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MTBs Step 3 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What is Prerenal Azotemia? What are some causes?

A

hypoperfusion of the kidneys leading to failure.

May be due to: hypotension, Hypovolemia, Low oncotic pressure, CHF, Constrictive Pericarditis, Renal Artery Stenosis

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2
Q

Urine sodium with prerenal azotemia? low or high?

A

LOW!

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3
Q

What type of casts will you see with prerenal azotemia?

A

Hyaline Casts

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4
Q

Why do you get elevation of BUN with prerenal azotemia? (i want mechanism)

A

low volume = increased ADH –> ADH increases urea transport activity =D

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5
Q

What are some causes of Postrenal Azotemia?

A

Stone in bladder or ureters, bilateral strictures, cancer of the bladder, prostate cancer, cervical cancer or neurogenic bladder

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6
Q

Urine sodium with intrarenal failure? high or low?

A

high >40

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7
Q

What is Acute Tubular Necrosis(ATN)?

A

death of the tubular cells of the kidney due to either hypoperfusion or various toxic injuries to the kidney(aminoglycosides, amphotericin, chemo, contrast)

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8
Q

What is the mechanism of contrast induced renal failure?

A

Contrast is directly toxic to the kidney tubule and causes vasoconstriction of the afferent arteriole. ==> decreased perfusion = rapid increase in Cr & decreased in urine Na.

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9
Q

What type of casts would you see with Acute tubular necrosis(ATN)?

A

“muddy brown” or granular

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10
Q

What is Allergic/Acute Interstitial Nephritis(AIN)?

A

Hypersensitivity reaction to medications. Look for UA with WBCs, fever and rash.
*use Wright Stain or Hansel Stain of the urine to detect eosinophils.

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11
Q

Pt has AIN for >48hrs. What do you do?

A

give them steroids

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12
Q

What is Rhabdomyolysis? What do you see with kidneys?

A

large-volume muscular necrosis –> Myoglobin from muscles is toxic to kidney tubules = UA with blood, Elevated Urine myoglobin, elevated CPK level, increased K & decreased Ca.

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13
Q

What is the mechanism of hypocalcemia with rhabdomyolysis?

A

damaged muscle releases SERCA. SERCA takes up Ca lowering the blood level of Ca.

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14
Q

How do you treat rhabdomyolysis?

A

Bolus NS, mannitol diuresis(decrease contact time of myoblin with tubule) & Alkalinization of urine to help precipitate myoglobin + EKG(hyperkalemia induced arrhythmia)

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15
Q

Pt with a UA showing envelope-shaped oxalate crystals. What did this person do? How do you tx them?

A

prob suicide by ingestion of antifreeze(ethylene glycol). Treat with Ethanol or Fomepizole + immediate dialysis

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16
Q

Pt with UA showing uric acid crystals. Whats the most common cause of this? How do you treat?

A

MCC = tumor lysis syndrome due to chemotherapy(often for lymphoma).

tx: hydration, allopurinol & rasburicase(breaks down uric acid)

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17
Q

What blood stuff would you see with a cholesterol embolism?

A

on skin = livedo reticularis

blood = low C3 &C4 + eosinophilia

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18
Q

What can you do to prevent contrast induced renal failure?

A

Pt who can still get contrast with renal failure will have a Cr between 1.5-2.5. Give NS + N-acetylcysteine + bicarb

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19
Q

Slight elevations of Cr above normal(1.5-2.5) means a loss of _______% of renal function at a minimum.

A

60-70%

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20
Q

How do NSAIDs cause kidney damage?

A
  • directly toxic and cause papillary necrosis
  • Allergic Interstitial nephritis = WBC + eosinophilia
  • Nephrotic Syndrome
  • afferent arteriolar vasoconstriction & decreased perfusion to the glomerulus = worsening renal function
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21
Q

Goodpastures Syndrome

sx?

A

cough, hemoptysis, SOB, lung shit

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22
Q

Goodpastures Syndrome

Best initial test? dx? tx?

A

best initial: Anti-basement membrane Abs
Most accurate: bx
Tx: plasmapheresis + steroids

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23
Q

Churg-Strauss Syndrome

sx? whats another name for this?

A

(aka Eosinophilic Granulomatosis with Polyangiitis)

sx: asthma, cough, eosinophilia + renal abnormalities

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24
Q

Churg-Strauss Syndrome

best initial test? dx? tx?

A

Best initial test: CBC for eosinophilia count, MPO-ANCA

dx: bx
tx: Glucocorticoids, if no response add cyclophosphamide

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25
Wegeners Granulomatosis with Polyangiitis | sx?
"C-disease" Upper respiratory problems(sinusitis, otitis), lung problems(cough, hemoptysis, abnormal CXR), Systemic vasculitis(joint, skin, brain, GI probs) + renal involvement
26
Wegeners Granulomatosis with Polyangiitis | best initial test? dx? tx?
initial: C-ANCA or anti-proteinase 3-ANCA dx: bx tx: cyclophosphamide + steroids
27
Microscopic Polyangiitis | sx? dx? tx?
sx: lung + renal vasculitis, no eosinophils or asthma. just lung and kidneys dx: NO GRANULOMAS on bx, MPO-ANCA present tx: steroids + cyclophosphamides
28
``` Polyarteritis Nodosa(PAN) sx? ```
sx: SYSTEMIC vasculitis involving EVERY ORGAN EXCEPT lungs. (myalgias, GI bleed + ab pain, purpuric skin lesions, stroke, renal shit, uveitis, neuropathy) * multiple nonspecific findings + fever and weight loss with multiple motor and sensory neuropathy with pain = dx key!
29
``` Polyarteritis Nodosa(PAN) initial test? dx? ```
initial: ESR for inflammation markers, Hepatitis B & C(associated with 30% of PAN) dx: Bx of sural nerve or the kidney, angiography showing "beading"
30
``` Polyarteritis Nodosa(PAN) tx? ```
tx: cyclophosphamide & steroids
31
IgA Nephropathy | whats another name for this? sx?
aka Berger Disease sx: painless recurrent hematuria, recent viral respiratory infection, Proteinuria
32
IgA Nephropathy | initial test? dx?
initial: no specific test! dx: renal bx is essential!!!
33
IgA Nephropathy | tx?
no proven effective therapy! - give steroids for worsening proteinuria - ACEi - Fish oil MAY delay progression
34
Henoch-Schonlein Purpura | sx?
- Raised, nontender, purpuric skin lesions(particularly on buttocks) - abdominal pain - possible bleeding - joint pain - renal involvment **seen in a kid
35
Henoch-Schonlein Purpura | best initial test? dx?
initial: physical exam! dx: bx showing IgA deposits but it is not necessary to make dx
36
Henoch-Schonlein Purpura | tx?
no specific tx = will resolve on its own! *give steroids if proteinuria worsens with the use of ACEi
37
Post-streptococcal Glomerulonephritis(PSGN) | sx?
recent illness followed by "tea/cola colored" urine, periorbital edema, HTN.
38
Post-streptococcal Glomerulonephritis(PSGN) | best initial test? dx?
initial: Anti-streptyolysin O, anti-DNase, Anti-hyaluronidase & low compliment lvls dx: bx! but not done routinely bc blood test are often sufficient. bx would show IgG depo + C3
39
Post-streptococcal Glomerulonephritis(PSGN) | tx?
Penicillin for infection, control HTN and fluid overload with diuretics
40
Cryoglobulinemia | sx?
hx of hepatitis C with renal involvement, joint pain, purpuric skin lesions + low compliment & cryoglobins(igm)
41
Cryoglobulinemia | best initial test? most accurate?
initial: serum cryoglobin component leves, compliment levels low (especially C4) most accurate: bx
42
Cryoglobulinemia | tx?
tx: treat hep C + rituximab
43
Alport Syndrome | sx? dx? tx?
sx: congenital problem with eye and ear + deafness & renal failure in 2nd decade of life. no dx & no specific tx
44
Thrombotic Thrombocytopenic Purpura(TTP) | sx? tx?
TTP = FAT RN * fever * anemia(intravasular hemolysis) * Thrombocytopenia * renal probs(elevated Cr) * Neurological abnormalities tx with plasmapheresis in severe cases. steroids
45
Hemolytic Uremic Syndrome(HUS) | sx? tx?
HUS = ART * anemia(intravasular hemolysis) * renal probs(elevated Cr) * Thrombocytopenia tx with plasmapheresis in severe cases. **DO NOT GIVE ABX as they may worsen
46
Nephrotic Syndrome | sx?
Hyperproteinuria, hypoprotemia, hyperlipidemia(lipoprotein lost in urine = not available to uptake LDL & VLDL), Edema, Thrombosis(due ot loss of antithrombin 3, PC & PS)
47
What is associated with minimal change disease?
children!
48
What is associated with membranous glomerulonephritis?
adults, cancer(especially lymphoma)
49
What is associated with Membranoproliferative glomerulonephritis?
hepatitis C
50
What is associated with Focal Segmental Glomerulonephritis(FSGN)?
HIV, heroine use
51
Under what circumstances is dialysis essential?
hyperkalemia, metabolic acidosis, uremia with encephalopathy, fluid overload, uremia with pericarditis, drug intoxication that requires dialysis(lithium, ethylene glycol, ASA), uremia induced malnutrition
52
4 main blood symptoms of uremia & how to treat them
1. hyperphosphatemia: Ca-acetate, Ca-carbonate phosphate binders 2. hypermagnesemia: restrict intake 3. Anemia: EPO 4. Hypocalcemia: Vita D replacment
53
What is Calciphylaxis?
type of extraskeletal calcification = calcification of blood vessels and skin vessels clotting and necrosis. See with ESRD, hyperparathyroidism, milk-alkali syndrome tx by increasing dialysis and normalizing Ca lvls
54
What is Nephrogenic Systemic Fibrosis? When would you see this?
skin fibrosis in response to the MRI contrast agent Gadolinium in patients with ESRD or severely low GFR (<30). Proliferation of dermal fibrocytes, leading to hardened areas of fibrotic nodules developing in the skin and in some cases joint and skin contractions.
55
Central DI | sx? tx? What will giving DDAVP do?
sx: low urine osmolality, low urine sodium, increased urine volume + NO CHANGE IN URINE OSMOLALITY WITH WATER DEPRIVATION. Giving DDAVP: decrease in urine vol, increase urine osmolality. tx: Give DDAVP or vasopressin
56
Nephrogenic DI | sx? tx? What will giving DDAVP do?
sx: low urine osmolality, low urine sodium, increased urine volume + NO CHANGE IN URINE OSMOLALITY WITH WATER DEPRIVATION. Giving DDAVP: no change in urine volume, no change in urine osmolality. tx: correct underlying cause such as hypokalemia, hypercalcemia & in the meantime use TZD.
57
3 common causes of hypervolemic hyponatremia? | tx?
congestive heart failure(CHF), nephrotic syndrome, cirrhosis tx: treat underlying cause
58
3 common causes of hypovolemic hyponatremia? | tx?
Diuretics(elevated urine Na), GI loss of fluids/vomiting/diarrhea(low urine Na), Skin loss of fluids/burns/sweating(low urine Na) tx: correct cause and replace with NS
59
4 common causes of euvolemic hyponatremia?
SIADH, hypothyroidism, psychogenic polydipsia, hyperglycemia
60
Hyperglycemia causes an _____ drop in Na by ___ for each ___ points of glucose.
ARTIFICAL, 1.6, 100
61
Addisons Disease cause? | electrolyte sx? tx?
hyponatremia due to insufficient aldosterone production. sx: hyponatremia, hyperkalemia, mild metabolic acidosis tx: alosterone replacement(fludrocortisone)
62
4 common causes of SIADH
any problems with CNS, any lung disease, cancer, medications(sulfonylureas, SSRIs, carbamazepine)
63
Electrolyte abnormalities with SIADH
high urine Na(>20), High urine Osm(>100), Low serum Osm(<290), Low serum uric acid, normal BUN, normal Cr, normal Bicarb
64
Treatment of Mild, Moderate & chronic SIADH?
mild: fluid restriction Mod: NA, loops, ADH blockers(conivaptan, tolvaptan) *do not correct Na more than 10-12 mEq/L in the first 24 hr Severe: Demeclocycline to block ADH on kidney.
65
List some causes of Hyperkalemia
* metabolic acidosis from transcellular shift out of cells * adrenal aldosterone deficiency(addisons disease) * BB * digoxin tox * insulin deficiency (DKA) * diuretics(spironolactone) * ACEi, ARBs * prolonged immobility, seizures, Rhabdomyolysis, or crush injury * T4 RTA * renal failure preventing K secretion
66
How do BB cause hyperkalemia?
Normal Na/K ATPase lowers blood K. BB decrease the activity of the Na/K ATPase, causing K levels to increase.
67
Effects of hyperkalemia on EKG
1st peaked Twaves then loss of P waves then widened QRS
68
tx of severe hyperkalemia(you have EKG abnormalities)
Ca-gluconate IV to protect the heart, insulin + glucose IV & kayexalate
69
tx of moderate hyperkalemia(no EKG abnormalities)
insulin +glucose, Bicarb to shift K into cells when acidosis is the cause, Kayexalate PO.
70
What will you see on a EKG for hypokalemia?
U-waves = extra wave after the T wave
71
Hypermagnesemia | sx? tx
sx: muscular weakness, loss of DTRs tx: restrict intake, NS to promote diuresis +/- dialysis depending on severity
72
Hypomagnesia always presents with hypo---- & cardiac arrhythmias.
hypocalcemia
73
causes of metabolic acidosis
MUDPILES: | methanol, uremia, DKA, Paracetamol, INH, Lactic Acidosis, Ethylene Glycol, ASA

MTBs Step 3 (30 decks)

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