Nephrology Flashcards
Poorly controlled DM and HTN with low Na+, high K+, low HCO3
RTA type 4
- hypoaldosteronism
- can be caused by DM
- Muddy brown granular casts
- RBC casts
- WBC casts
- Fatty casts
- Broad & waxy casts
- ATN
- glomerulonephritis
- interstitial nephritis & pyelonephritis
- nephrotic syndrome
- chronic renal failure
Within 5 days of upper respiratory tract infection, young adult men, gross hematuria, normal complement levels
IgA nephropathy
Nephro risk with acyclovir
kidney rapidly excretes it in the urine, but the drug has low urine solubility –> obstruction
Prevent uric acid stones
alkalinize urine with potassium citrate
child with edema, hypoalbuminemia, elevated urine protein and Hepb +
membranous nephropathy
Pt with HTN, DM 2, HLD, and CKD has a K+ of 6.0. Only sx are mild fatigue. Next best step
Review current medications
Pt with CKD starts bleeding from blood draw site
Uremic coagulopathy - platelet dysfunction (platelet-vessel wall and platelet-platelet interaction) due to uremic toxins (guanidinosuccinic acid)
tx = DDAVP
18 yo AA male with polyuria and nocturis despite fluid restriction. Normal sodium and low urine osmolality. Mom died from sickle cell disease and stroke
Hyposthenuria - inability of kidneys to concentrate the urine (seen in SCD and SCT)
Fever, tinnitus, tachypnea in an overdose patient
ASA toxicity - mixed respiratory alkalosis and anion gap metabolic acidosis
gross hematuria in African American male with no other sx or lab abnormalities
Renal papillary necrosis - associated with sickle cell dz
Patient with recurrent sinusitis and otitis media with 2+ protein and blood on UA.
Granulomatosis with polyangiitis
- upper resp: sinusitis/otitis, saddle nose
- lower resp: lung nodules, cavitation
- renal: rapidly progressive GN
- skin: levido reticularis, nonhealing ulcers
- ANCA: PRS, MPO
- tx: steroids, immunomodulators
how to calculate serum osmolal gap
measured serum osmolality - calculated serum osmolality
calculated = (2*Na) + (glucose/18) + (BUN/2.8)
high anion gap metabolic acidosis with osmol gap
- ethylene glycol (urinary calcium oxalate crystals)
- methanol (blindness)
- propylene glycol
Pt with hx of RA presents with 4+ proteinuria, hepatomegaly and enlarged kidneys
Amyloidosis
- amyloid deposits that stain with Congo Red that demonstrate an apple green birefringence under polarized light
kidney dz most likely associated with HIV
FSGS
Pt with nephrotic syndrome is at risk for developing
Hypercoagulability - urinary loss of antithrombin 3, altered levels of protein C and S, increased platelet aggregation, hyperfibrogenemia due to increased hepatic synthesis
- protein malnutrition
- iron-resistant microcytic hypochromic anemia
- increased susceptibility to infection
- vit D deficiency
Pt whos on cannabinoids and cocaine with CK of 26000 is at risk for
acute renal failure
What you see in the kidneys due to HTN
arteriosclerotic lesions of the afferent and efferent arterioles and glomerular capillary tufts
What you see in kidneys due to DM
increased extracellular matrix, BM thickening, mesangial expansion, fibrosis
Tx to aid in passage of a stone in distal ureter
Tamsulosin
- alpha receptors are found in distal ureter and relaxing them allows passage of stone
Effect of fibromuscular dysplasia on the kidneys
Decreases perfusion to kidneys –> increased aldosterone and renin (secondary hyperaldosteronism)
How to prevent uric acid kidney injury with initiation of chemotheraphy
pretreatment with iv fluids and allopurinol
Male with recurrent UTIs treated multiple times with abx and has minor improvement. Prostate is smooth and nontender. He has pain with ejaculation. External genitalia are normal. UA shows pyuria with bacteria
Chronic bacterial prostatitis
- tx with fluoroquinolones for 6 weeks
Effect of trimethoprim on kidneys
blocks epithelial sodium channel in collecting tubule - leads to hyperkalemia
Fluctuating fatigable extraocular and bulbar (dysarthria, dysphagia) muscle weakness as well as symmetrical proximal weakness of the neck and extremities
Myasthenia gravis
- problem with motor end plate/NM junction
When urgent dialysis is required
AEIOU
Acidosis (metabolic) pH<7.1
Electrolytes (hyperkalemia - sx or >6.5)
Ingestion (toxic alcohols, salicylate, lithium, sodium valproate, carbamazepime)
Overload by fluids
Uremia (pericarditis, encephalitis, bleeding)
Homeless man with hypocalcemia and calcium oxalate deposition in kidneys
Ethylene glycol ingestion
- give fomepizole or ethanol to inhibit alcohol dehydrogenase
- sodium bicarb to correct acidosis
- dialysis
management of kidney stones
< or = 5: will pass on own
6-10: can give alpha blocker
>10, refractory pain, anuria, AKI, urosepsis: urology consult
4 month old with macrocytic anemia, reticulocytopenia, normal platelets and WBCs. Has triphalangeal thumbs and craniofacial abnormalities (cleft palate, webbed neck).
Diamond-Blackfan anemia
- congenital erythroid aplasia
- tx: corticosteroids and transfusions RBCs
deposits on C3 in GBM with fatigue, LE edema and dark urine
Membranoproliferative glomerulonephritis
- activation of alternate complement pathway
Well defined hypoechoic testicular mass with elevated bhcg and negative afp
seminoma
Drugs that cause hyperkalemia
NSAIDs, TMP/SMX, ACEi, ARBs
sx: muscle weakness, cardiac arrhythmia, decreased DTRs
Renal vein thrombosis is most common seen with
membranous glomerulopathy
- loss of antithrombin III in the urine increases the risk
- sudden abdominal pain, hematuria and fever
Electron micro of alport syndrome
splitting of basement syndrome
Acute interstitial nephritis
- hypersensitivity to meds like NSAIDs and PPIs (also rifampin, penicillins, cephalosporins) or AI
- rapid decline in renal function
- Rash, fever and eosinophilia are the classic triad of symptoms
- inflammatory infiltrate on biopsy
- tx: steroids
cause of HTN in ADPKD
renal ischemia –> increased renin release –> secondary hyperaldosteronism
-tx: ACEi
hepatorenal syndrome
decrease in GFR without any other cause of renal dysfunction, mild hematuria, and lack of improvement with volume resuscitation
- due to splanchnic arterial dilation, decreased vascular resistance, and local renal vasoconstriction due to RAAD
pancytopenia, intravascular hemolysis, and acute thrombosis. Flow cytometry demonstrates absence of CD55 and CD59.
paroxysmal nocturnal hemoglobinuria
hypospadias is associated with
chordee, cryptorchidism, and inguinal hernias.
patients with nephrotic syndrome are at increased risk of infection with
encapsulated organisms (strep pneumo) - vaccinate with PPV23
He has right- and left-sided costovertebral angle tenderness. He gives a urine sample, which has a strong odor, like rotten eggs. When sodium cyanide-nitroprusside is added to his urine, the sample turns purple.
Cysteine stones - caused by renal defect in transport of certain amino acids (cystine, ornithine, lysine and arginine)
*COLA
