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Step 2 Rotation Cards > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Pre Renal causes of Acute Kidney Injury (AKI)

A

MI, CHF
nephrosis, cirrhosis, gastrosis - all lower albumin

diuresis, dehydration, diarrhea, and da hemorrhage
fibromuscular dysplasia, renal artery stenosis

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2
Q

presentation of fibromuscular dysplasia in AKI

A

young women with secondary HT and renal failure

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3
Q

Post Renal causes of AKI

A

obstruction levels

  • ureters - cancer and stones
  • bladder - cancer, stones, neurogenic bladder
  • urethra - cancer, stones, BPH, kinked foley, etc
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4
Q

Intra renal causes of AKI

A

glomerulonephritis

Acute interstitial nephritis (AIN)

Acute tubular necrosis (ATN)

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5
Q

glomerulonephritis and AKI

A

intrarenal cause

RBC casts - r/o nephrotic syndrome (>3.5 g protein per day and increased cholesterol and edema)

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6
Q

AIN and AKI

A

WBC casts, WBCs eosinophils
caused by infections and rxn to meds
- TMP-SMP, PCNs and cephalosporins

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7
Q

ATN and AKI

A

muddy brown casts
ischemia or exposure to toxins
IV contrast or myoglobin
–> tx = vigorous IVF

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8
Q

ATN phases

A

prodrome - increased Cr
oliguric - decreased urine output
polyuric - increased urine output

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9
Q

AKI workup

A

increased Cr –> r/o pre renal –> check:

  • BUN/Cr –> if >20 = prerenal
  • Una —> if <10 = prerenal
  • Fena —> if <1% = prerenal
  • Feurea —> if < 35% = prerenal

if Pre Renal –> volume down –> IVF
–> volume u –> diuretics

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10
Q

AKI workup if not pre renal

A

r/o post renal –> US or CT –> hydroureter or hydronephrosis –> if post renal –> tx = foley/ nephrostomy/sx—- > if NOT post renal –> intra renal

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11
Q

AKI workup if not post renal

A

Intrarenal –> Hx and PE –> UA –> Dx

  • may have to do a biopsy to –> Dx
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12
Q

Acute indications for hemodialysis

A 
A - acidosis
E - electrolytes - Ca and K+
I - intoxications 
O - overload 
U - uremia
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13
Q

CKD stages

A

I - GFR >90
II - GFR 60-89
III - GFR 30-59 - complication management
IV - GFR 15-29 - prepare for dialysis - put in AV fistula if HD is next step
V - GFR <15 - ESRD - perform dialysis

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14
Q

types of dialysis

A

HD - 3/wk - 4hrs in length

Peritoneal dialysis - every night - 6-8hrs in length

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15
Q

preventing progression of CKD

A

HTN - goal <130/<80 - ACE-I or ARB

DM - goal A1c <7 - blood glucose 80-120 - oral meds (not metformin or insulin)

Proteinuria - ACE-I or ARB + low protein diet

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16
Q

complications of CDK

A 
Anemia 
secondary hyperparthyroidism 
mineral bone disease 
volume overload 
metabolic acidosis
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17
Q

anemia of CKD

A

kidneys make EPO - decreased EPO - decreased Hgb
pt asymptomatic Hgb <12
dx - of exclusion

tx - iron supp, EPO, transfusions - goal Hgb >10

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18
Q

secondary hyperparathyroidism of CKD leading to mineral bone dz path

A

increased PO4 + decreased Ca –> increased PTH –> increased bone reabsorption –> mineral bone disease

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19
Q

presentation and dx of secondary hyperparathyroidism in CKD

A

asymptomatic, if Ca x PO4 >55 -> risk for caclphylaxis (ulcerations of skin)

dx - BMP - Ca and PO4

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20
Q

tx of secondary hyperparathyrodism in CKD

A

phosphate binders - sevelarer - decreased PO4 —> decreased PTH

calcimimetics = cinacalecet

Ca and Vit D

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21
Q

Volume overload in CKD

Metabolic acidosis in CKD

A

tx - loop diuretics and add thiazides if needed

met acid - bicarb - 10-20 –> tx - oral bicarb

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22
Q

tx of hyponatremia

A

mild - dz specific
moderate - IVF
severe - 3% NaCl

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23
Q

tx of hypernatremia

A

mild - PO H2O
moderate - IVF
Severe - D5W (half of nml saline)

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24
Q

signs and symptoms of various Na levels

A

mild - asymptomatic
moderate - N/V, confusion, HA
severe - coma, seizure

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25
Q

workup of hyponatremia

A

serum osm –> nml = isotonic/pseudohyponatremia (lab problem fats and protein

serum osm –> high –> hypertonic hyponatremia –> every 100 BG above 100 needs Na corrected by 1.6

serum osm –> low –> hypontonic hyponatremia –> Hx and PE

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26
Q

serum osm formula

A

2xNa + (glucose/ 18) + (BUN/2.8) = nml 280

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27
Q

if blood glucose = 500 and Na = 140 the corrected sodium =

A

500 = 4 x 100 –> 4 x 1.6 = 6.5

140 + 6.5 = 146.6

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28
Q

hypotonic hyponatremia

A

volume up – diuresis
volume down - IVF
evolemic - RATS

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29
Q

evolumic causes

A

R - rental tubular acidosis - UA
A - addisons dz - cortisol
T - thyroid dz - TSH
S - SIADH - dx of exclusion –> volume restriction, gentle diuresis, and if all else fails demeclocycline

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30
Q

UNa = surrogate for

Uosm = surrogate for

A

UNa - surrogate for aldosterone

Uosm - surrogate for ADH

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31
Q

limitations to dropping sodium to not cause osmotic demylinating syndrome

A

0.25 per hr
4-6 per day to reduce symptoms

except in severe correct until seizures stop

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32
Q

PTH affects on bone

A

reabsorption of bone by osteoclasts
increased Ca
increased P

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33
Q

PTH affects on kidney

A

1,25 Vit D turned on
reabsorption of Ca = increased Ca
excretion of P = decreased P

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34
Q

PTH affects on gut

A

absorption of both Ca and P
increased Ca
increased P

artifical vit D - from granulomas (TB or sarcoid) can affect gut

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35
Q

most Ca is bound to albumin except 1% free ionized so corrected albumin formula

A

nml albumin = 4
nml Ca = 10

change in 1 for albumin = 0.8 change in Ca
albumin =3 then Ca = 9.2

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36
Q

signs of hypocalcemia

A

tetany
perioral tingling
trousseaus sign - bp cuff carpal pedal spasm
chvosteks sign - cheek tap facial N

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37
Q

workup of hypocalcemia

A

check albumin - if corrected - no problem

if still low –> ionized Ca –> if low –> tx = IV Ca - gluconate or carbonate

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38
Q

hypercalcemia workup

A

recheck Ca –> if still high –> hyper Ca –> tx if symptomatic

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39
Q

hypercalcemia signs

A

bones, moans, groans, stones, and psychiatric overtones

bone pain
kidney stone
abd pain
AMS

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40
Q

tx of hypercalcemia

A 
IVF IVF IVF IVF 
then 
bisphosphinates 
unless 
super super high Calcitonin
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41
Q

types of hyperparathyroidism

A

primary - autonomous - single adenoma
secondary - early CKD
tertiary - multiple adenomas

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42
Q

pt presentation in hyperparathyroidism and dx

A

pathologic fxs, decreased bone density, brown tumors - eat away the bone

increased PTH –> increased Ca + decreased PO4

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43
Q

dx differentiation of primary secondary and tertiary hyperparathyroidism and tx

A

sestamibiscan

  • primary - single adenoma with other glands atrophied
  • tertiary - multiple large adenomas

tx - resect and watch out for low Ca after sx due to other glands left behind being atrophied

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44
Q

HyperCa in cancer path

A

mets –> invades bone –> release Ca and PO4 –> increased Ca and increased PO4decreased PTH

PTHrP –> scc lung cancer –> “PTH” kidney wins –> increased Ca decreased PO4 but –> decreased PTH

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45
Q

when is a vit D test needed

A

hypervitaminosis D
- causes - vti D3 po heavy diet but more common = granolomatous dz –> increased Ca + increased PO4 –> decreased PTH

check 1,25 vit D level

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46
Q

hypercalcemia due to immobilization

A

increased Ca –> decreased PTH –> increased PO4

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47
Q

familial hypercalcemic hypocalcuria

A

asymptomatic - increased Ca –> urine Ca decreased

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48
Q

hypoparathyroidism

A

iatrogenic - thyroid sx botch or parathyroid resection and only atrophied glands left over

autoimmune

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49
Q

pt presentation in hypoparathyroidism

A

tetany
perioral tingling
post op day 1

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50
Q

dx of hypoparathyroidism and Tx

A

decreased PTH –> decreased Ca

tx - IV Ca

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51
Q

pseudohypoparathyroidism

A

end organ resistance to PTH (insensitivity)

increased PTH –> increased Ca and decreased PO4

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52
Q

vit D def

A

lack of dairy and/or sunshine - all day inside no dairy diet

osteopenia, dexa scan -2.0

25-vit D level

tx - Ca and high dose vit d –> if severely osteopenic –> bisphosphonates

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53
Q

CKD and hypoCa

A

early on impairment of vit D formation –> secondary hypoparathyroidism –> tx Ca + vit d + cinacalet

late stage –> hyper PO4

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54
Q

pancreatitis and HypoCa

A

sequestration

ominous sign

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55
Q

causes of HyperK

A 
low aldosterone state 
ingestion + CKD 
Iatrogenic 
ESRD 
Artifact Hemolysis
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56
Q

low aldosterone state causes of Hyper K

A

ACE-I
ARBs
Aldosterone antagonist

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57
Q

workup of hyperkalemia

A

recheck –> if still high –> EKG –> unstable –> emergent

–> stable –> urgent tx

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58
Q

EKG signs of hyperkalemia

A

peaked T waves

wide QRS

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59
Q

emergent tx of hyperkalemia

A

stabilize - CaCl (min) stabilzied cardiac myocytes

temporize - shift K into cells - insulin + D50 or sodium bicarb or beta agonist

decreased total body K+ - loop diuretics, kayexalate (stool) or hemodialysis

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60
Q

Causes of hypokalemia

A

renal losses - hypoaldosterone, diuretics (thiazides, loops), genetics (barters, gittlemens)

GI losses - Vomiting, Diarrhea

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61
Q

workup of hypokalemia

A

recheck K –> EKG –> replete

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62
Q

repletion to tx hypokalemia

A

oral > IV
peripheral line <10mEq/hr - since it burns
central line <20mEq/hr - induces hyperkalemic symptoms on EKG

if all else fails Mg

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63
Q

10mEq leads to what change in serum K+

A

0.1 change to K+

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64
Q

presentation of kidney stone pt

A

colicky abd pain that radiates into the groin
+/- hematuria
N/V
extreme pain

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65
Q

workup of kidney stone

A

U/A –> microscopic blood –> non con CT –> radiopaque stone or hydronephrosis –> tx

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66
Q

tx of kidney stone

A

<5mm - IVF, pain meds
<7mm - IVF, pain meds, medical explosive therapy - CCB and alpha blockers
>1.5cm - sx - proximal laparoscopic - distal PAN
>3cm - sx

strain urine and repeat in 6wks

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67
Q

tx of septic stone and an inbetween stone

A

inbetween stone

  • proximal - lithotripsy
  • distal - uretoscopy

septic

  • nephrostomy tube (proximal)
  • stenting (distal)
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68
Q

calcium oxalate stones

A

radio opaque
risk factors - increased Ca urine, increased Oxalate urine

modify - thiazide, decreased oxalate - decreased red meats - increased citrate - fruits/veggies

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69
Q

struvite stone

magenesium ammonium phosphorus

A

radioopaque
proteus - urease splitting
staghorn

tx - abx, remove stone burden

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70
Q

uric acid stone

A

radiolucent
gout or tumor lysis
- gout - allopurinol
- TLS - rasburicase

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71
Q

cysteine stone

A

radiolucent

genetic

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72
Q

simple cysts in kidney

A

asymptomatic - found incidentally
small, no loculations, no septations
do nothing

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73
Q

complex cysts in kidney

A

large, septations, loculations, different echogenecities - heterogenous

flank mass - infection -> pyelo
flank pain - rupture -> hematuria

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74
Q

dx and tx of complex kidney cyst

A

dx - CT scan unless pregnant US

tx - dz specific

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75
Q

renal cell carcinoma (RCC)

A

flank pain, flank mass, hematuria

dx - CT scan - DONT biopsy –> hematoma

tx - nephrectomy

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76
Q

paraneoplatic syndromes of RCC

A

anemia
polycythemia vera
spread hematogenously –> DVT

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77
Q

AR PCKD

A

newborns
anuric, renal failure day 1
palpable flank masses bilaterally

dx - US - biopsy (radially oriented cysts)
tx - supportive

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78
Q

AD PCKD

A

adults
asymptomatic –> HTN –> ESRD

palpated cysts –> flank pain
infected -> pyelo
replaces the kidneys normal parenchyma

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79
Q

dx and tx of AD PCKD

A

dx - CT and then biopsy

tx - supportive –> transplant

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80
Q

complications of AD PCKD

A

cysts in liver and pancreas (hepatitis and pancreatitis)

berrys aneursyms (SAH) –> screens with MRI angiogram, CT angiogram, angiogram

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81
Q

causes of resp acidosis

A

opiod overdose
asthma, COPD - air trapping
muscular strength - vent long term, OSA

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82
Q

causes of resp alkalosis

A

hyperventilation

  • pain anxiety
  • hypoxemia
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83
Q

causes anion gap metabolic acidosis

A 
M - methanol 
U - uremia 
D - DKA
P - propanylglycol 
I - isoproyl glycol 
L - lactic acidosis
E - ethylene glycol - crystals in urine
S - salicyclates
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84
Q

causes of metabolic alkalosis

A

volume responsive - diuretics, dehydration, emesis, NG suction

non volume responsive - HTN -> + -> hyperaldo -> renal artery stenosis

(if not HTN - barters or gittlemens)

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85
Q

causes of non anion gap metabolic acidosis

A

neg urine anion gap - diarrhea

+ urine anion gap - renal tubular acidosis

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86
Q

ABG workup for pH < 7.4

A

acidemia

  • -> CO2 >40 - resp acidosis
  • -> CO2 <40 - metabolic acidosis -> check anion gap (Na-Cl-CO2)

——-> if non anion gap –> check urine anion gap (Na + K + Cl)

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87
Q

ABG workup for pH >7.4

A

if CO2 < 40 –> resp alkalsosi
if CO2 >40 –> met alka –> check urine Cl -
—–> if Cl <10 –> volume responsive
—–> if Cl nml –> check HTN

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88
Q

In resp acidosis a change of 10 in CO2 leads to what change in bicarb

A

acute - change in bicarb 1

chronic - change in bicarb 3

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89
Q

in resp alkalosis a change of 10 in CO2 leads to what change in bicarb

A

acute - change in bicarb 2

chronic - change in bicarb 4

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90
Q

normal anion gap = 12 = what in albumin

A

albumin x 3

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91
Q

winters formula and interpretation

A

1.5 x bicarb + 8 +/- 2

CO2 Calculated > expected = resp acidosis
CO2 Calculated < expected = resp alkalosis

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92
Q

bicarb add on formula and interpretation

A

anion gap - 12(nml gap) + bicarb lab value

calculated bicarb >24 = metabolic alkalosis
calculated bicarb <24 = metabolic acidosis

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93
Q

focal segmental glomerulosclerosis

A

blacks and hispanics
HIV and heroin use

nephrotic range proteinuria
rapid development of renal failure

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94
Q

central DI

A

decreased ADH production
causes - trauma, hemorrhage, infection and tumors

water deprivation test –> desmopressin given –> nml results large increase

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95
Q

nephrogenic DI

A

ADH resistance at the kidney level
causes - lithium, cidofovir, amphotercin, tubulointerstital dz

water deprivation test –> desmopressin given –> no change

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96
Q

lithium Nephrogenic DI tx

A

salt restriction and stop lithium

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97
Q

indications for urgent dialysis

A

A - acidosis - pH < 7.1 - refractory to medical therapy
E - electrolyte imbalance - refractory to medical tx
I - ingestion - toxic alcohol, salicylcalte, lithium
O - overload - volume refractory to diuresis
U - uremia - symptomatic

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98
Q

tx of asterexis without liver cirrhosis

A

dialysis

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99
Q

winters formula = expected
- if PCO2 higher =
if PCO2 lower =

A

if PCO2 > expected = resp acidosis

if PCO2< expected = resp alkalosis

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100
Q

causes of metabolic alkalosis that is saline responsive

A 
vomiting
gastric suctioning 
diuretics 
laxatives 
volume depletion
101
Q

causes of metabolic alkalosis that is saline resistant

A

primary hyperaldosteronism
cushings syndrome
severe hypokalemia <2

102
Q

SLE glomeruloneprhitis

A

renal failure with erythrocyte cats
proteinuria
significantly low serum C3

HTN

103
Q

heavy vomiting leads to what electrolyte abnormalities

A

decreased Cl and K

hypochloremic metabolic alkalosis with hypokalemia

104
Q

complications of nephrotic syndrome

A

hypercoagulable state –> venous or arterial thrombus - renal Vein thrombosis (MC) –> membranous glomerulopathy
HTN

protein malnutrition, vit D def
iron resistant microcytic anemia

105
Q

management of uric acid stones

A

highly soluble in alkaline urine - potassium citrate can help

106
Q

MCC of death in dialysis patients and renal transplant pts

A

cardiovascular dz

107
Q

causes of AKI

A

acyclovir - cryalluria – obstruction
sulfonamides
MTX

ethylene glycol
protease inhibitors
Tumor lysis syndrome

108
Q

acute interstitial nephritis

A

rash
eosinophilia, eosinohpiluria
WBC casts

109
Q

Aspirin overdose metabolic state

A

mixed respiratory alkalosis
and
metabolic acidosis

110
Q

refractory hypokalemia can be caused by

A

hypomagenisum due to the removal of the inhibition of renal potassium secretion

111
Q

causes of pre renal AKI

A

decreased renal perfusion
- volume depletion, HF, cirrhosis, sepsis, pancreatitis
RAS
NSAIDs

112
Q

causes of primary adrenal insufficiency (addisons dz)

A 
TB 
histoplasmosis 
coccidomycosis 
cryptoccocic 
sarcoidisis
113
Q

presentation of primary adrenal insufficiency

A

increased K - due to decreased aldosterone secretion
decreased cortisol
decreased adrenal sex hormones

  • kidney losing Na while retaining K and H –> non anion gap metabolic acidosis
114
Q

acute organ rejection tx

A

IV steroids

115
Q

simple renal cysts

A

thin
smooth
unilocular
no septae

benign

116
Q

malignant renal cysts

A

multilocular mass
irregular walls
thickened septae

117
Q

causes of resp alkalosis

A

hyperventilation
high altitude
salicylate intoxication

118
Q

ADR of loop diuretics

A

decreased K
metabolic alkalosis - loss of H ions
pre renal kidney injury

119
Q

management of uncomplicated cystitis

A

nitrofuranotin 5 days (doesnt require culture)
TMP SMP 3 days
Fosfomycin single dose

120
Q

management of complicated cystitis

A

fluoroquinolones (5-14 days)

121
Q

management of pyelonephritis

A

cipro or IV Cipro

122
Q

pathological hallmark of diabetic nephropathy

A

nodular glomerulosclerosis

123
Q

memnranoproliferative glomerulonephritis

A

dense intramembranous deposits that stain C3 - caused by persistent activation of the complement pathway

124
Q

AL amyloidosis

A 
causes - MM, waldenstrom macroglobulinemia 
light chains (usually lambda)
125
Q

AA amyloidosis

A

chronic inflammatory conditions - RA, TB

beta 2 microglobulin apoliporpotein or transthyeritn

126
Q

crescent formation glomerulonephritis is indicative of

A

Rapidly progressing GN

127
Q

diabetic nephropathy leads to hyalinosis that affects

A

both the afferent and efferent arteiroles

128
Q

linear deposits on immuofluourescne are typical for

A

antiglomerular basement membrane dz = goodpasture syndrome

129
Q

granular deposits are present in

A

immune complex GN - lupus, IgA nephropathy

130
Q

older woman with RA hx with glomuerula deposits seen on special staining =

A

amylodosis

131
Q

causes of papillary necrosis

A 
NSAIDS 
N - NSAIDS
S- sickle cell 
A- analgesic abuse
I- infection (pyelo) 
D- DM
132
Q

adverse rxns of thiazides

A

hyperglycemia
increased LDL and TGL

decreased K, Mg, Na
increased Ca - decreased Ca excretion in urine

133
Q

best dietary advice to reduce risk of recurrent calcium oxalate stones

A

decreased Na diet - leads to decreased Ca excretion

nml Ca diet
lots of fluids

134
Q

abnormal hemostasis in chronic renal failure

A

platelet dysfunction - increased bleeding time
nml PT, PTT, INR
nml platelets

DOC - DDavp

135
Q

causes of non anion gap metabolic acidosis

A

diarrhea
fistulas
carbonic anyhydrase inhibitors
renal tubular acidosis

ureteral diversion

136
Q

renal tubulular acidosis (type 4)

A

non anion gap metabolic acidosis
hyperkalmeia

out of proportion to the renal function

137
Q

leading cause of ESRD

A

diabetic nephropathy

increased extracellular matrix
BM thickening
mesangial explosion and fibrosis

138
Q

intimal thickening and luminal narrowing of renal arterioles with evidence of sclerosis is indicative of what cause

A

HTN

139
Q

metabolic alkalosis with decreased urine Cl

A

vomiting
Nasogastric aspiration
prior diuretic use

140
Q

metabolic alkalosis with increased urine Cl

A

hypo/euvolemic = bartter, gittleman

hypervolemic - primary hyperadlosteronism, cushing dz, ectopic ACTH

141
Q

membranous nephropathy

A

adenocarcinoma
NSAIDs
Hep B
SLE

142
Q

membranoproliferative glomerulonephritis

A

Hep B
Hep C
Lipodystrophy

143
Q

minimal change disease

A

NSAIDs

Lymphoma (hodgkins)

144
Q

IgA nephropathy

A

preceding URI by approx 5 days
MCC of GN in adults

pts have recurrent episodes of hematuria

145
Q

Amikacin - adr

A

nephrotoxic

146
Q

subepithelial humps consisting of C3 and decreased serum C3

A

PSGN

147
Q

alport

A

x linked defect in type 4 collagen formation

hearing loss, ocular abnormalities, hematuria
progressive renal insufficiency

148
Q

horseshoe kidney complications

A

ureteropelvic junction obstruction
renal stones
VUR
chronic UTIs

149
Q

dipstick in pyelo will show

A

+ nitrites

+ leukocyte esterase

150
Q

muddy brown casts =

A

ATN

151
Q

RBC casts =

A

glomerulonephritis

152
Q

WBC casts

A

interstitial nephritis
or
pyelonephritis

153
Q

fatty casts =

A

nephrotic syndrome

154
Q

broad and waxy casts =

A

chronic renal failure

155
Q

most sensitive screening test for nephropathy

A

random urine for microalbumin/ creatinine ratio

156
Q

obstructive uropathy presentation

A

flank pain
low volume voids with or without occasional high volume voids
`

157
Q

hepatorenal syndrome risk factors and precipitating factors

A

risk factor - cirrhosis

precipitating factors - reduced renal perfusion, GI bleed, vomiting, sepsis, excessive diuretics, reduced GFR - NSAID use

158
Q

hepatorenal syndrome dx and tx

A

dx- renal hypoperfusion labs

tx - splachnic vasoconstrictors can help (octreotide, midoadrine, NE), liver transplant

159
Q

management of iatrogenic hyponatremia and acute hyponatremic encephalopathy

A

hypertonic (3%) saline

160
Q

acetazolamide

A

diuretic that inhibits proximal renal bicarbonate resorption

used in pts with hypervolemia and metabolic alkalosis

161
Q

medications that can cause hyperkalemia

A

Non selective beta adrenergic blockers

ACE-I, ARBS
K sparing diuretics (amilioride)

digoxin
NSAIDs

Trimethoprim

162
Q

drugs that cause interstitial nephritis

A

PCNs
cephalosporins
sulfonamides
NSAIDs

rifampin
phenytoin
allopruinol

163
Q

cryoglobulinemia

A

palpable purpura
glomerulonephritis

arthralgias, hepatosplenomegaly, peripheral neuropathy

hep C hx

164
Q

acute therapy indications for hyperkalemia

A

only if K >7.0 or abnormal ECG

165
Q

hypovolemic hypernatremia tx

A

0.9% saline until euvolemic –> 5% dextrose in water

166
Q

characteristic findings in SIADH

A

serum osmolality <275
urine osmolality >100
euvolemic pt

decreased Na
N/V AMS

167
Q

rapid correction of hyponatremia can lead to

A

osmotic demyelination syndrome

168
Q

mannitol use

A

treating ICP and higher intraocular pressure

169
Q

sodium bicarb uses

A

severe metabolic acidosis and hyperkalmia

170
Q

RCC can cause

A

varicocele

workup includes - CT abd

171
Q

SSRIs have what kidney side affect

A

SIADH

172
Q

when rapidly correcting hypernatremia complication =

A

cerebral edema

173
Q

Lab findings of PSGN

A

decreased C3
increased Creatinine
increased Anti DNase
increased ASO

174
Q

largest risk factor for CKD =

A

diabetic microangiopathy

175
Q

initial therapy for Renal artery stenosis (RAS)

A

ACE-I or ARB

Stenting only if flash pulmonary edema or HF is present

176
Q

when should metformin never be given

A

acutely ill pts with acute RF, liver failure or sepsis

since it can increase the risk of lactic acidosis

177
Q

most common findings of AKI

A

weight gain and edema - due to positive water and sodium balance

MCC of AKI = pre renal failure

178
Q

NSAIDs affect on arterioles

A

constricts AFFERENT arteriole

179
Q

ACE-I affect on arterioles

A

EFFERENT arteriole vasodilation

180
Q

pathophys of pre renal failure

A

decreased RBF -> decreased GFR -> decreased clearance of metabolite (BUN, Cr, Uremic toxins) -> increased Cr and increased BUN

181
Q

rhabdo pathophys

A

skeletal muscle breakdown -> release of muscle fiber contents (myoglobin) into blood stream -> nephrotoxic –> AKI

increased CPK increased K increased uric acid
decreased Ca

182
Q

tests for post renal failure

A

palpate bladder
US - obstruction, hydronephrosis
Catheter - large volume of urine

183
Q

course of ATN

A

oliguric phase - azotemia and uremia (10-14days)

diuretic phase - urine output >500 - due to fluid overload

recovery phase - recovery of tubular function

184
Q

urine osmolality

A

dehydration -> increased reabsorption -> make concentrated urine

185
Q

ATN and urine osmolality - patho phys

A

tubular cells are damaged and cannot reabsorb water (or sodium) -> so urine cannot be concentrated –> low urine osmolality

186
Q

radiographic contrast affects on kidney

A

can cause ATN - very rapidly by causing spasm of the AFFERENT arteriole

187
Q

small kidneys
UA with broad casts
Hx of HTN
edema

A

CKD

188
Q

urine output <500

without uremic symptoms

A

AKI

189
Q

azotemia =

A

increased BUN >60

190
Q

mcc of secondary HTN

A

renal failure

191
Q

tx of hyperphosphatemia

A

calcium citrate

192
Q

complications of CKD

A

hyperkalemia
pulmonary edema secondary to volume overload
infections

193
Q

dialyzable substances

A

lithium
salicyclic acid
ethylene glycol
magnesium containing laxatives

194
Q

pathophys behind hypoalbuminemia seen in nephrotic syndrome

A

hepatic albumin synthesis cannot keep up with renal losses

195
Q

key features of nephrotic syndrome

A

proteinuria
hypoalbuminemia
hyperlipidemia

196
Q

type I RTA

A

inability to secrete H+ –> non anion gap metabolic acidosis
renal stones

197
Q

type IV RTA

A

hyperkalemia

acidic urine

198
Q

hartnup syndrome

A

AR - def of AA transproter - decreased absorption of tryptophan

pellagra, dermaitits, diarrhea, ataxia and psych disturbances

199
Q

causes of renal artery stenosis

A

atherosclerosis - elderly man

fibromuscular dysplasia - young female

look for bruit on exam

200
Q

2nd MCC of ESRD

A

nephrosclerosis

201
Q

causes of hyperoxaluria

A

severe steatorrhea of any cause
small bowel dz - crohns
pyridoxine def

202
Q

risk factors for prostate cancer

A

age
black
high fat diet
family hx

exposures to herbacide and pesticides

203
Q

indications to perform a TRUS for prostate cancer

A

PSA >10

DRE abnormal

204
Q

prostate mets to

A

the bone and if there are urinary obstruction issues on findings = late dz course

205
Q

RCC

A

2x more common in men
sporadic

risks = smoking, phenacetin, ADPKD, chronic dialysis,eposure to heavy metals

206
Q

bladder cancer

A

90% caused by transitional cell carcinoma

risks - smoking, industrial carcinogens, aniline dyes, azo dyes, long term cyclophosphamide

207
Q

mc testicular tumor

A

seminous

208
Q

choriocarcinoma testicular tumor facts

embryonal tumors facts

A

chorion = increased beta HCG

embry = increased AFP

209
Q

epididmytitis

A

children and elderly = e coli

young men = gonorrhea or chlamydia

210
Q

3 reasons for oliguria

A

low blood flow to kidney
kidney problems
post regnal obstruction - tx foley

211
Q

why is glucose given along with saline

A

to prevent muscle breakdown

212
Q

lactated ringer

A

excellent for replacement of intravascular volumes
MC used for trauma resuscitation fluid

DO NOT USE IF INCREASED K

213
Q

do not combine blous fluids with dextrose due to

A

hyperglycemia cause or hyperkalemia

214
Q

signs of volume overload

A

elevated jugular venous pressure
pulmonary rales - due to pulm edema
peripheral edema

215
Q

calculating maintenance fluids

A

100 x first 10kg
50 x second 10kg
20 x remaining 10kg

divide this number by 24

216
Q

aldosterone basic function

A

increased Na reabsorption

217
Q

ADH basic function

A

increased H2O reabsorption

218
Q

low urine sodiu < 10 implies

A

increased Na retention by kidneys to compensate for extra renal losses - such as diarrhea, vomiting, nasogastric suction

219
Q

decreased Na –> decreased osmolality <280 –>

A

assess ECF
if low –> assess urine Na

low = extra renal losses - D/V 
high = renal loss excessive diuretics
220
Q

excess exogenous glucocorticoids

A

hypervolemic hypernatremia

221
Q

Diabetes insipidus and Na

A

isovolumic hypernatremia

222
Q

tx of hypervolumic hypernatreia

A 
give diuretics (furosemide) 
D5W to remove excess sodium
223
Q

pH affects on metabolites

A

increased pH - increased Ca binding to albumin

increased pH - decreased K and vice versa

224
Q

acute pancreatitis and renal insufficiency affects on Ca

A

decreases ca

renal - due to decreased production of 1,25 dihydroxyvitamin D

225
Q

hypocalcemia symptoms

A

rickets and osteomalacia
tetany
hyperactive DTR

chvosteks signs/trousseaus sign
prolonged QT

226
Q

ECG affect with hypercalcemia

A

shortened QT interval

227
Q

multiple myeloma

A

increased Ca due to release of osteoclastic activating factors and lysis of bone tumor cells

228
Q

random causes of increased Ca

A

thiazides
lithium
SCC
saroidosis

229
Q

signs of hypercalcemia

A

stones bones groans moans and psych overtones

230
Q

ECG changes with hypokalemia

A

t wave flattens out
if severe t wave inverts
u wave appears

231
Q

causes of hypokalemia

A

gi losses - v/d/ nasogastric suction
renal losses - diuretics, RTA not type IV, excessive glucocorticoids, mg def

bactrim and amphoterecin B
B2 agonists

232
Q

K and digoxin

A

hypokalemia predisposes pts to doxin toxicity

233
Q

IV KCL can be given if K

A

K <2.5

234
Q

causes of hyperkalemia

A 
renal failure 
K+ sparing diuretics 
ACE - I 
insuline def 
addisons dz

prolonged use of a tourniquet with or without repeatedly clenching fist

235
Q

ECG changes in hyperkalemia

A

peaked t waves
prolonged PR interval
widened of QRS with T wave

236
Q

hyperkalemia workup

A

check gfr -> if nml -> check aldosterone level ->

if low –> hypoaldosteronism

nml to high –> K+ sparing diuretics

237
Q

kay exalate

A

GI potassium exchange resin - leads to decreased K absorption in the gut

238
Q

hypomagenisum leads to

A

difficulty treating hypokalemia and hypocalcemia

239
Q

causes of hypomagensium

A

GI - malabsorptive, steatorrhea states (MCC)
acoholism
SIADH
drugs - gentamicin, amphotercecin B cisplatin

240
Q

ECG changes in decreased Mg

A

torsades de pointes

241
Q

cause of increased Mg

A 
renal failure (MCC)
rhabdo
242
Q

MCC of severe hypophosphatemia

A

DKA and alcohol abuse

243
Q

effects of acidosis

A

right shift –> increased O2 delivery to tissues
depresses CNS
decreased pulm blood flow
arrhythmias

impairs myocardial function
hyperkalemia

244
Q

effects of alkalosis

A

decreased cerebral blood flow
left shift - decreased O2 delivery to tissues
arrythmias
tetany seizures

245
Q

salicylate (aspirin)

A

primary resp alkalosis

primary metabolic acidosis

246
Q

metabolic alkalosis with volume contraction

A

due to fluid loss - vomiting or diuretics

247
Q

metabolic alkalosis with volume expansion

A

usually due to pathology of adrenal gland

248
Q

increased PaCO2 –>

A

increased cerebral blood flow –> increased CSF pressure –> CNS depression

and vice versa

Step 2 Rotation Cards (14 decks)

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