmune disease, hepatitis b, syphilis, meds). most associated with clots

hematuria, erythrocyte casts, hypertension

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12
Q

Preeclampsia

HELLP

A

hypertension+ proteinuria OR htn+end organ damage

hemolysis+ elevated LFTs+ low platelets

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13
Q

hyperphosphatemia in CKD treatment

A

sevelamer/ lanthum

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14
Q

hyporesponsiveness to EPO

give iron especially if

A

iron deficiency

transferrin <30% / ferritin <500

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15
Q

Lines in CKD5/ESRD patient

A

central venous access

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16
Q

preggo na

A

mild hyponatremia and hypo osmolality

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17
Q

IgA vasculitis (henoch-schonlein purpura)

A

URI->then fatigue, jt pain, abd pain, glumeronephritis, palpable purpura
NORMAL COMPLEMENT LEVELS

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18
Q

Vomiting urine labs

bartter
sjogren’s

A

increased sodium, low chloride, elevated urine potassium

increased everythang
hyperchloremic metabolic acidosis

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19
Q

Shiga-toxin associatd hemolytic uremic syndrome

diagnosis

A

bloody diarrhea, then microangiopathic hemolytic anemia, thrombocytopenia, kidney failure, shiga toxin e. coli

peripheral blood smear (even in TTP, smear before ADAMST13)
**can also be caused by chemo(bevacizumab, sunitinib)

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20
Q

Suspected kidney stone when CT is contraindicated (preggo)

A

kidney ultrasound

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21
Q

calcium oxalate stones with elevated urine oxalate (from too much oxalate or low calcium/fatty acids binding calcium)
deceased citrate in urine

idiopathic hypercalciuria

A

increase calcium intake/ cholestyramine (esp in patients who have undergone small bowel resection)/ UOP of at least 2L
give citrate to bind calcium in urine and prevent stones
thiazide

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22
Q

Medication induced tubulointerstitial disease (AIN/CIN) (tenofovir, PPI)

A

slowly progressive, no clear trigger, subnephrotic proteinuria, bland sediment, atrophic kidneys on u/s
glucosuria, hypophosphatemia

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23
Q

membranoprolif glomerulonephritis

A

chronic hep b, hematuria, dysmorphic casts, proteinuria, reduced GFR

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24
Q

Beware of refeeding syndrome in alcoholics and malnourished. can occur even with dextrose containing fluids, due to

A

hypophosphatemia

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25
Q

Hypertension diagnosis

Rule out meds such as

A

140/90 3 different times over 1 week or longer

NSAIDs (also cause hyperkalemia) and herbs

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26
Q

Anion gap metabolic acidosis in patients with short bowel

ethylene glycol/methanol/propylene glycol

A

D-lactic acidosis
confusion, slurred speech, ataxia

osmolal gap >10

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27
Q

dialysis catheter related infection

A

abx, then remove catheter if blood cultures are positive

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28
Q

Metabolic alkalosis with uncertain volume status

A

measure urine chloride

low: hypovolemia, give saline
high: saline resistant

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29
Q

Bilateral abdominal masses with kidney symptoms

A

ADPKD, hematuria and acute pain occur with rupture of cysts
MRA to screen for cerebral aneurysm only if family history of aneurysm/hemorrhage or personal history or occupation where sudden rupture would affect others

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30
Q

TLS

Rasburicase
Dialysis if

A

hyperphosphatemia, hyperuricemia, hyperkalemia, hypocalcemia

rapidly decreases uric acid
oliguric/anuric/persistent hyperkalemia/syptomatic hypocalcemia/

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31
Q

Rasburicase vs allopurinol

A

reduces circulating uric acid vs prevents formation

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32
Q

IgA nephropathy treatment

A

low risk: observe, serial BP, urine studies and creatinine

high risk: steroids (urine-protein creatinine ratio >1000, low GFR, hypertension, kidney dysfunction)

33
Q

preeclampsia treatment

A

delivery at 37 weeks

34
Q

FSGS

primary treatment
secondary

collapsing form FSGS caused by

A

low albumin, podocyte foot process effacement, hypertension, nephrotic range proteinuria
immunosupression
weight loss and ACEI/ARB (enlarged glomeruli, mild effacement, minimal edema)

HIV (can be slowed by HAART and ACEI/ARB)

35
Q

atheroembolism

treatment

A

peripheral eosinophilia, hypocomplementemia, eosinophiluria

supportive care

36
Q

black people hypertension

A

ccb, hctz (ccb is not first choice if patient is on statin)

avoid ACEI as they don’t work as well

37
Q

ethylene glycol intoxication

treatment

A

anion gap+ osmolal gap+ kidney failure+ AMS

sodium bicarb+ fomepizole+ dialysis+ hydration

38
Q

ESRD referral

A

stage 4-5, transplant eval once GFR<20

39
Q

Kidney dysfunction in patients who have had abd surgery, have received fluids, have ascites + tense abdomen

diagnosis

A

Abdominal compartment syndrome

bladder pressure management

40
Q

ESRD on dialysis renal cysts and atrophic kidneys

A

acquired cystic kidney disease, associated with RCC

41
Q

CKD screening in DM

A

urine albumin

42
Q

hyperosmolar hyponatremia

A

glucose: every 100 increase, 1.6 drop in sodium

43
Q

primary respiratory acidosis

A

hypoventilation, opioids

44
Q

prevent CIN with

A

IV isotonic saline, discontinue diuretics

45
Q

AIN urinalysis

A

erythrocytes, lekocytes, leukocyte casts

46
Q

coffin lid shaped crystals

A

struvite stone->removal

caused by chronic UTI with proteus or klebsiella

47
Q

worsening kidney function+ htn+ proteinuria+hematuria+ dysmorphic erythrocytes+ erythrocyte casts
fever+arthralgia+ palpable purpura+ weight loss

A

glomerulonephritis->kidney biopsy

vasculitis

48
Q

Overcorrection of sodium

treatment

A

> 8/ 24 hours

desmopressin in dextrose

49
Q

Hypertension in frail people

A

frail=can’t complete 6 meter walk in less than 8 secs
don’t need to lower
in non frail elderly people, 130/80

50
Q

Hypertension in frail people

A

frail=can’t complete 6 meter walk in less than 8 secs
don’t need to lower
in non frail elderly people, 130/80

51
Q

SIADH vs beer potomania

A

high urine osmolality

52
Q

Type 1 (hypokalemic distal) RTA

acetaminophen
Type 2 (proximal) RTA

Type 4 (hyperkalemic distal) RTA

A

hyperchloremic metabolic acidosis, normal anion gap, ph>6, stones
anion gap metabolic acidosis
normal anion gap, hypokalemia, glycosuria, proteinuria, phosphate wasting, urine ph <5.5
urine ph<5.5, hyperkalemia, hypoaldosteronism

53
Q

Aminoglycoside AKI

A

ATN, granular casts, FeNa >1%, 5-10 days after

54
Q

immunosupression complications

A

DM and HLD, HTN, infection, cancer

always check for medication interactions before starting treatment

55
Q

Stone larger than 1cm/ failed medical management/ urosepsis/ AKI/ anuria

A

mechanical removal

56
Q

IgG4 related interstitial nephritis

treatment

A

interstitial nephritis=mild proteinuria, leuks
associated with autoimmune panc, diffusely enlarged kidneys
steroids

57
Q

ANCA-associated vasculitis
anti-GBM

anti-GBM treatment
vs microscopic polyangitis

lupus nephritis

A

significant proteinuria and hematuria
pulmonary-renal syndrome, protein, erythrocytes and leuks in urine, normal complements, crescents on biopsy

cyclophosphamide, steroids, plasmapheresis
pauci immune glomerulonephritis on biopsy

significant proteinuria

58
Q

hypovolemic metabolic alkalosis normal urine response

A

low urine sodium and choride

if high->suspect diuretic use/Bartter/Gittelman

59
Q

decreased muscle mass creatinine

A

decreases

60
Q

normal anion gap metabolic acidosis workup

A

urine anion gap (Na+K-Cl)

positive: losing acid in urine
negative: GI loss (laxative abuse)

61
Q

screening in kidney transplant patients

A

skin cancer and lymphoprolif disease in addition to age and sex appropriate screening

62
Q

risk factors for AKI after cardiac surgery

A

CKD, elevated preop creatinine, age, female, LV dysfunction, DM, PVD, COPD

63
Q

bone pain + hypophosphatemia+ low 1,25 vitamin D+ normal 25 hydroxy + elevated alk phos

treatment

A

oncogenic osteomalacia

resection

64
Q

ATN with oliguria (needing dialysis) + hemodynamic instability

A

CRRT, not hemodialysis

65
Q

Bactrim causes creatinine increase without affecting GFR.

A

Continue therapy

66
Q

Feurea<35 or FeNa <1

A

pre-renal

67
Q

lupus nephritis treatment

A

Class III/IV->prednisone + mycophenolate/ cyclophosphamide

68
Q

Balkan endemic nephropathy

A

tubulointerstitial disease linked to aristolochic acid, increased risk of transitional cell carcinoma
annual urine cytology

69
Q

hemoglobinuria

A

no erythrocytes

can be caused by intravascular hemolysis from mechanical valve

70
Q

Resistant hypertension

In CKD

A

3 agents including DIURETIC. if BP uncontrolled, start diuretic.

use loop diuretic

71
Q

AL amyloidosis

A

infiltration: cardiomyopathy, organomegaly, peripheral neuropathy, purpura, macroglossia, proteinuria , diarrhea, postural hypotension

apple green on congo red staining
Myeloma proteins cannot be seen on dipstick testing

72
Q

Hematuria

glomerular hematuria

A

glomerulus vs somewhere else

tea-colored urine with dysmorphic erythrocytes+ proteinuria

73
Q

Thin glomerular basement membrane disease

hereditary nephritis (Alport syndrome)

A

family history of hematuria, normal kidney function

ESRD, x-linked, sensorineural hearing loss, lenticonus

74
Q

combination antihypertensive therapy when

A

> 20/10 above goal

75
Q

ESRD in elderly patients with plenty of comorbidities and poor functional status

A

no dialysis

76
Q

uric acid kidney stones treatment

if refractory

A

water for increased UOP, urine alkalinization,

allopurinol

77
Q

isolated hematuria in young person

A

serial kidney function and urine protein measurements

78
Q

infection related glomerulonephritis

A

treat underlying infection (hematuria and leuks in septic patient)

MKSAP (6 decks)

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