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Boards 2 > Nephrology > Flashcards

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
Q

Treatment options for pyelonephritis

A
  • Inpatient
    • ceftriaxone
    • cefepime
    • levofloxacine
    • ciprofloxacin (PO) young patient
  • Oupatient
    • young patient who is not all the ill appearing. PO-ciprofloxacin
26
Q

Presentation and treatment of polycystic kidney disease?

A
  • 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
Q

Renal cell carcinoma

Risk factors, Pt, Dx, Tx.

A
  • 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
Q

Most common cause of interstitial nephritis?

A

Drug-induced NSAIDs and Antibiotics.

29
Q

Meaning of the Fractional excretion of sodium

A
  • 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
Q

STages of Renal failure.

A
  • 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
Q

Treatment for CKD?

A
  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
Q

Indications for emergent dialysis?

A

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
Q

Urine sodium is < 10. What is your differentical diagnosis

A
  • Extrarenal sodium losses
    • GI loss (vomiting, diarrhea, NG tube)
    • Peritonitis, pancreatitis
    • Sweating, burn loss
34
Q

Urine sodium levels > 20, indicates what for DDx

A
  • Intrarenal loss of sodium
    • Thiazide diuretic.
    • Salt-losing renal disease
    • Partial urinary tract obstruction
    • adrenal insufficiency
35
Q

Treatment for diabetes insipidus

A
  1. Central DI: desmopressin (ADH)
  2. Nephrogenic DI:
    1. HCTZ
    2. Indomethacin as an adjunct
  3. Lithium-induced
    1. Amiloride.
36
Q

How will you treat hyperkalemia

A
  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
Q

Presentation, Findings, and Treatment for Hypercalcemia.

A
  • Pt
    • Bone pain, fractures, nephrolithiasis, NV, ulcers, AMS, polyuria.
  • Dx
    • Short QT interval
  • Tx
    • Hydration
    • Calcitonin
    • Bisphosphonates
    • Steroids
    • Surgical resection of primary hyperparathyroidism
38
Q

Presentation, findings, treatment for HYPOcalcemia

A
  • 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
Q

What are the most common primary sources that metastasize to the brain?

A

Lots of Bad Stuff Kills Glia

  • Lung
  • Breast
  • Melanoma (Skin)
  • Kidney (RCC)
  • GI tract
40
Q

DDx for normal anion gap metabolic acidosis with Low serum Potassium.

A
  • Renal tubular acidosis I, II
  • Diarrhea
  • Fanconi Syndrome
41
Q

DDx for normal anion gap metabolic acidosis with a High serum Potassium.

A
  • Addison disease
  • Renal tubular acidosis IV
  • Hyperalimentation (TPN)
42
Q

Defect, Cause, urine pH, labs, Tx for Renal Tubular Acidosis type 1

A
  • 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
Q

Defect, Cause, urine pH, labs, Tx for Renal Tubular Acidosis type 2

A
  • 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
Q

Defect, Cause, urine pH, labs, Tx for Renal Tubular Acidosis type 4

A
  • Cause
    • HYPOaldosteronism
    • Addison Dz
  • Urine pH
    • < 5.3
  • Labs
    • hyperkalemia
  • Tx
    • Fludrocortisone
    • K restriction

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