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Nephrology Flashcards

1
Q

Acetazolamide

A
  • carbonic anhydrase inhibitor
  • MOA: blocks resoprtion of bicarb
  • Use
    • glaucoma, idiopathic intracranial HTN, altitude sickness, metabolic alkalosis.
  • ADR
    • metabolic acidosis, hypokalemia
    • nephrolithiasis, sulfa allergy
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2
Q

Mannitol

A
  • Osmotic diuretic
  • MOA
    • prevents max concentration of urine
  • Use
    • elevated ICP
    • acute angle-closure glaucoma.
    • AKI
  • ADR
    • Hyponatremia, then hypernatremia
    • Hyperosmolarity.
    • Pulmonary edema
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3
Q

Furosemide, bumetanide, torsemide, ethacrynic acid

A
  • Block Na/K/Cl transport in loop of henle.
  • Use
    • CHF
    • ascites
    • pulm edema
    • hypercalcemia
  • ADR
    • hypocalcemia, hypokalemia, hyperuricemia, ototoxicity, sulfa allergy (except ethacrynic acid)
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4
Q

HCTZ, Chlorthalidone, Metolazone

A

Thiazide diuretics: Block Na/Cl transport in distal tubule.

  • USE
    • HTN, CHF, hypercalciuria, nephrogenic DI.
  • ADR
    • hypokalemia, hyponatremia, hyperuricemia, hypercalcemia.
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5
Q

Spironolactone, Eplerenone

A

K-sparing diuretics (Aldosterone receptor antagonists)

  • Use
    • hyperaldosteronism
    • CHF, post-MI, Portal HTN.
    • acne, PCOS
  • ADR
    • Hyperkalemia
    • Gynecomastia
    • menstrual irregularities
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6
Q

Amiloride, Triamterene

A

Inhibit Na channel of collecting tubule.

  • Use
    • HTN,
    • Prevent hypokalemia
    • Lithium-induced nephrogenic DI
  • ADR
    • hyperkalemia
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7
Q

Discuss the pathology, findings, and treatment for Post-streptococcal glomerulonephritis.

A
  • Path
    • S.pyogenes causes subepithelial IgG immune complex deposits.
  • Pt
    • childre. HTN, Edema. Brown urine. High ASO titer.
    • EM: subepithelial bumps.
  • Td
    • supportive - self limited disease
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8
Q

Discuss the pathology, findings, and treatment for Lupus Nephritis

A
  • Path
    • SLE causes immune deposits, mesangial proliferation, BGM thickening.
  • Pt
    • proteinuria. (+) ANA.
    • (+) Anti-dsDNA
    • LM = endothelial deposits as wire loops.
  • Tx
    • Glucocorticoids
    • ACEi
    • Statins
    • Immunosuppresants.
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9
Q

Discuss the pathology, findings, and treatment for Granulomatosis w/ polyangiitis

A
  • Path
    • Kidneys, lungs, Upper airway
  • Pt
    • microscopic hematuria
    • pulmonary nodules, saddle nase, sinus disease, palate granulomas.
    • (+) c-ANCA
  • Tx
    • Glucocorticoids
    • Cyclophosphomide
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10
Q

Discuss the pathology, findings, and treatment for Goodpasture Syndrome

A
  • Path
    • IgG antibodies against GBM
  • Pt
    • proteinuria, hematuria.
    • hemoptysis.
    • pulmonary infiltrates.
  • Tx
    • plasmapheresis
    • glucocorticoids.
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11
Q

Discuss the pathology, findings, and treatment for IgA nephropathy

A
  • Path
    • IgA complexes deposit in mesangium
  • Pt
    • Children with HSP
    • Follows URI.
  • Tx
    • ACEi
    • Glucocorticoids
    • Cyclophosphomide
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12
Q

Discuss the pathology, findings, and treatment for Alport syndrome

A
  • Path
    • X-linked defect of Collagen Type IV
  • Pt
    • cataracts.
    • nephritis
    • high frequency hearing loss
  • Tx
    • ACEi
    • Renal transplantation
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13
Q

Discuss the pathology, findings, and treatment for Pauci-immune rapidly progressive glomerulonephritis

A
  • Path
    • crescent shpaed fibrin deposits in glomeruli
  • Pt
    • microscopic hematuria
    • proteinuria
    • (+) p-ANCA
  • Tx
    • glucocorticoids
    • cyclophosphomide

severely rapid progression to ESRD (< 1 year)

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14
Q

Which medication can be used as prophylaxis for meningococcal meningitis?

A
  • Ciprofloxacin
  • Rifampin
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15
Q

Discuss the pathology, findings, and treatment for Minimal Change Disease

A
  • Path
    • Podocyte effacement. However minimal change is seen on microscopy.
  • Pt
    • Children w/ proteinura.
    • Hypoalbuminemia, edema, HTN
  • Tx
    • glucocorticoids
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16
Q

Discuss the pathology, findings, and treatment for Focal segmental glomerular sclerosis

A
  • Path
    • Focal sclerosis affects < 50% glomeruli and segmental only affects one region.
  • Pt
    • Nephrotic in adults (proteinuria)
  • Tx
    • Steroids
    • ACEi
    • Statins
    • +/- cyclosporine
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17
Q

Discuss the pathology, findings, and treatment for Membranous nephropathy

A
  • Path
    • Basement membrane thickening
    • Spike and Dome pattern
  • Pt
    • secondary to HIV, SLE.
    • Proteinuria >>> hematuria
  • Tx
    • ACEi
    • Statin
    • +/- cyclophosphamide + steroid.
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18
Q

Discuss the pathology, findings, and treatment for membranoproliferative glomerulonephritis

A
  • Path
    • Train track appearance.
    • subendothelial humps of IgG along GBM
    • Mesangial immune deposits
  • Pt
    • SLe, bacterial endocarditis, HCV
  • Tx
    • underlying dz
    • steroids.
    • +/- cyclophosphamide.
19
Q

Discuss the pathology, findings, and treatment for Diabetic nephropathy

A
  • Path
    • GBM thickening.
    • Kimelsteil - Wilson bodies (acellular eosinophilic nodules in mesangium)
  • Pt
    • proteinuria in diabetic pt
  • Tx
    • Glycemic control
    • BP control
    • ACEi/ARB
20
Q

Discuss the pathology, findings, and treatment for Renal Amyloidosis

A
  • Path
    • amyloid protein deposit in tissue leading to mesangium expansion and (+) congo red stain = apple birefringence
  • Pt
    • Hemodialysis, hereditary amyloidosis, chronic inflammatory disease
  • Tx
    • Melphalan
    • stem cell transplant
21
Q

Hyaline casts indicate

A

normal renal function. Concentrated urine

22
Q

RBC casts indicate…

A

Nephritis

Vasculitis

23
Q

WBC casts indicate…

A

Pyelonephritis

Interstitial dz

24
Q

Acute Interstitial nephritis

Etiology, Pt, Dx, Tx

A
  • Etiology
    • b-lactams, sulfonamides, aminoglycosides, NSAID, allopurinol.
  • Pt
    • rash, fever, High Cr, Eosinophilia
  • Dx
    • renal Bx
  • Tx
    • stop agent.
    • steroids
  • Complications
    • acute tubular necrosis, ESRD
25
Treatment options for pyelonephritis
* Inpatient * ceftriaxone * cefepime * levofloxacine * **ciprofloxacin (PO)** young patient * Oupatient * young patient who is not all the ill appearing. PO-ciprofloxacin
26
Presentation and treatment of polycystic kidney disease?
* Pt * Flank pain, Chronic UTI's, gross hematuria, palpable kidneys, HTN * Tx 1. ACEi /ARB for HTN 2. Statins *if hyperlipidemia* 3. Tolvaptan; vasopressin receptor antagonist to decrease cAMP and cyst size * Complications * ESRD, hepatic cysts, intracranial aneurysms (at the bifurcation points), MVP.
27
Renal cell carcinoma ## Footnote *Risk factors, Pt, Dx, Tx.*
* Risk * smoking. cadmium, asbestos * Pt * flank pain, wt loss, abd/flank mass, HTN, fever, hematuria, +/- scrotal varicocele * Dx * Renal imaging, along w/ polycythemia and elevated EPO. * Tx * Nephrectomy or renal sparing resection w/ LN dissection * Immunotherapy * Chemotherapy * Radiation
28
Most common cause of interstitial nephritis?
Drug-induced NSAIDs and Antibiotics.
29
Meaning of the Fractional excretion of sodium
* FENA \< 1%: * Na and water are being resorbed. Indicates a low volume state. * Often Prerenal * FENA \>2% * Indicates some form of intrinsic or post-renal process.
30
STages of Renal failure.
* Stage 1 : \>90mL/min * Stage 2: 60-89 * Stage 3a: 45-59 * Stage 3b: 30-44 * Stage 4: 15-29 * Stage 5: \<15 This is probably super low key.
31
Treatment for CKD?
1. smoking cessation 2. BP control 1. diuretic (loops) 2. ACEi / ARB 3. Bblock - reduces CAD risk 4. Dihydropyridine CCB (-dipine) 3. HgbA1c goal of **\< 6.5%** 4. Statins 5. Hgb 11-12 6. Vit D replacement 7. Phosphate binders. 8. Daily ASA 81mg to reduce CAD risk.
32
Indications for emergent dialysis?
**AEIOU** * Acidosis (metabolic) * Electrolyte derangment (Hypernatremia, Hyperkalemia, hypocalcemia) * Cr \>12. BUN \> 100 * Intoxication (toxins) * Volume overload (peripheral edema, ascites) * Uremia (pericarditis, pericardial friction rub)
33
Urine sodium is \< 10. What is your differentical diagnosis
* Extrarenal sodium losses * GI loss (vomiting, diarrhea, NG tube) * Peritonitis, pancreatitis * Sweating, burn loss
34
Urine sodium levels \> 20, indicates what for DDx
* Intrarenal loss of sodium * Thiazide diuretic. * Salt-losing renal disease * Partial urinary tract obstruction * adrenal insufficiency
35
Treatment for diabetes insipidus
1. Central DI: desmopressin (ADH) 2. Nephrogenic DI: 1. HCTZ 2. Indomethacin as an adjunct 3. Lithium-induced 1. Amiloride.
36
How will you treat hyperkalemia
1. IV Calcium gluconate. 2. B-agonist (albuterol) 3. Insulin + dextrose 4. Sodium bicarb. If still high Tx w/ removal: *hemodialysis, kayexalate, loop diuretic*
37
Presentation, Findings, and Treatment for Hypercalcemia.
* Pt * Bone pain, fractures, nephrolithiasis, NV, ulcers, AMS, polyuria. * Dx * Short QT interval * Tx * Hydration * Calcitonin * Bisphosphonates * Steroids * Surgical resection of primary hyperparathyroidism
38
Presentation, findings, treatment for HYPOcalcemia
* Pt * Tingling of lips/fingers, paresthesia, carpal pedal spasm, tetay, layngeal spasm . * Chovstek's sign * Trousseau's sign * Findings * Prolonged QT * Tx * oral/IV calcium * Vit D supplement
39
What are the most common primary sources that metastasize to the brain?
Lots of Bad Stuff Kills Glia * Lung * Breast * Melanoma (Skin) * Kidney (RCC) * GI tract
40
DDx for normal anion gap metabolic acidosis with Low serum Potassium.
* Renal tubular acidosis I, II * Diarrhea * Fanconi Syndrome
41
DDx for normal anion gap metabolic acidosis with a High serum Potassium.
* Addison disease * Renal tubular acidosis IV * Hyperalimentation (TPN)
42
Defect, Cause, urine pH, labs, Tx for Renal Tubular Acidosis type 1
* Defect * impaired H secretion * Cause * autoimmune * drugs, infection, cirrhosis, SLE, obstruction neuropathy. * Urine pH * \> 5.3 * Labs * hypokalemia * Tx * Oral bicarb * potassium * Thiazide diuretic
43
Defect, Cause, urine pH, labs, Tx for Renal Tubular Acidosis type 2
* Defect * Impaired Bicarb absorption. * Cause * multiple myeloma, amyloidosis, Fanconi syndrome, wilson disease, vit D deficiency * Urine pH * \< 5.3 * Lab * hypokalemia, low bicarb * Tx * Oral bicarb * potassium * HCTZ
44
Defect, Cause, urine pH, labs, Tx for Renal Tubular Acidosis type 4
* Cause * HYPOaldosteronism * Addison Dz * Urine pH * \< 5.3 * Labs * hyperkalemia * Tx * Fludrocortisone * K restriction

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