Nephrology Flashcards
(183 cards)
1
Q
Severe proteinuria means ________ damage?
A
Glomerular
2
Q
If the P/Cr ratio or the 24-hour urine are both in answer choices, which should you pick?
A
P/Cr ratio
3
Q
What defines microalbuminuria?
A
30-300mg/24 hrs
4
Q
What WBCs are in the urine in Acute Interstitial Nephritis?
A
Eosinophils
5
Q
Can a normal UA differentiate between eosinophils vs neutrophils?
A
No, you need a Wright and Hansel stain for eosinophils
6
Q
What are RBC casts associated with?
A
Glomerulonephritis
7
Q
What are WBC casts associated with?
A
Pyelonephritis
8
Q
What are Eosinophil casts associated with?
A
AIN
9
Q
What are Hyaline cats associated with?
A
Dehydration
10
Q
What are waxy casts associated with?
A
Chronic renal disease
11
Q
What are granular “muddy brown” casts associated with?
A
ATN
12
Q
What are the 3 types of AKI?
A
- Prerenal azotemia (decreased perfusion)
- Postrenal azotemia (obstruction)
- Intrinsic renal disease (ischemia and toxins)
13
Q
NSAIDS constrict the ________ arteriole?
A
Afferent
14
Q
ACE inhibitors dilate the ________ arteriole?
A
Efferent
15
Q
Can retroperitoneal fibrosis (from bleomycin, radiation) cause postrenal azotemia?
A
Yes
16
Q
What’s the most common cause of intrinsic renal disease?
A
ATN
17
Q
What is ATN from?
A
Toxins or prolonged ischemia
18
Q
What can the following all cause:? AIN Rhabdo Contrast agents Chemo drugs NSAIDS Crystals Bence-Jones protein Post-strep infex
A
ATN
19
Q
What imaging study is dangerous in a patient with borderline renal function?
A
CT angio
20
Q
How do you differentiate between the types of AKI with labs?
A
If BUN:creatinine is above 20:1, it’s either pre-or post. Intrarenal BUN:creatinine is more like 10:1.
21
Q
Can postrenal AKI present with massive release of urine with catheter placement?
A
Yes
22
Q
How does prerenal azotemia present with urine sodium?
A
Low UNa (<20) and low FENa (<1%)
23
Q
When do you give a sickle cell patient hydroxyurea?
A
If they have painful crises >4x per year
24
Q
What’s the urine sodium lab in ATN?
A
> 20
25
What's the FENa in ATN?
>1%
26
How long does CT contrast take to cause kidney injury?
Immediately/next day
27
What are the following labs in contrast-induced ATN (hint: they're not the normal ATN values bc the contrast causes spasm of the afferent arteriole)?:
UNa:
FENa:
Urine specific gravity:
UNa: 5 (very low)
FENa: <1%
Urine specific gravity: 1.040 (very high)
28
2 days after chemo, creatinine rises in a person with a hematologic malignancy due to _____ _____ ____?
Tumor lysis syndrome (hyperuricemia)
29
How long does it take for cisplatin and drug toxicities to cause a rise in creatinine?
5-10 days
30
What can be given prior to chemo to avoid tumor lysis syndrome associated renal failure?
Allopurinol, hydration, and rasburicase
31
What toxic ingestion can cause ATN, hypocalcemia, and oxalate crystals?
Ethylene glycol
32
What is methanol toxicity associated with?
Inflammation of the retina
33
What is opioid toxicity associated with in terms of the kidney?
Focal segmental glomerulonephritis
34
What can abx, acyclovir, amphotericin, cisplatin, and vancomycin all cause?
ATN
35
What can trauma, prolonged immobility, snake bites, cocaine, seizures, statins, hypokalemia, and crush injuries all cause?
Rhabdomyolysis
36
T/F: don't treat hypocalcemia in rhabdomyolysis if asymptomatic?
True; the Ca will come back out of the muscles
37
T/F: there is no specific therapy proven to benefit ATN?
True; don't answer steroids, diuretics, mannitol, or DA
38
Do you dialyze for hypocalcemia?
No, give vitD and calcium
39
What are the 5 main indications for initiating dialysis?
1. Fluid overload
2. Encephalopathy
3. Pericarditis
4. Metabolic acidosis
5. Hyperkalemia
40
Does furosemide cause ototoxicity?
Yes
41
What dx is caused by liver disease and presents with very low uNa (<10-15), FENa <1%, and elevated BUN:creatinine >20:1?
Hepatorenal syndrome
42
What can cause Livedo Reticularis and eosinophiluria?
Cholesterol emboli
43
What 2 common abx can cause AIN?
1. Penicillins
| 2. Sulfa drugs
44
T/F: AIN usually resolves spontaneously, but temporary dialysis and steroids may be needed?
True
45
What dx presents in sickle cell patients with extra NSAID use and sudden onset of flank pain, fever, and hematuria, wth visible necrotic material passed in the urine?
Papillary necrosis
46
Is there a tx for papillary necrosis?
No
47
What will a UA show in papillary necrosis?
Red and WBCs
48
Are tubular injuries normally acute or chronic?
Acute
49
Are glomerular injuries normally acute or chronic?
Chronic
50
What are glomerular injuries often treated with?
Steroids
51
What dx presents with UA with hematuria, dysmorphic RBC's, RBC casts, low UNa and FENa, and proteinuria?
Glomerulonephritis
52
```
What do the following 4 conditions have in common?:
SLE
Endocarditis
Cryoglobulinemia
Post-strep glomerular disease
```
Low complement levels
53
Goodpasture disease is limited to which 2 organs?
1. Lung
| 2. Kidney
54
What does kidney biopsy show in Goodpasture syndrome?
Linear deposits
55
What's the best initial test for Goodpasture syndrome?
Antiglomerular basement membrane antibodies
56
What's the best tx for Goodpasture syndrome?
Plasmapharesis and steroids
57
What dx presents in an Asian patient with recurrent episodes of gross hematuria 1-2 days after a URI?
IgA Nephropathy
58
How long after strep does glomerulonephritis follow?
1-2 weeks
59
How do you treat severe proteinuria in IgA nephropathy (?
ACE inhibitors and steroids
60
What dx presents with cola colored urine, periorbital edema, hypertension, oliguria, and has proteinuria and RBC casts?
Post-Strep Glomerulonephritis
61
How do you confirm PSGN?
Antistreptolysin O titers (ASO)
62
What dx is a congenital defect of collagen that results in glomerular disease combined with hearing loss, visual disturbance?
Alport Syndrome
63
What type of collagen is Alport Syndrome a defect in?
Type IV collagen
64
Stroke or MI in a young person suggests which vasculitis?
PAN
65
What's the best initial test for PAN?
Renal, mesenteric, or hepatic angiography?
66
What tx (2 drugs) do you use for the following:
- SLE
- PAN
- Granulomatosis w/ polyangiitis
- Eosinophilic granulomatosis with polyangiitis
- Microscopic polyangiitis
Steroids + cyclophosphamide
67
______is indispensable in determining therapy for lupus nephritis?
Biopsy
68
```
What abnormal protein is associated with the following conditions?:
Myeloma
Inflammation
RA
IBD
Chronic infex
```
Amyloidosis
69
What's the definition of nephrotic syndrome?
When the severity of proteinuria is so great that the liver can't produce enough albumin to compensate
70
What can cause nephrotic syndrome in kids?
Minimal change disease
71
What are the 2 most common causes of nephrotic syndrome?
1. Diabetes
| 2. HTN
72
How does nephrotic syndrome present?
Generalized edema
73
How do you differentiate between CHF and nephrotic?
CHF leads to edema of dependent areas (like the legs); nephrotic patients are edematous everywhere
74
What's the best initial test for nephrotic?
UA
75
How does the urine albumin/creatinine ratio measure the protein level?
A ratio of 2:1 means 2 grams of protein excreted over 24 hours
76
What's the definition of nephrotic in terms of protein?
>3.5 grams per 24 hours
77
What's the best initial tx for nephrotic?
Glucocorticoids + salt restriction, diuretics, and statins (if HLD)
78
What's the definition of ESRD?
Renal failure so severe that it needs dialysis or transplant
79
Does ESRD have uremia?
Yes
80
Uremia is frequently associated with which 5 factors?
I1. Metabolic acidosis
2. Fluid overload
3. Encephalopathy
4. Hyperkalemia
5. Pericarditis
81
T/F: each of the 5 factors of uremia is an indication for dialysis?
True
82
What's the difference between uremia and azotemia?
Uremia is when you have urea in the blood, and azotemia is when you have nitrogen in the blood
83
In renal failure, what are calcium levels like?
Low
84
Platelets do not ________ in a uremic environment?
Degranulate
85
Without degranulation, _________ won't effectively combat infex?
Neutrophils
86
What are phosphate levels in uremia?
High
87
What are PTH levels like in uremia?
High
88
T/F: hypogonadism occurs in renal failure?
True
89
What can you use to treat hyperphosphatemia in uremia (4 options)?
1. Calcium acetate
2. Calcium carbonate
3. Sevelamer
4. Lanthanum
90
What 2 diagnoses present with intravascular hemolysis, renal insufficiency, and thrombocytopenia?
1. TTP
| 2. HUS
91
What do schistocytes indicate?
Hemolysis
92
What's the diff between TTP and HUS?
TTP is associated with neuro sx and fever, and is usually due to HIV, cancer, or drugs. HUS is associated with E. Coli and Shigella.
93
What are PT and aPTT like in TTP/HUS?
Normal
94
What's the tx for HUS?
None; spontaneously resolves
95
What's the tx for TTP?
Urgent plasmapharesis
96
What dx presents with pain, hematuria, stones, infex, and HTN?
Polycystic Kidney Disease
97
What's the most common cause of death from PCKD?
Renal failure
98
What's the diff between hypernatremia and DI?
Hypernatremia is loss of free water; DI is due to insufficient/ineffective ADH
99
What are some causes of nephrogenic DI?
Lithium, CKD, hypokalemia, hypercalcemia
100
What does high volume nocturia clue you into?
DI
101
Increased urine volume despite dehydration and hyperosmolality of the blood suggests what condition?
DI
102
What's the best test for DI?
Water deprivation test
103
What's the urine osmolality in DI?
Low
104
What does a "positive" water deprivation test mean?
The urine volume stays high despite withholding water
105
What are the 3 most common causes of hyponatremia with hypervolemia?
1. CHF
2. Nephrotic
3. Cirrhosis
106
Why does Addison disease cause hyponatremia?
Loss of aldosterone
107
What are the 4 most common causes of hyponatremia with euvolemia?
1. Hyperglycemia
2. Polygenic polydipsia
3. Hypothyroidism
4. SIADH
108
What is the urine osmolality in SIADH?
High
109
When hyponatremia is so severe that the patient has lethargy, seizures, and coma, what should you add to hypertonic saline?
Vaptans
110
What drug treats chronic SIADH?
Demeclocycline
111
How slowly must sodium be corrected in hyponatremia?
0.5-1 mEq per hour
112
Low to high, the ___ will die?
Pons
113
Do ACEi/ARBs increase or decrease potassium?
Increase
114
Insulin drives K __ to the cells?
In
115
Is K usually inside or outside the cell?
Inside
116
Does vomiting and diarrhea cause hyper or hypokalemia?
Hypokalemia
117
Can hypokalemia cause rhabdomyolysis?
Yes
118
Bartter syndrome is like which drug?
Furosemide
"I furiously Bartter"
119
Gitelman syndrome is like which drug?
Thiazide
120
Liddle syndrome is like which drug?
Aldosterone
121
Anion gap =
Anion gap = Sodium minus (Chloride plus Bicarb)
122
The distal tubule is responsible for generating new _________ under the influence of aldosterone?
Bicarbonate
123
What can drugs like amphotericin and topiramate cause?
Distal RTA
124
What will distal RTA present with in terms of pH?
High pH above 5.5
125
What's the treatment for distal (Type I) RTA?
Replace bicarb
| "B1carb"
126
The proximal tubule is responsible for reabsorbing _________?
Bicarb
127
What can amyloidosis, myeloma, Fanconi syndrome, acetazolamide, or heavy metals cause?
Proximal RTA
128
What is urine pH like in proximal RTA?
Low pH below 5.5
129
What's the tx for proxima (Type II) l RTA?
Thiazide diuretics plus bicarb
"2 thighs"
130
In Type IV RTA, there is a decreased amount or effect of __________ at the kidney tubule?
Aldosterone
131
In Type IV RTA there will be a ____ level of urine Na?
High
132
Which steroid has the highest "aldosteronelike" effect?
Fludrocortisone
133
What's the tx for Type IV RTA?
Fludrocortisone
| "Diabetics flu"
134
Urine anion gap =
Urine anion gap = Sodium - Chloride
135
RTA has a __ UAG?
Positive
136
Diarrhea has a __ UAG?
Negative
137
How do you know if a non-anion gap metabolic acidosis is RTA vs diarrhea?
Look at the urine anion gap
138
What's the mnemonic for causes of metabolic acidosis with an elevated anion gap?
"LO FUKS"
139
What does "LO FUKS" stand for?
Lactate
Oxalic acid
Formic acid
Uremia
Ketoacids
Salicylates
140
What can cause oxalic acidosis?
Ethylene glycol OD
141
What can cause formic acidosis?
Methanol OD
142
What can cause salicylic acidosis?
Aspirin OD
143
What's the treatment for lactic acidosis?
Correct hypoperfusion
144
What's the treatment for ketoacidosis?
Insulin and fluids
145
What's the treatment for oxalic acidosis?
Fomepizole, dialysis
146
What's the treatment for formic acidosis?
Fomepizole, dialysis
147
What's the treatment for uremia?
Dialysis
148
What's the treatment for salicylic acidosis?
Alkalizing the urine
149
What's the mnemonic for the 5 causes of respiratory acidosis from First Aid 1?
"AA COW" breathes slowly
150
What does "AA COW" stand for?
Airway obstruction
Acute lung disease
Chronic lung disease
Opioids, sedatives
Weakening of respiratory muscles
Breathes slowly = Hypoventilation
151
What's the main cause of respiratory alkalosis from First Aid 1?
Hyperventilation
| "The scared Elk hyperventilates"
152
What's the mnemonic for elevated anion gap metabolic acidosis from First Aid 1?
"MUDPILES"
153
What does "MUDPILES" stand for?
Methanol (formic)
Uremia
DKA
```
Propylene glycol
Iron tablets
Lactic acidosis
Ethylene glycol (oxalic)
Salicylates
```
154
What's the mnemonic for normal anion gap metabolic acidosis from First Aid 1?
It's normal to be a "HARDASS"
155
What does "HARDASS" stand for?
Hyperalimentation
Addison disease
RTA
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
156
What are the 4 causes of metabolic alkalosis from First Aid 1?
Loop diuretics
Vomiting
Antacid use
Hyperaldosteronism
157
What's the most common type of kidney stone?
Calcium oxalate
158
What's the most accurate diagnostic test for kidney stones?
CT scan
159
Stones 5-7mm get ________ and ________to help them pass?
Nifedipine and tamsulosin
160
Stones between 0.5-3cm should be treated with __________?
Lithotripsy
161
Watch out for cm vs mm!
Ok!
162
Stones >2cm are best managed how?
Surgically with stent placement
163
What's the etiology of struvite stones?
UTI caused by urease positive bugs, such as Proteus mirabilis, S saprophyticus, or Klebsiella
164
What's the best medication for someone with chronic calcium oxalate stones?
Hydrochlorothiazide (it removes calcium from the urine by reabsorbing it)
165
Can metabolic acidosis cause kidney stones?
Yes because it decreases citrate, which normally binds calcium
166
Which kind of kidney stone looks like an envelope?
Calcium
167
Which kind of kidney stone looks like a coffin lid?
Struvite
168
Which type of kidney stone looks like a rosette or rhomboid?
Uric acid
169
What causes uric acid stones?
Gout, leukemia
170
Which type of kidney stone is hexagonal?
Cystine
171
What's the etiology of cystine stones?
Hereditary AR condition
172
Which type of incontinence presents in an older woman with urinary leakage from coughing, laughing, or lifting?
Stress
173
What's the tx for stress incontinence?
Kegels, estrogen, surgery
174
Which type of incontinence presents with sudden pain in bladder followed by urge to urinate?
Urge
175
What's the tx for urge incontinence?
Anticholinergic therapy such as oxybutynin
176
What's the physical exam finding for renal artery stenosis?
Bruit at the flank
177
What's the most effective lifestyle modification for HTN?
Weight loss
178
When should 2 BP meds be used from the get-go?
When BP is >160/100
179
What's the safest first-line BP drug during pregnancy?
Beta blocker
180
What's the first line drug for hypertensive crisis if there is no arterial line?
Labetalol
181
What's the first line drug for hypertensive crisis if there is an arterial line?
Nitroprusside
182
If a patient BPH, which BP drug should you use?
Alpha blocker
183
If a patient has depression or asthma, which BP drug should you avoid?
Beta blockers
