Nephrology Flashcards by Marissa Justine

Liddle syndrome

pseudoaldosteronism
AD
hypertension, hypokalemia, and metabolic alkalosis (with high urinary chloride).

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Gordon Syndrome

pseudohypoaldosteronism

hypertension, hyperkalemia, metabolic acidosis, and normal renal function

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Treatment of Scleroderma Renal Crisis

ACEI

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CKD G1

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CKD G2

60-89

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CKD G3a and b

3a 45-59

3b 30-44

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CKD G4

15-29

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CKD G5

<15

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Alb/Crt Ratio

A1 <30
A2 30-300
A3 >300

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Prot/Cr Ratio

<200 (or 150?)

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24 Urine Protein

<150

>3.5 Nephrotic

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Value for potential treatment of anemia in CKD

<10

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CKD: When to Add Sodium Bicarb

Bicarb <22

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Kidney Disease and Vitamin D

inability to convert to active form of Vit D
Decreased Calcium
Due to CKD, increased phos (normally decreased)
Increase in PTH

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Primary Hyperparathyroidism Values

High PTH –> High Ca and High Phos

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Secondary Hyperparathyroidism due to CKD

Low Calcium, High Phos –> High PTH (due to Vit D + inability of kidneys to filter phos)

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Secondary Hyperparathyroidism due to Vit D Def

Low Ca and Low Phos

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Tertiary Hyperparathyroidism due to CKD

HIgh Ca, Phos, PTH

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Agents that reduce proteinuria

ACEI
ARB
Non-dihydropine CCBS: Verapamil and Dilt

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Nephrogenic Systemic Fibrosis - GFR to worry about

<30 and gadolinium (MRI)

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ADH - mechanism

stimulate reabsorption of water in the collecting duct

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AIN Triad

fever, rash and peripheral eosinophilia

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Anion Gap

Na-Cl+HCO3

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Albumin Correction of AG

Ag + 2.5 x (normal/measured)

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Delta/Delta Ratio

AG- 12 / Bicarb -24

Delta Delta Ratio Values

<1 - NAGMA | >2 - metabolic alkalosis

Type A Lactic Acidosis

Tissue Hypoperfusion = MUDPILES

Type B Lactic Acidosis

- Propofol - metformin - HIV NRVT - Heme/Malignancy

D-lactic Acidosis

short bowel syndrome

MUD (of MUDpiles)

Methanol Uremia DKA, Drugs

PILES (of MudPILES)

``` Phosphate or Paraldehyde Ischemia Lactate Ethylene Glycol Starvation or Salicylates ```

NGMA - DURHAM

``` Diarrhea Urteral Diversion RTA Hyperalimentation Addison Disease, Acetazolamide Misc (chloride, amph B, toluene) ```

Winter's Formula for HAGMA compensation

1.5 x Bicarb + 8 +/- 2

Metabolic Alkalosis - Low Urine Cl/Saline Responsive

Diuretic Use Vomiting NG Suction Post-hypercapnia alkalosis

Metabolic Alkalosis - High Urine Cl w/o HTN

Decreased Mg or K Barter or Gietlman Laxative Abuse

Metabolic Alkalosis - High Urine Cl w/ HTN

Cushing Syndrome Conn RAS/RVH Liddle Syndrome

Urine Anion Gap

Na+K-Cl negative = presence of ammonium (base, means acid secretion is happening) positive = lack of ammonium

Proximal Tubule Function (for RTA)

bicarb reabsorption

Distal Tubule Function (for RTA)

acid excretion/clearing daily acid load | H + NH3 = NH4+ (ammonium)

Type II RTA

proximal tubule defect, lack of bicarb reabsporption

Causes of Type II RTA

Drugs - Topiramate, Acetazolamide Multiple Myeloma Fanconi Syndrome

HTN Secondary Causes "A"

Apnea | Alcohol

HTN Secondary Causes "B"

bad kidneys - CKD, RAS, FMD, PCKD

HTN Secondary Causes "C"

coarctation of aorta, cocaine

HTN Secondary Causes "D"

drugs + diet

HTN Secondary Causes "E"

Endocrine: hyper/hypothyroid, pheochromocytoma, increasing aldosterone/Conn, Cushing

Most Common Types of Kidney Stones

Calcium Oxalate > Calcium Phos

Calcium Oxalate Stones associated with

hypercaliuria/hypercalcemia hyperoxaluria hypocitraturia

What stones can be seen on KUB?

Radiopaque = Ca ox + Ca phos

Treatment of Calcium Stones

Thiazide diuretics Limit Sodium K citrate or K bicarb Limit oxalate intake

Type I RTA

distal, hypokalemic, can't excrete hydrogen!

Type I RTA common causes

Autoimmune = Sjogrens, SLE Sickle Cell Anemia Reflex/Obstructive Uropathy

Type IV RTA

distal, hypoaldosteronism | hyperkalemic

Type IV RTA common causes

DM Obstructive Uropathy Drugs = Heparin, ACE, ARB, NSAIDs

Treatment Anemia in CKD - goals

transferritin sat >30 | ferritin >500

ADPCKD associations

hepatic cysts MVP intracranial aneurysms

Tuberous Sclerosis renal manifestations

renal angiomylolipomas renal cell carcinoma renal cysts

Hereditary Nephritis =

Alport Syndrome X linked sensioneural hearing loss, eye abnormalities

Thin Glomerular Basement Membrane Disease

Benign Familial Hematuria | type IV collagen defects

Fabry Disease

X-linked Recessive defieincy of alpha-glactosiadase A CKD of unknown etiology in young adults!

Pyroglutamic Acidosis

5-oxoproloine, HAGMA mental status changes in older/frail person on chronic Tylenol at low dose can measure urine levels of pyroglutamic acid

Treatment of Alcohol KetoAcidosis

D5-NS | stimulate insulin secretion to correct ketoacidosis

Hyperaldosteronism classic triad

resistant HTN metabolic alkalosis hypokalemia

Hypermagnesemia treatment

Saline Diuresis for magnesium excretion | IV Calcium

Nephrotic Syndrome - 4 things

nephrotic range proteinuria edema hyperlipidemia hypoalbuminemia

APOL1 gene

FSGS, African americans

Causes of Membranous Nephropathy

SLE, hepatitis, solid tumors

spikes of immune deposits, dx?

podocyte effacement or fusion, dx?

MCD

Nephritis Syndrome/GN/RPGN Charactersitis

HTN hematuria proteinuria azotemia

Definition of RPGN

50 % decline in GFR | extensive glomerular creseents

ANCA GN with worse progrnosis

C ANCA/anti-PR3

"Full House" appearance on IF, dx?

Lupus Nephritis

Pauci-Immune GN?

ANCA associated

Linear GN?

Ant-GBM antibody disease

Infection Related GN latency period

1-2w URI | 2-4 skin infections

Infection Related GN common infections in adults

S aureus, GN bacteria

PTH Mediated Hypercalcemia

Primary and Tertiary Hyper PTH Familial Hypocalciuric Hypercalcemia Ectopic PTH Secretions

Non-PTH Mediated Vitamin D-Dependent Hypercalcemia

excess vitamin d intake granulomatous disease lymphomas

Non-PTH Non-Vitamin D Dependent Hypercalcemia

PTHrp | Bone Mets/infiltration (MM)

Clue for Light Chain/MM/Cast Nephropathy

elevated Ur/Prot Cr ration with minimal prot on dipstick