Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

OME > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Patient presentation of kidney stone

A

o Colicky flank pain
o Radiates to groin
o Nausia / vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

• How to tell pyelonephritis from a kidney stone and Renal cell carcinoma

A

o Pyelonephritis will have fever and WBC casts*
o RCC will have palpable mass
o All could have hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tests to order if kidney stone is suspected

A

o UA
o Noncon CT is gold standard. IF PREG: use US
o NO KUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

• UA of kidney stone

A 
o	Blood (even microscopic hematuria) (Note: in the absence of blood,  probability of symptomatic stone is low) 
o	Absence of casts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

• Treatment of stone and Difinitive Management based on size of kidney stone

A

o IVF and analgesia
o < 0.5mm : Pass spontaniously: Hydration and pain control
o 0.7 – 1.5 mm : Medical Exulsive therapy: CCB (amlodipine) and/or Alpha blockers (terazosin
o > 1.5mm : Resection (laproscopic (proximal) / lithotripsy (distal)
o Strain and analyze stone, 24 hr urinalysis in 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Radio opaque vs radio leucent stones with causes

A

o Opaque: Calcium oxalate / Magnesium Ammonium Phosphate

o Leucent: Uric acid / cystine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

• What happens in hyponatremia and hyper

A

o Hyponatrimia – less in blood, fluid extravisates into body
o Hypernatrimia – more in blood, fluid extravisates into blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  • Hypernatrimia
  • What is it
  • How do you fix it
A

o Always a deficiency of water
o Fix is with PO water if possible. Consider hypotonic sulutions such as D5W or 1/2ns.
Before replacing the free water deficite, fix volume with NS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

• Hyponatrimia AND hypernatremia –sxs in Mild vs Moderate vs Severe state

A

o Mild – asymptomatic
o Moderate – Nausia, vomiting, headache
o Acute / Severe – Coma, Seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

• Tx for severe state hyponatremia

A

o Coma / Seizure

o Hypertonic Saline (3%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

• How fast can you correct hyponatremia?

A

o No faster than 0.25 mmol / hr OR 6 in a day
o Usually symptoms will go away after a day of treatment
o Correction Too fast will lead to osmotic demyelination syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

• General rules of thumb when looking at Urine osms and Na in a patient with hyponatremia

A

o If urine Na is low – kidneys are working, low perfusion is cause
o If urine has high osms [ ] then ADH is high.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

• Euvolemic Hyponatremia

A 
o	RATS
o	Renal Tubular acidosis  (UA) 
o	Addisions ( urine cortisol) 
o	Thyroid disease (TSH) 
o	SIADH (dx of exclusion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SXS of volume up

A

o JVD
o Edema
o CHF
o Anasarca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

• Sxs of volume down

A

o Dry mucous membranes
o Tachypnia, Hypotension
o Fevers
o Burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

• SIADH tx

A

o Volume restriction
o Possible gentle diuresis
o If refractory – demeclocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

• Steps to make DX of cause with Na <135

A

1) Determine serum osmoles – for every 100 glucose over 100, subtract 1.6 Na

2) Volume status?
Overload (hypervolemic)
— Determine cause and diurese

Normal (Euvolemic)
—- RATS – UA, Cortisol, TSH

Down
IVF – see if it corrects
Urine Na
Intrarenal – High urine Na: ATN AIN

Extranrenal - low urine Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

• Calculation fo Serum Osmoles

A

o 2xNa + gluc/18 + BUN/2.8

o Normal is 275-295

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

K normal

A

o 3.5-5.5

o >4 is normal in cardiac patatients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  • Sxs of hyperkalemia

* Exam Findings of hyperkalemia

A 
Usually its asymptomatic. If severe pt will report 
o	Decreased motor, dec sensation 
o	Flaccid paralysis
o	Parestheisea
o	Chest pain / palpitations 
EXAM may show
o	ECG changes 
o	Areflexia
o	Numbness 
`
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

• First thing to do when there is a high K level?

A

o Repeat lab

o ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

• DDX of hyperkalemia

A 
o	Artifact
o	K-sparing diuretics (Ace, Arb, Spironilactone ) 
o	Hypoaldosterone 
o	CKD / RTA 
o	Ingestion
o	Hemolysis 
o	Iatrogenic (over administered)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

• Findings of High K on ECG

A

o PR prolongs
o QRS widens
o T waves Peak

24
Q

• 3 stages of treatment of hyperkalemia

A

o I : Stabalize myocardium with calcium gluconate
o II: Dec serum K : Insulin + glucose or Bicarbonate
o III: Dec total body K with Kayexalate or diuretics
o If Renal failure or extreme ECG changes, dialysis
o NOTE: if stable – just give kayexelate

25
• Causes of Hypokalemia
GI loss ♣ Vomiting ♣ Diarhea ♣ Laxatives Renal Losses ♣ Hyperaldosterone (primary or secondary) ♣ Loop diuretics ♣ Thiazide Diuretics
26
• Replacement of K
o Oral preferred | o IV: <10meq/hr peripheral or <20 central
27
What are the regulators of calcium? What is it bound to? How to adjust for Alb?
``` o Clacitonin o PTH ♣ Activates osteoclasts ♣ Kidneys: Ca in, P out ♣ Inc Vit D 1,25absorb Ca and P from gut ``` o Mostly bound to albumin. Very little is ionized ♣ Alb adjust: every point below 4, add 0.8 Ca
28
Symptoms of hypercalcemia
Bones – fracture, osteopenia Psychic Moans – AMS only if severe – 13-15 Stones Abdominal Groans – (Nausia, Vomiting, abdominal pain)
29
TX of hypercalcemia
o IVF – always first line o Furosimide – inc naturesis and Ca exc but ONLY when volume status is corrected o Calcitonin – acts / fades fast o Bisphosphonates – long term
30
DDX of Hypercalcemia
``` o Primary, secondary, tertiary hyperparathyroid o Familial hypocalciuric hypercalcemia o Malignancy o Immobilization o Vit D excess ```
31
``` Primary Hyperparathyroidism. Cause labs an interesting sequellae, dx tx FU ```
Cause: Single autonomous gland PTH Labs: High Ca, Low P Seq: Could get Brown tumor (fibrosa cystica) – osteoclast stimulation DX – radionucliotide scan. (sestamibi) TX – resection FU – watch for hypocalcemia on FU (Hungry bone syndrome)
32
Secondary hyperparathyroid - cause - labs
Cause: Erly renal failure – vit D not made – causes low Ca, so inc PTH and parathyroid hypertrophy Labs: High Ca, Low P
33
``` Tertiary hyperparathyroid: Cause labs tx a note ```
o Continued renal failure causes PTH glands to become autonomous (just like primary) o Labs: High Ca, Low P o TX –resction o Note: no risk of cancer
34
Familial Hypocacciuric Hypercalcemia: ``` Cause Labs Sxs tx sequellae ```
o Cause – abnormal calcium sensing receptor, so new set point. o Labs: inc Ca, low P (inc PTH) o SXS, Asymptomatic o TX – none o Sequellae: inc risk of stenotic aortic disease in old age
35
Malignancy - two ways it can cause increased Ca
PTH-rp – looks like primary hyperPTH but low PTH ♣ High Ca, Low P Mets – way high Ca ♣ High Ca, High P
36
Immobilization as cause of inc in Ca. Cause labs sxs tx
o Cause – dec impact stress o Labs- low PTH , Inc Ca, Inc P, o Sxs – asx o Tx – inc movement
37
Vit D excess as a cause of inc Ca Cause labs tx
o Cause: granulomatous dz: TB, sarcoid o Labs –low PTH, Inc P, Inc Ca o Tx – steroids to treat dz
38
Hypocalcemia DDX – extensive
Hypoalbuminemia (adjuct fo alb and ca will normally correct) ♣ Cirrhosis, Nephrosis, poor nutrition Hypoparathyridism ♣ Iatrogenic (postsurgical “hungry bone” which means atrphyied glands) Vit D deficiency ♣ Renal failure ♣ Sunlight / diet deprivation ♣ These lead to secondary hyperparathyroidism – initially though there will be decreased Ca CRF Calcium Sequestration ♣ PANCREATITS Pseudohypoprarthytroidism
39
Sxs of Hypocalcemia tx
SXS Perioral tingling Tetany (chovstek = chvozTAP , trassaue = arm) TX replace Ca: PO Ca and Vit D If non emergent. IV if emergent
40
Pseudohypoprarthytroidism – what it is and why the name is bad, labs
o High PTH due to end organ resistance | o High Ca, high P but everything is functioning normally. ignore it.
41
Hypoparathyridism, cause and labs
``` o Iatrogenic (postsurgical “hungry bone” which means atrphyied glands) o Labs – dec PTH, Dec Ca, Dec P ```
42
Presentation of AKI
o Elevate Cr o Decreased urine output Note: Kidneys are redundant, so electrolytes will not be out of wack until GFR is severely reduced. Patient will likely be asx and it will be noted on routine labs
43
Prerenal AKI Cause Labs TX. Note on most common cause in outpatient
Cause: Low perfusion Make sure to check volume status! (ask about this in the future) Labs: Low Urine Na, Low Fe Na (Make sure patient not on diuretic) BUN/CR >20 TX Volume Down - fluids (this is prerenal azotemia (gentle diuresis if vol up?) Note: prerenal azotemia is most common cause in outpatient setting.
44
``` Postrenal AKI: Cause, DDX, DX, TX depending on location ```
Cause: obstruction DDX Distal: BPH, Neurogenic bladder, Kinked cath Proximal: stones and cancer DX – US preferred, CT can be used. TX – Distal – cath. Poximal – stent, nephrostomy tubes, surg
45
• Intrarenal AKI ddx and qyick notes about each
ATN ♣ Ischemia ♣ Toxin exposure ♣ Muddy brown casts – phases of recovery AIN ♣ Drugs, infection, deposition dz ♣ RBCS, WBCS , eosinophils Glomerularnephritis ♣ RBC casts. TONS of causes. Lupus, IgA neph, goodpast, HSP, etc ♣ Rule out nephrotic synd with with UA spot test / 24 hr urine
46
AEIOU
``` reasons for dialysis A - acidosis E -electrolytes (K) I - intoxicants / toxins (methanol ethylene glycol, Li, ASA) O - overload U - uremia ```
47
You have ARF, how do you work it up?
Order U-Na, FEna BMP for Bun / Cr levels (will rule out Pre renal) US – R/o post renal Then get a UA
48
• Goals of CKD Treatment
Prevent progression ♣ If HTN or Protinuria – Ace / Arb ♣ If DM – Annual UA with goal A1C <7 Manage Complications ♣ Anemia – from dec EPO. Give Iron / EPO. Goal Hg >10. Transfusions w/ dialysis if refractory. ♣ Secondary hyperparathyroidism – A product of phosphate retention (inc PTH!) and Vit D def (no conversion to 1,25). Give binders (sevelamir – causes excretion of P in gut) and calcimimetics (Cinacalcet – acts like Ca, lowers PTH needs). Osteoporosis from long term high PTH – dexa >-2.5 – prev with Calcium and Vit D supplementation. ♣ Volume Overload – due to loss of urinary output. Stilulate nephroms that are working with Furosimide intially, can add metolazone. Ultimately dialysis Acidosis – will cause bicarb between
49
• General Pathology of CKD
o Over three months of reduced GFR (60ml/hr), this will cause the Cr to rise (above 2 generally)
50
Stages of CKD
``` ♣ 1 Above 90 ♣ 2 60-90 mild ♣ 3 30-59 Moderate ♣ 4 15-30 Severe kidney disease - Prep dialysis / xplant ♣ 5 <15 Kidney falure - Dialysis ```
51
How to determine if acid base disturbance is resp vs metabolic
♣ pH above or below 7.4? | ♣ Is the Co2 above or below 40
52
What would indicate metabolic acidosis, and what would you do next. What would DDX be
Labs: pH < 7.4, CO2 < 40 Next: Calculate Anion Gap: Na – Cl – Bicarb ♣ Gap above 12: MUDPILES. gap below 12: do urine anion gap Na + K – Cl ♣ If positive – RTA ♣ If negative – Diarhea
53
MUDPILES
``` Acronym for high anion gap metabolic acidosis M methanol U uremia D KA P paradehyde - ignore I iron - izoniazid L lactiac acidosis E thalyne glycol (antifreeze) S salicylates ```
54
What labs indicate resp acidosis, and what is the DDX
Labs pH < 7.4, CO2 >40 ``` DDX: Hypoventilation • Opiates • COPD • Asthma • OSA ```
55
What labs would indicate Resp Alkalosis and what is the DDX
♣ pH > 7.4, CO2 < 40 ♣ Hyperventialation • Pain • Anxiety • Hypoxia
56
What labs would indicate Metabolic Alkalosis what do you do next If it is volume responsive, general treatment for each.
♣ pH > 7.4, CO2 < 40 ♣ Get a urine Cl to rule out weird stuff: if >10 then consider Hyper aldosterone (RAS, Conns* will also have htn!) or genetics (Bartter, gitelman) ♣ If <10, then it is volume responsive: DDX inc Diuretics, dehydration emesis NG suction Diuretics - Red dose. Can add K sparing diuretics (spironilactone, amiloride, eplerinone, triamterine) / acetazolamide can be added dehydration - Fluids emesis - anti emet. NG suction - if has to continue, use PPI or H2blockers to lower secretion
57
• Triad for RCC, risk factors, workup, worried about
o Flank pain, flank manss, hematuria (almost garuntees cancer) o RF – VHL gene, smoking, ESRD. o Workup: UA, US or CT, then BX /resect o Worry about renal vein thrombosis, anemia, polycythemia

OME (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions