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Step 2CK > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Severe proteinuria means ________ damage?

A

Glomerular

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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

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3
Q

What defines microalbuminuria?

A

30-300mg/24 hrs

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4
Q

What WBCs are in the urine in Acute Interstitial Nephritis?

A

Eosinophils

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5
Q

Can a normal UA differentiate between eosinophils vs neutrophils?

A

No, you need a Wright and Hansel stain for eosinophils

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6
Q

What are RBC casts associated with?

A

Glomerulonephritis

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7
Q

What are WBC casts associated with?

A

Pyelonephritis

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8
Q

What are Eosinophil casts associated with?

A

AIN

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9
Q

What are Hyaline cats associated with?

A

Dehydration

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10
Q

What are waxy casts associated with?

A

Chronic renal disease

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11
Q

What are granular “muddy brown” casts associated with?

A

ATN

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12
Q

What are the 3 types of AKI?

A
  1. Prerenal azotemia (decreased perfusion)
  2. Postrenal azotemia (obstruction)
  3. Intrinsic renal disease (ischemia and toxins)
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13
Q

NSAIDS constrict the ________ arteriole?

A

Afferent

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14
Q

ACE inhibitors dilate the ________ arteriole?

A

Efferent

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15
Q

Can retroperitoneal fibrosis (from bleomycin, radiation) cause postrenal azotemia?

A

Yes

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16
Q

What’s the most common cause of intrinsic renal disease?

A

ATN

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17
Q

What is ATN from?

A

Toxins or prolonged ischemia

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18
Q 
What can the following all cause:?
AIN
Rhabdo
Contrast agents
Chemo drugs
NSAIDS
Crystals
Bence-Jones protein
Post-strep infex
A

ATN

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19
Q

What imaging study is dangerous in a patient with borderline renal function?

A

CT angio

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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.

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21
Q

Can postrenal AKI present with massive release of urine with catheter placement?

A

Yes

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22
Q

How does prerenal azotemia present with urine sodium?

A

Low UNa (<20) and low FENa (<1%)

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23
Q

When do you give a sickle cell patient hydroxyurea?

A

If they have painful crises >4x per year

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24
Q

What’s the urine sodium lab in ATN?

A

> 20

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25
Q

What’s the FENa in ATN?

A

> 1%

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26
Q

How long does CT contrast take to cause kidney injury?

A

Immediately/next day

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27
Q

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:

A

UNa: 5 (very low)
FENa: <1%
Urine specific gravity: 1.040 (very high)

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28
Q

2 days after chemo, creatinine rises in a person with a hematologic malignancy due to _____ _____ ____?

A

Tumor lysis syndrome (hyperuricemia)

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29
Q

How long does it take for cisplatin and drug toxicities to cause a rise in creatinine?

A

5-10 days

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30
Q

What can be given prior to chemo to avoid tumor lysis syndrome associated renal failure?

A

Allopurinol, hydration, and rasburicase

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31
Q

What toxic ingestion can cause ATN, hypocalcemia, and oxalate crystals?

A

Ethylene glycol

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32
Q

What is methanol toxicity associated with?

A

Inflammation of the retina

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33
Q

What is opioid toxicity associated with in terms of the kidney?

A

Focal segmental glomerulonephritis

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34
Q

What can abx, acyclovir, amphotericin, cisplatin, and vancomycin all cause?

A

ATN

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35
Q

What can trauma, prolonged immobility, snake bites, cocaine, seizures, statins, hypokalemia, and crush injuries all cause?

A

Rhabdomyolysis

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36
Q

T/F: don’t treat hypocalcemia in rhabdomyolysis if asymptomatic?

A

True; the Ca will come back out of the muscles

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37
Q

T/F: there is no specific therapy proven to benefit ATN?

A

True; don’t answer steroids, diuretics, mannitol, or DA

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38
Q

Do you dialyze for hypocalcemia?

A

No, give vitD and calcium

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39
Q

What are the 5 main indications for initiating dialysis?

A
  1. Fluid overload
  2. Encephalopathy
  3. Pericarditis
  4. Metabolic acidosis
  5. Hyperkalemia
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40
Q

Does furosemide cause ototoxicity?

A

Yes

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41
Q

What dx is caused by liver disease and presents with very low uNa (<10-15), FENa <1%, and elevated BUN:creatinine >20:1?

A

Hepatorenal syndrome

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42
Q

What can cause Livedo Reticularis and eosinophiluria?

A

Cholesterol emboli

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43
Q

What 2 common abx can cause AIN?

A
  1. Penicillins

2. Sulfa drugs

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44
Q

T/F: AIN usually resolves spontaneously, but temporary dialysis and steroids may be needed?

A

True

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45
Q

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?

A

Papillary necrosis

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46
Q

Is there a tx for papillary necrosis?

A

No

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47
Q

What will a UA show in papillary necrosis?

A

Red and WBCs

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48
Q

Are tubular injuries normally acute or chronic?

A

Acute

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49
Q

Are glomerular injuries normally acute or chronic?

A

Chronic

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50
Q

What are glomerular injuries often treated with?

A

Steroids

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51
Q

What dx presents with UA with hematuria, dysmorphic RBC’s, RBC casts, low UNa and FENa, and proteinuria?

A

Glomerulonephritis

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52
Q 
What do the following 4 conditions have in common?: 
SLE
Endocarditis
Cryoglobulinemia
Post-strep glomerular disease
A

Low complement levels

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53
Q

Goodpasture disease is limited to which 2 organs?

A
  1. Lung

2. Kidney

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54
Q

What does kidney biopsy show in Goodpasture syndrome?

A

Linear deposits

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55
Q

What’s the best initial test for Goodpasture syndrome?

A

Antiglomerular basement membrane antibodies

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56
Q

What’s the best tx for Goodpasture syndrome?

A

Plasmapharesis and steroids

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57
Q

What dx presents in an Asian patient with recurrent episodes of gross hematuria 1-2 days after a URI?

A

IgA Nephropathy

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58
Q

How long after strep does glomerulonephritis follow?

A

1-2 weeks

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59
Q

How do you treat severe proteinuria in IgA nephropathy (?

A

ACE inhibitors and steroids

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60
Q

What dx presents with cola colored urine, periorbital edema, hypertension, oliguria, and has proteinuria and RBC casts?

A

Post-Strep Glomerulonephritis

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61
Q

How do you confirm PSGN?

A

Antistreptolysin O titers (ASO)

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62
Q

What dx is a congenital defect of collagen that results in glomerular disease combined with hearing loss, visual disturbance?

A

Alport Syndrome

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63
Q

What type of collagen is Alport Syndrome a defect in?

A

Type IV collagen

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64
Q

Stroke or MI in a young person suggests which vasculitis?

A

PAN

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65
Q

What’s the best initial test for PAN?

A

Renal, mesenteric, or hepatic angiography?

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66
Q

What tx (2 drugs) do you use for the following:

  • SLE
  • PAN
  • Granulomatosis w/ polyangiitis
  • Eosinophilic granulomatosis with polyangiitis
  • Microscopic polyangiitis
A

Steroids + cyclophosphamide

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67
Q

______is indispensable in determining therapy for lupus nephritis?

A

Biopsy

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68
Q 
What abnormal protein is associated with the following conditions?: 
Myeloma
Inflammation
RA
IBD
Chronic infex
A

Amyloidosis

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69
Q

What’s the definition of nephrotic syndrome?

A

When the severity of proteinuria is so great that the liver can’t produce enough albumin to compensate

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70
Q

What can cause nephrotic syndrome in kids?

A

Minimal change disease

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71
Q

What are the 2 most common causes of nephrotic syndrome?

A
  1. Diabetes

2. HTN

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72
Q

How does nephrotic syndrome present?

A

Generalized edema

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73
Q

How do you differentiate between CHF and nephrotic?

A

CHF leads to edema of dependent areas (like the legs); nephrotic patients are edematous everywhere

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74
Q

What’s the best initial test for nephrotic?

75
Q

How does the urine albumin/creatinine ratio measure the protein level?

A

A ratio of 2:1 means 2 grams of protein excreted over 24 hours

76
Q

What’s the definition of nephrotic in terms of protein?

A

> 3.5 grams per 24 hours

77
Q

What’s the best initial tx for nephrotic?

A

Glucocorticoids + salt restriction, diuretics, and statins (if HLD)

78
Q

What’s the definition of ESRD?

A

Renal failure so severe that it needs dialysis or transplant

79
Q

Does ESRD have uremia?

80
Q

Uremia is frequently associated with which 5 factors?

A

I1. Metabolic acidosis

  1. Fluid overload
  2. Encephalopathy
  3. Hyperkalemia
  4. Pericarditis
81
Q

T/F: each of the 5 factors of uremia is an indication for dialysis?

82
Q

What’s the difference between uremia and azotemia?

A

Uremia is when you have urea in the blood, and azotemia is when you have nitrogen in the blood

83
Q

In renal failure, what are calcium levels like?

84
Q

Platelets do not ________ in a uremic environment?

A

Degranulate

85
Q

Without degranulation, _________ won’t effectively combat infex?

A

Neutrophils

86
Q

What are phosphate levels in uremia?

87
Q

What are PTH levels like in uremia?

88
Q

T/F: hypogonadism occurs in renal failure?

89
Q

What can you use to treat hyperphosphatemia in uremia (4 options)?

A
  1. Calcium acetate
  2. Calcium carbonate
  3. Sevelamer
  4. Lanthanum
90
Q

What 2 diagnoses present with intravascular hemolysis, renal insufficiency, and thrombocytopenia?

A
  1. TTP

2. HUS

91
Q

What do schistocytes indicate?

92
Q

What’s the diff between TTP and HUS?

A

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
Q

What are PT and aPTT like in TTP/HUS?

94
Q

What’s the tx for HUS?

A

None; spontaneously resolves

95
Q

What’s the tx for TTP?

A

Urgent plasmapharesis

96
Q

What dx presents with pain, hematuria, stones, infex, and HTN?

A

Polycystic Kidney Disease

97
Q

What’s the most common cause of death from PCKD?

A

Renal failure

98
Q

What’s the diff between hypernatremia and DI?

A

Hypernatremia is loss of free water; DI is due to insufficient/ineffective ADH

99
Q

What are some causes of nephrogenic DI?

A

Lithium, CKD, hypokalemia, hypercalcemia

100
Q

What does high volume nocturia clue you into?

101
Q

Increased urine volume despite dehydration and hyperosmolality of the blood suggests what condition?

102
Q

What’s the best test for DI?

A

Water deprivation test

103
Q

What’s the urine osmolality in DI?

104
Q

What does a “positive” water deprivation test mean?

A

The urine volume stays high despite withholding water

105
Q

What are the 3 most common causes of hyponatremia with hypervolemia?

A
  1. CHF
  2. Nephrotic
  3. Cirrhosis
106
Q

Why does Addison disease cause hyponatremia?

A

Loss of aldosterone

107
Q

What are the 4 most common causes of hyponatremia with euvolemia?

A
  1. Hyperglycemia
  2. Polygenic polydipsia
  3. Hypothyroidism
  4. SIADH
108
Q

What is the urine osmolality in SIADH?

109
Q

When hyponatremia is so severe that the patient has lethargy, seizures, and coma, what should you add to hypertonic saline?

110
Q

What drug treats chronic SIADH?

A

Demeclocycline

111
Q

How slowly must sodium be corrected in hyponatremia?

A

0.5-1 mEq per hour

112
Q

Low to high, the ___ will die?

113
Q

Do ACEi/ARBs increase or decrease potassium?

114
Q

Insulin drives K __ to the cells?

115
Q

Is K usually inside or outside the cell?

116
Q

Does vomiting and diarrhea cause hyper or hypokalemia?

A

Hypokalemia

117
Q

Can hypokalemia cause rhabdomyolysis?

118
Q

Bartter syndrome is like which drug?

A

Furosemide

“I furiously Bartter”

119
Q

Gitelman syndrome is like which drug?

120
Q

Liddle syndrome is like which drug?

A

Aldosterone

121
Q

Anion gap =

A

Anion gap = Sodium minus (Chloride plus Bicarb)

122
Q

The distal tubule is responsible for generating new _________ under the influence of aldosterone?

A

Bicarbonate

123
Q

What can drugs like amphotericin and topiramate cause?

A

Distal RTA

124
Q

What will distal RTA present with in terms of pH?

A

High pH above 5.5

125
Q

What’s the treatment for distal (Type I) RTA?

A

Replace bicarb

“B1carb”

126
Q

The proximal tubule is responsible for reabsorbing _________?

127
Q

What can amyloidosis, myeloma, Fanconi syndrome, acetazolamide, or heavy metals cause?

A

Proximal RTA

128
Q

What is urine pH like in proximal RTA?

A

Low pH below 5.5

129
Q

What’s the tx for proxima (Type II) l RTA?

A

Thiazide diuretics plus bicarb

“2 thighs”

130
Q

In Type IV RTA, there is a decreased amount or effect of __________ at the kidney tubule?

A

Aldosterone

131
Q

In Type IV RTA there will be a ____ level of urine Na?

132
Q

Which steroid has the highest “aldosteronelike” effect?

A

Fludrocortisone

133
Q

What’s the tx for Type IV RTA?

A

Fludrocortisone

“Diabetics flu”

134
Q

Urine anion gap =

A

Urine anion gap = Sodium - Chloride

135
Q

RTA has a __ UAG?

136
Q

Diarrhea has a __ UAG?

137
Q

How do you know if a non-anion gap metabolic acidosis is RTA vs diarrhea?

A

Look at the urine anion gap

138
Q

What’s the mnemonic for causes of metabolic acidosis with an elevated anion gap?

A

“LO FUKS”

139
Q

What does “LO FUKS” stand for?

A

Lactate
Oxalic acid

Formic acid
Uremia
Ketoacids
Salicylates

140
Q

What can cause oxalic acidosis?

A

Ethylene glycol OD

141
Q

What can cause formic acidosis?

A

Methanol OD

142
Q

What can cause salicylic acidosis?

A

Aspirin OD

143
Q

What’s the treatment for lactic acidosis?

A

Correct hypoperfusion

144
Q

What’s the treatment for ketoacidosis?

A

Insulin and fluids

145
Q

What’s the treatment for oxalic acidosis?

A

Fomepizole, dialysis

146
Q

What’s the treatment for formic acidosis?

A

Fomepizole, dialysis

147
Q

What’s the treatment for uremia?

148
Q

What’s the treatment for salicylic acidosis?

A

Alkalizing the urine

149
Q

What’s the mnemonic for the 5 causes of respiratory acidosis from First Aid 1?

A

“AA COW” breathes slowly

150
Q

What does “AA COW” stand for?

A

Airway obstruction
Acute lung disease

Chronic lung disease
Opioids, sedatives
Weakening of respiratory muscles

Breathes slowly = Hypoventilation

151
Q

What’s the main cause of respiratory alkalosis from First Aid 1?

A

Hyperventilation

“The scared Elk hyperventilates”

152
Q

What’s the mnemonic for elevated anion gap metabolic acidosis from First Aid 1?

A

“MUDPILES”

153
Q

What does “MUDPILES” stand for?

A

Methanol (formic)
Uremia
DKA

Propylene glycol
Iron tablets
Lactic acidosis
Ethylene glycol (oxalic)
Salicylates
154
Q

What’s the mnemonic for normal anion gap metabolic acidosis from First Aid 1?

A

It’s normal to be a “HARDASS”

155
Q

What does “HARDASS” stand for?

A

Hyperalimentation
Addison disease
RTA
Diarrhea

Acetazolamide
Spironolactone
Saline infusion

156
Q

What are the 4 causes of metabolic alkalosis from First Aid 1?

A

Loop diuretics
Vomiting
Antacid use
Hyperaldosteronism

157
Q

What’s the most common type of kidney stone?

A

Calcium oxalate

158
Q

What’s the most accurate diagnostic test for kidney stones?

159
Q

Stones 5-7mm get ________ and ________to help them pass?

A

Nifedipine and tamsulosin

160
Q

Stones between 0.5-3cm should be treated with __________?

A

Lithotripsy

161
Q

Watch out for cm vs mm!

162
Q

Stones >2cm are best managed how?

A

Surgically with stent placement

163
Q

What’s the etiology of struvite stones?

A

UTI caused by urease positive bugs, such as Proteus mirabilis, S saprophyticus, or Klebsiella

164
Q

What’s the best medication for someone with chronic calcium oxalate stones?

A

Hydrochlorothiazide (it removes calcium from the urine by reabsorbing it)

165
Q

Can metabolic acidosis cause kidney stones?

A

Yes because it decreases citrate, which normally binds calcium

166
Q

Which kind of kidney stone looks like an envelope?

167
Q

Which kind of kidney stone looks like a coffin lid?

168
Q

Which type of kidney stone looks like a rosette or rhomboid?

169
Q

What causes uric acid stones?

A

Gout, leukemia

170
Q

Which type of kidney stone is hexagonal?

171
Q

What’s the etiology of cystine stones?

A

Hereditary AR condition

172
Q

Which type of incontinence presents in an older woman with urinary leakage from coughing, laughing, or lifting?

173
Q

What’s the tx for stress incontinence?

A

Kegels, estrogen, surgery

174
Q

Which type of incontinence presents with sudden pain in bladder followed by urge to urinate?

175
Q

What’s the tx for urge incontinence?

A

Anticholinergic therapy such as oxybutynin

176
Q

What’s the physical exam finding for renal artery stenosis?

A

Bruit at the flank

177
Q

What’s the most effective lifestyle modification for HTN?

A

Weight loss

178
Q

When should 2 BP meds be used from the get-go?

A

When BP is >160/100

179
Q

What’s the safest first-line BP drug during pregnancy?

A

Beta blocker

180
Q

What’s the first line drug for hypertensive crisis if there is no arterial line?

181
Q

What’s the first line drug for hypertensive crisis if there is an arterial line?

A

Nitroprusside

182
Q

If a patient BPH, which BP drug should you use?

A

Alpha blocker

183
Q

If a patient has depression or asthma, which BP drug should you avoid?

A

Beta blockers

Step 2CK (31 decks)

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