Nephrology

Question 1

What are some triggers of hypertensive emergency/urgency?

Answer 1

• Medication noncompliance
• Diet fluctuations
• Toxicology (cocaine, pseudophed, etc.)
• Pheochromocytoma

Question 2

When someone presents with acute, extremely elevated blood pressure, what things do you need to assess to decide if they are having end-organ damage?

Answer 2

Go by body system and assess for the following:
- Brain: AMS, focal neurologic deficit
- Eyes: vision changes, retinal hemorrhages
- Heart: ACS, acute heart failure
- Aorta: dissection
- Kidneys: AKI, anuria
- Blood: MAHA

Question 3

__________ can cause supine hypertension.

Answer 3

Midodrine

Question 4

What posterior landmarks are the kidneys next to?

Answer 4

They are just behind the costo-vertebral angle.

Question 5

What is normal urine output in infants, children, and adults?

Answer 5

• Infants: 2 mL/kg/hr
• Children: 1 mL/kg/hr
• Adults: 0.5 mL/kg/hr

Question 6

IV fluids and ____________ are the two treatments for rhabdomyolysis.

Answer 6

mannitol

It increases urine output and is a free radical scavenger.

Question 7

What dose of insulin and dextrose should ber given to adults with critical hyperkalemia?

Answer 7

D50 25 g with 10 units of insulin

Question 8

What dose of SDS can be given in hyperkalemia?

Answer 8

15 g to 50 g

Question 9

If you are giving albuterol for hyperkalemia, use a minimum dose of __________ mg.

Answer 9

10

Question 10

Patients with Conn syndrome have oversecretion of a hormone from what organ?

Answer 10

Adrenal gland (the hormone being aldosterone)

Question 11

What ECG findings are seen in hyperkalemia?

Answer 11

• First: peaked T waves
• Second: widened QRS complex
• Third: prolongation of the PR complex
• Fourth: bradycardia
• Fifth: sinusoidal wave pattern

Question 12

Review the dosing of calcium for hyperkalemia.

Answer 12

Calcium for hyperkalemia can be given as calcium gluconate or calcium chloride.
- Calcium gluconate is usually given in 1000 mg boluses over 2-3 minutes
- Calcium chloride is usually given as 500 mg bolus also over 2-3 minutes

Note: calcium chloride has thrice the concentration of elemental calcium, so it is much more caustic to peripheral veins. It usually requires a central line unless no other options are available.

Each formulation can be given serially after five minutes if EKG findings persist.

Question 13

True or false: rhabdomyolysis typically causes high Ca.

Answer 13

False

Question 14

Which marker of kidney function (BUN or creatinine) is more elevated in volume overload?

Answer 14

BUN

Question 15

In which patients with hyperkalemia would you not give calcium gluconate?

Answer 15

Those with suspected digitalis toxicity

There is a theoretical risk of causing “stone heart” in those with digitalis toxicity who are given calcium gluconate.

Question 16

You accidentally overcorrected a hyponatremic patient. What two things could you do?

Answer 16

DDAVP or D5

Question 17

Per boards, treat all hyponatremia less than ____ with hypertonic saline.

Answer 17

120

Question 18

What levels of CK are clinically significant?

Answer 18

Most importantly, rhabdomyolysis is a clinical diagnose that dose not require a specific CK level. Even mildly elevated CK levels can be seen in rhabdo if the patient otherwise has a clinical scenario consistent.

However, that being said, levels 5x thee upper limit of normal (usually about 700) should not be ignored.

Question 19

What is the albumin corrected anion gap?

Answer 19

Low albumin causes a falsely low anion gap. Accounting for hypoalbuminemia can detect gaps you might otherwise miss.

Formula:

AG = [(Na+K) - (HCO + Cl)] + 2.5(4 - measured albumin)

Question 20

What causes hyponatremia with elevated urine sodium and elevated FeNa?

Answer 20

Kidney dysfunction (acute or chronic)

In low volume states, the kidneys hang on to sodium, so urine sodium and FeNa are low in dehydration (with concentrated urine).

Question 21

What syndromes would you expect to see pigmented casts?

Answer 21

Nephrotoxic AKI, such from contrast, aminoglycosides, or amphotericin