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Internal Medicine > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Important information

A

Major extracellular buffer in human blood is the carbon dioxide-bicarbonate buffer pair, which has a pK of 6.1

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2
Q

How seizures cause High Anion Gap Metabolic acidosis?

A

Due to increased production of lactate from muscles and decrease hepatic uptake of lactate

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3
Q

Name the cause of high anion gap metabolic acidosis in which is osmolal gap is increased

A

Ethylene glycol

Methanol

Propylene glycol

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4
Q

Name the acid which causes mixed anion gap metabolic acidosis viz anion gap metabolic acidosis and respiratory alkalosis

A

Aspirin

Lactate

Sulfuric acid

Phosphoric acid

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5
Q

Name the causes of Metabolic Alkalosis in which urine chloride level is low

A

Vomiting

NG aspiration

Prior Diuretic use

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6
Q

Name the causes of Metabolic Alkalosis in which urine chloride is high but patient is normotensive

A

Current diuretic use

Gitelman syndrome

Bartter syndrome

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7
Q

Name the causes of Metabolic Alkalosis in which urine chloride is high but patient is Hypertensive

A

Excessive mineralocorticoid activity due to;

Conn syndrome
Cushing syndrome
eCtopic ACTH production

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8
Q

Important information regarding Metabolic Alkalosis

A

If urine chloride level is <20mEq/L = Saline responsive

If urine chloride level is >20mEq/L = Saline un-responsive

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9
Q

Important information

A

In pregnancy Respiratory alkalosis occurs due to activation of respiratory center by Progesterone

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10
Q

Triad of Type 1 RTA

A
  • Inability of distal cells of nephron to secrete H+
  • Low body pH But high urine pH
  • Low Potassium level
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11
Q

Why kidney stones developed in type 1 RTA?

A

Due to inability of distal cell of nephron to secrete H+ in lumen results alkaline urine produce which increases the formation of stones

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12
Q

Which type of Renal tubular acidosis occur in sickle cell trait?

A

Type 1 RTA

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13
Q

Traid of type 2 RTA

A
  • Inability of proximal cells of nephron to absorb HCO3-
  • Low pH of body as well as urine (due to distal cells )
  • low potassium in body
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14
Q

How to d/f liddle syndrome and Conn syndrome?

A

In former Sr aldosterone is undetectable and in latter Sr aldosterone is detectable and very high

Liddle syndrome occurs due to mutation in collecting cells of nephron result excessive absorption of sodium ions

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15
Q

Name the drugs causing Hyperkalemia

A 
A = ACEI / ARBs
B = BB
C = Cyclosporine
D = Digoxin 
N = NSAID
S = Succinylcholine
K = K+ sparing diuretics
H = Heparin
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16
Q

What are the ECG findings of Hyperkalemia?

A

Tall T waves with PR Prolongation

QRS widening

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17
Q

How to stabilise cardiac membrane in hyperkalemia?

A

Give Calcium Chloride Or Calicum gluconate

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18
Q

Important information

A

Pts with chronic hyperkalemia may be asymptomatic until K+ gradually rises >/=7.0 mEq/L.

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19
Q

INDICATIONS FOR EMERGENT TREATMENT OF HYPERKALEMIA

A
  • Marked elevation (>6.5 mEq/L) without characteristic ECG changes OR
    • Presence of hyperkalemia-related ECG changes
    • Rapid rise in serum potassium level due to tissue breakdown
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20
Q

How low level of Magnesium decreases potassium level?

A

Mg is imp.cofactor for K+ uptake and maintenance of intracellular K+ check and correct Mg in chronic alcoholics to correct hypokalemia.
Another cause of hypomagnesemia is diuretics

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21
Q

How to t/m severe Hypercalcemic>14mg/DL Or Symptomatic?

A
  • long term give Bisphosphonate

* Short term Hydrate PT & give calcitonin and Avoid to give diuretic unless volume overload

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22
Q

How to t/m moderate Hypercalcemia that is 12-14mg/DL?

A
  • No t/m unless Symptomatic

* And if symptomatic then t/m A/c to severe Hypercalcemia

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23
Q

When to use hemodialysis as a t/m for Hypercalcemia

A

Hemodialysis is an effective treatment for hypercalcemia, but is typically reserved for patients with renal insufficiency or heart failure in whom aggressive hydration cannot be administered safely

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24
Q

How to t/m Euvolemic Or Hypervolemic hypernatremia?

A

Free water supplementation Or 5% D/W in water

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25
Q

How to t/m Asymptomatic Hypovolemic hypernatremia?

A

5% D/W in 0.45% N/S

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26
Q

How to t/m Symptomatic Hypovolemic hypernatremia?

A

0.9% N/S until euvolemic then used 5% D/W

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27
Q

What are the causes of HyperVolemic Hypo osmolarity Hyponatremia ?

Hint = Body is edemic

A
  • CHF
  • Hepatic failure.
  • Nephrotic syndrome
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28
Q

What are the causes of EuoVolemic Hypo osmolarity Hyponatremia ?

A

• If urine Sodium more than 20 and Urine Osm more than normal = SIADH

If urine Sodium more than 20 but Urine Osm is normal( due to intact ADH system )= Psychogenic polydipsia Or Beer Potomania

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29
Q

What are the causes of Hypovolemic Hypo osmolarity Hyponatremia?

A
  • If urine Sodium less than 10 = Dehydration/Vomiting/Diarrhea
  • If urine Sodium more than 10 = Diuretics/ACEI/Mineralocorticoid deficiency
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30
Q

What will be the t/m of moderate SIADH viz confusion and lethargy?

A
  • Give hypertonic saline 3% in first 3-4 hrs to increased Sr.Na more than 120meq/l
  • later on fluid restriction/ possible oral salt tablets/ loop diuretics if urine osmolality 2times greater than Sr osmolality
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31
Q

What will be the t/m of Severe SIADH viz fits/ not able to communicate and coma?

A
  • Bolus of hypertonic saline until Sx resolute

* Vasopressin Receptor Antagonist?

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32
Q

Name the enzyme deficient in syndrome of “Apparent” mineralocorticoid excess

A

11 beta hydroxysteriod dehydrogenase responsible to convert cortisol into cortisone

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33
Q

What happens in syndrome of apparent mineralocorticoid excess?

A

Due to deficiency of 11beta hydroxy dehydrogenase, cortisol will activate aldosterone receptors result:
HTN,

High Sr.Na,

low Sr.K and “low Sr Aldosterone”

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34
Q

How to t/m SAME?

A

Give potassium sparing diuretics

And Exogenous steroid which will inhibit endogenous production of steroid

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35
Q

Name the acid which can cause SAME?

A

Glycyrrhetinic acid present in Licorice

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36
Q

Name the bacteria which have positive Urease Test

A

Proteus
Klebsiella
Saprophyticus

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37
Q

Important information of UTI due to “Serratia marcescens”

A

Some strains produce a “red pigment;

often nosocomial and drug resistant

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38
Q

Important information of UTI due to “Pseudomonas aeruginosa”

A

Blue-green pigment and fruity odor;

usually nosocomial and drug resistant.

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39
Q

Important information of UTI due to “Proteus mirabilis”

A

Motility causes “swarming” on agar;

associated with struvite stones.

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40
Q

What is the t/m of Pyelonephritis esp in non pregnant females?

A

Gives Quinolones as “Outpatient t/m”

Give IV Quinolones Or Aminoglycosides with or W/O ampicillin

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41
Q

What is the t/m of Complicated Cystitis esp in non pregnant females?

A

Quinolones for 5-14 days

For severe cases Give extended Spectrum Abx( Ampicillin/Gentamicin)

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42
Q

What is the t/m of Un-Complicated Cystitis esp in non pregnant females?

A

Nitrofurantoin for 5 days

Tmx-Sx for 3days

Fosfomycin single dose

Quinolones If above options cannot be used

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43
Q

Name the Abx for UTI given in pregnancy instead of Quinolones

A

Augmentin

Fosfomycin

Cephalexin

Cefpodoxime

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44
Q

D/f b/w Glomerular* Vs Non Glomerular Hematuria**

A

Microscopic hematuria/RBC cast & dysmorphic RBC and protein in urinalysis*

Gross hematuria/No cast, normal shape RBC, blood present but not protein in urinalysis**

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45
Q

If “Spike and Dome” appearance seen on Electron microscope then what is the cause of nephrotic syndrome?

A

Membranous nephropathy

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46
Q

What will be seen on Light microscopy in membranous nephropathy?

A

Diffuse capillary and GBM thickening

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47
Q

Patient with HBV has strong potential to develop which kinda of nephrotic syndrome?

A

Membranous nephropathy

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48
Q

What will be seen on LM in focal segmental Glomerulosclerosis?

A

Segmental sclerosis and hyalinosis

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49
Q

immunofluorescence report of Post infectious glomerulonephritis will show what?

A

Stary sky granular appearance (Lumpy bumpy) due to IgG, IgM and C3 deposition along with GBM and Mesangium.

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50
Q

Granular immunofluorescence will seen in which conditions of nephrotic and nephritic?

A

Membranous nephropathy

PSGN & DPGN

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51
Q

Pattern of immune complex deposition in GoodPasture syndrome would be?

A

Linear immunofluorescence due to antibodies to alveolar basement and GBM

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52
Q

Name the cause of nephritic syndrome which shows “wire looping of capillaries” on LM?

A

DPGN

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53
Q

Name the cause of nephritic syndrome which shows “Basket weave” on electron microscope?

A

Alport syndrome

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54
Q

Triad of Mixed Essential CRYOGLOBULINEMIA

A

palpable purpura,

hematuria,

proteinuria

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55
Q

MC coagulopathy occur due to nephrotic syndrome

A

Renal vein thrombosis esp in membranous nephropathy

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56
Q

Important information for minimal change diseases

A

Renal biopsy is indicated in children age>10yrs with nephrotic syndrome, or

in any child with nephritic syndrome or minimal change disease that is unresponsive to steroids

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57
Q

Conditions associated with “AL amylodosis

A

Multiple myeloma

And Waldenstrom macro globulinemia

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58
Q

Composition of amyloid in “AL amyloidosis”

A

Light chains usually lambda

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59
Q

Conditions associated with “AA amyloidosis”

A

Chronic inflammatory conditions viz. RA and IBD

Chronic infections viz Tb and osteomyelitis

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60
Q

Composition of Amyloid in “AA amyloidosis”

A

Abnormally folded protein: beta 2 micro globulin

App lipoprotein Or Transthyretin

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61
Q

What is the earliest renal abnormality in diabetic nephropathy?

A

Glomerular hyperfiltration

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62
Q

What is the first changed in diabetic nephropathy that can be quantified?

A

Thickening Of GBM

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63
Q

Histological finding of diabetic nephropathy

A

Diffuse glomerulosclerosis but

Pathognomonic finding: nodular glomerulosclerosis (with Kimmelstiel Wilson nodules)

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64
Q

Why dipstick test not recommended in diabetic nephropathy?

A

B/c it only detects macro albuminuria which is not seen in early in Diabetic nephropathy

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65
Q

What are the clues that suggest albuminuria due to non diabetic nephropathy?

A

onset of proteinuria <5 years after disease onset,

active urine sediment (eg, red cells, cellular casts),

and >30% reduction of GFR within 2-3 months of starting ACEi or ARB

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66
Q

Important information regarding Renal artery stenosis

A

Suspect Renal artery stenosis if patient developeds resistant HTN and diffuse atherosclerosis

67
Q

Non medical treatment for Renal artery stenosis

A

Renal artery stenting or surgical revascularization is reserved for patients with resistant hypertension OR

recurrent flash pulmonary edema and/or refractory heart failure due to severe hypertension

68
Q

Important points of Renal artery stenosis

A

Asymmetric renal size with abdominal bruit

Increase in Sr creatinine more than 30% after using ACEI/ARBs

Unexplained atrophic kidney seen in imaging

69
Q

Important information of Calcium stones

A

Calcium oxalate stones develops in normal serum calcium and high urine calcium

70
Q

Risk factors to develop Calcium Oxalate stone

All them result in fat bound with Calcium and oxalate get absorb result stone formation

A

Ethylene glycol ingestion
Vitamin C abuse

Decrease citrate level
Malabsorption

Crohn diseases
Bowel resection

71
Q

What is the shape of calcium oxalate stone?

A

Envelope or Dumbbell

72
Q

What are the risk factors to develop calcium phosphate stone?

A 
primary  hyperparathyroidism  
And RTA (renal tubular  acidosis)
73
Q

What is the shape of calcium phosphate stones?

A

Wedge shape prism

74
Q

What is the shape of uric acid stone?

A

Rhomboid Or Rosettes

75
Q

What is the shape of cysteine stone?

76
Q

Name the especial test to diagnose cysteine stone

A

Positive urine nitroprusside test:

detect high level of urinary cysteine, used as qualitative screening procedure and help confirm diagnosis esp. in homozygotes

77
Q

What is the shape of ammonium magnesium phosphate stone?

A

Coffin lid

78
Q

Name the bacteria which are involved in ammonium magnesium phosphate stone formation?

A

Proteus
Staph saprophytius
Klebsiella

79
Q

What’s the size of renal stone which need conservative management?

A

Less than 5mm and will pass spontaneously

80
Q

When to consult urology ward for renal stone?

A

If stone size is less than 10 mm which doesn’t resolve with medical management

And if stone size is more than 1cm

81
Q

How alpha blockers help in treating renal stones?

A

Αlpha receptors are found on distal ureter, base of detrusor, bladder neck and urethra so give alpha blocker which will relax these sites and stone will pass

82
Q

How to prevent recurrent renal stones formation?

A

Reduce sodium intake / Protein / oxalate containing diet

Increase fluid intake/ citrate containing diet

83
Q

How stress incontinence occurred?

A

Due to outlet incompetence (uretheral hypermobility Or Intrinsic sphincteric Deficiency

84
Q

What is Q tip test in stress incontinence?

A

place pt in dorsal lithotomy position –> insert cotton swab into urethral orifice–> angle >/=30* from horizontal on ↑ in intra-abdominal pressure signify urethral hypermobility

85
Q

How to t/m stress incontinence?

A

Do kegel exercise as First line t/m otherwise do uretheral sling surgery if exercise fails

Pessary for poor surgical candidates

86
Q

Why urge incontinence occurs?

A

Due to overactivity of bladder muscle and it is usually associated with UTI.

87
Q

Name the medicine given in urge incontinence

A

Oxybutynin it is anticholinergic medicine

88
Q

Why overflow incontinence occurred?

A

Due to underactivity of bladder muscle or outlet obstruction

89
Q

Symptoms of overflow incontinence

A

Constant involuntary dribbling of urine and incomplete emptying

90
Q

Name the condition occur in old age men causing overflow incontinence

91
Q

Triad of bladder painful syndrome (interstitial cystitis)

A
  • bladder pain with filling and relief with voiding
  • more than 6 wks
  • normal urinalysis and associated with psychiatric disorder and pain syndrome (fibromyalgia)
92
Q

Name the drugs causing crystal induced AKI

SAME P

A 
SAME P
S sulfonamide
A acyclovir
M methotrexate
E Ethylene glycol

P protease inhibitors

93
Q

Triad of Acute interstitial nephritis

A

Fever with maculopapular rash

+Ve Hx of drugs

Urinalysis show eosinophils

94
Q

Name the drugs causing Acute interstitial nephritis

Remember 6Ps

A 
Pee drugs = Diuretic
Pain free = NASIDs
Penicillin and cephalosporins
PPI
rifamPin
95
Q

Triad of Renal papillary necrosis

A

Gross Hematuria

Proteinuria

Associated with NASID/ SCD / DM / Acute pyelonephritis

96
Q

MCC of AKI in Hospitize patient

A

Acute tubular necrosis

97
Q

How CT contrast induced nephropathy present?

A

spike in creatinine within 24 hours of contrast administration, followed by return to normal renal function within 5-7

98
Q

How to t/m CT contrast induced nephropathy?

A

Adequate pre-CT hydration

Acetylcysteine shown to prevent nephropathy by dilating vessels and neutralise oxidants

99
Q

Most common cause of death in dialysis and renal transplant pt

A

cardiovascular disease

100
Q

What are the Risk factors for cardiovascular disease due to ESRD and dialysis?

A

ESRD / Anemia

Increase homocysteine/ Calcium

Inhibition of nitric oxide

101
Q

Features of Simple Renal cyst

A

Unilocular thin smooth regular wall cyst without septae

Homegenous content

Absence of contrast enhancement on CT/MRI
Usually Asymptomatic

102
Q

Features of Malignant Renal cyst

A

Multilocular thick irregular wall cyst with multiple sepate

Heterogeneous content (solid / cystic)

Presence of contrast enhancement on CT/MRI
Usually symptomatic

103
Q

Triad of RCC

A

Flank pain

Hematuria

Palpable abdominal Renal masses

104
Q

Which imaging is sensitive and specific for RCC?

105
Q

RCC incidence increases in which patients?

A

Smoker

And Obese patients

106
Q

Important information for RCC

A

It is resistant to chemotherapy and radiation therapy

107
Q

What’s the histological presentation of RCC?

A

Polygonal clear cells filled with accumulated lipids and carbohydrates

108
Q

Renal oncocytoma

A

Benign “Epithelial” cell tumor arising from collecting duct

109
Q

What is the histological presentation of Renal oncocytoma?

A

Large eosinophils cells with abundant mitochondrion w/o peri nuclear clearing

110
Q

Important information

A

Cystoscopy is recommended for all patients with unexplained gross hematuria or with microscopic hematuria and other risk factors
for bladder cancer

111
Q

Conditions in which transitional cell carcinoma is associated;

A

Phenacetin
Smoking

Anyone dye
Cyclophosphamide

112
Q

What are the indications for cystoscopy?

A
  • Gross Hematuria w/o evidence of glomerular disease or Infection
  • Increase risk of malignancy but Microscopic Hematuria w/o evidence of glomerular disease or Infection
  • Recurrent UTI
  • Obs symptoms with suspicion for stricture and stones
  • Irritative Sx without urinary infection
  • Abnormal bladder imaging Or urine cytology
113
Q

How to approach symptomatic

Ureteral stone if patient has any Urosepsis / Aki / complete Obs?

A

Stat uro consult

114
Q

How to approach symptomatic Ureteral stone if patient doesn’t have Urosepsis / Aki / complete Obs?

A

Check stone size —>if >1cm —-> Uro consult

If <1cm—> give fluids, alpha blocker , pain controller—>still present of stone or pain persist—> Uro consult

115
Q

Why Ringer lactate than Normal saline given in Burn patient?

A

RL is balanced with physiological level of ions and contain Lactate which converts into HCO3 in liver

Whereas Normal saline is unbalanced fluid contain more chloride causing Met acidosis and hypo coagulation

116
Q

Important point of D/f types of fluid

A

Hypotonic fluid like D/W 5% or half saline given in hypernatremia

Hypertonic fluid like 3% given in symptomatic hyponatremia

117
Q

Important point of D/f types of fluid (2)

A

Isotonic fluid like Normal saline or Ringer lactate

Albumin 5% or 25% given in Spont bacterial peritonitis or Hepatorenal syndrome

118
Q

Important point of ADPKD

A

Give ACEI for HTN

Dialysis or Renal transplant for ESRD

119
Q

How to prevent recurrence of renal stones via meds?

A

Thiazides
Allopurinol
Alkalisation of urine via potassium citrate

120
Q

Name the nephritic condition in which low complement noted

A

Post infectious GN
MPGN
Mixed cryoglobulinemia

121
Q

How thin basements membrane syndrome present?

A

Adult with hematuria without proteinuria

Bx shows thin basement membrane

122
Q

Association of MCD/ MPGN and IgA nephropathy

A

1) MCD—-> NASIDS , lymphoma
2) MPGN—->HBV, HCV and lipodystrophy
3) IgA nephropathy—->Upper RTI

123
Q

Association of Membranous nephropathy

ABC

A

A adenocarcinoma
B HBV
C SLE / NASIDS

124
Q

Association of Focal segmental GS

A 
HIV 
Heroin 
African American 
Hispanics 
Obesity
125
Q

Define Oliguria

A 
UOP
less than 250ml in 12 hrs
Less than 0.5ml/kg/hr
Less than 400 ml / day 
Less than 6ml /kg /day
126
Q

How ileus Occur due to stones and how to manage it?

A

Due to vagal reaction

Rx—->Remove stones

127
Q

Classified Proteinuria on the basis of Urine dipstick

A

1 plus —-> 30-100mg/dl

2 plus—-> 100-300mg/dl

3 plus ——> 300-1000mg/dl

4 plus —-> more than 1k mg/dl

128
Q

Name the Edema causes which occur due to lymphatic obstruction / increase interstitial oncotic pressure

A

Lymph node obstruction

Malignant ascites

Hypothyroidism

129
Q

Name the Edema causes which occur due to increases capillary permeability

A

Burns, Trauma and sepsis

Allergic Rxn

ARDS

Malignant ascites

130
Q

Name the Edema causes which occur due to decreases oncotic pressure

A

Synthesis problem::
Cirrhosis / malnutrition

Protein loss::
Nephrotic syndrome
Protein losing enteropathy

131
Q

Name the Edema causes which occur due to increase capillary hydrostatic pressure

A

HF

Venous Obs like cirrhosis and venous insufficiency

Primary renal sodium retention (renal diseases and drugs)

132
Q

How to Evaluate Hyponatremia?

A

Start with Sr.Osmlality
If increase—> Renal failure Or hyperglycemia

If Decrease—>check urine osmolality

133
Q

How to Evaluate Hyponatremia if patient has low Sr osmolality? Part 2

A

Check urine osmolality
If less than 100—>primary polydipsia Or beer drinker

If not less than 100—>check urine sodium

134
Q

How to Evaluate Hyponatremia if patient has low Sr osmolality with urine osmolality not less than 100? Part 2

A

Check urine sodium
If less than 25 —> volume depletion / CHF / cirrhosis

If not less than 25—->SIADH/ hypothyroidism/adrenal insufficiency

135
Q

How to dx bladder cancer?

Urine D/R

A

Gold standard is —->flexible cystoscopy with Bx.

136
Q

How to treat bladder cancer?

A

If No muscle invasion—->TURBT and Intravesical immunotherapy

If muscle invasion—->Radical cystectomy and systematic chemotherapy

If spread with postive mets—> systematic chemotherapy and Immunotherapy

137
Q

What are the causes of Type 1 RTA?

GAM

A

G genetic disorder
A autoimmune like RA / sjogren syndrome
M. Medicine

If type 2 —–> fanconi syndrome

138
Q

What are the causes of Type 4 RTA?

A

Obstructive uropathy

Congenital adrenal hyperplasia

139
Q

Differentiate Pre renal and Intra renal AKI on the basis of parameters

A 
Pre renal:
Met-alkalosis with low Sr.K 
Urea to Cr >20 
Urine Na <20 with feNa <1%
Urine osmolality>500
Specific gravity > 1.020
Intra renal 
Met-Acidosis with increase Sr. K 
Urea to Cr <20 
Urine Na >20 with feNa >1%
Urine osmolality <500
Specific gravity < 1.020
140
Q

Why dialysis relayed amylosis have affinity for osteoarticular feature?

A

Inclearance of B2 microglubin via dialysis further stabilize by Connective tissue that’s why
Bone cyst , carpal tunnel syndrome
Scapulohumeral periarthritis

141
Q

How ACEi helps in DM nephropathy?

A

By reducing glomerular hydrostatic pressure result slow down the development of glomerular capillaries sclerosis

(Afferent dilate and efferent constrict will not only maintain GFR but it increases the sclerosis process)

142
Q

How to prevent recurrence of kidney stones via medical and non medical?

A

Non medical:
Increase fluid and citrate containing food
Decrease sodium, protein and oxalate.
Normal calcium intake 1200mg /day

Medical::
Thiazide
Allopurinol for uric acid stones
Make urine alkaline viz potassium citrate/HCO3 salt.

143
Q

What are the side effects of Magnesium sulfate toxicity?

A

Somnolence
Loss of depp tendon reflex
Resp-distress

But there will not be focal weakness

144
Q

How to Evaluate Red urine?

A

Check urinalysis
If ≥3 RBC —->Hematuria

If 0-2 RBC—–> Due to myoglobinuria Or Hemoglobinuria (either due to hemolysis or Decrease haptoglobin and hemoglobin)

145
Q

How to Evaluate Mixed incontinence?

A

Voiding diary and find pre dominant type then treat accordingly

146
Q

What clinical features suggest Rhabdomyolysis?

A

Increase Ck level

1) It leads to Intra renal AKI
2) Increase k, Phosphate, AST to ALT ratio and decrease calcium

3) Dark urine due to myoglobinuria/pigmenturia
4) Though blood in Urine D/R but no RBC on microscopy

147
Q

Name the d/f mechanisms causing Rhabdomyolysis

Face

A

1) If direct myotoxicity —>fibrates, statins, cocaine, colchicine, ethanol
2) Vasoconstrictive ischemia like cocaine amphetamine
3) prolong immobilization leads to compression ischemia —->benzo opioid ethanol

148
Q

Important point of physiological hydronephrosis in pregnancy

A

Occurs due to progesterone induced Ureteral dilation which result in dilation of b/L renal pelvis and proximal ureters

It doesn’t need any treatment

If bladder obstruction occur then there will be both proximal and distal ureter dilation

149
Q

What does mean by Complicated cystitis?

A

If cystitis associated with:
1) DM and Pregnancy/ Immunosuppression

2) Renal failure, Urinary tract obstruction, Indwelling catheter
3) Urinary procedure like cystoscopy
4) Hospital acquired

150
Q

How to manage Complicated cystitis non pregnant ?

A

Before giving ABx, obtain sample for urine culture and then adjust Abx as needed

Abx like Quinolones for 5-14 days
Or Extended spectrum Abx like ampicillin/Gentamicin

151
Q

How to manage Uncomplicated cystitis non pregnant?

A

In this case, Urine culture sent only if treatment fail otherwise no need to send culture

1) Nitrofurantoin but avoid in pyelonephritis or CrCl less than 60ml/min
2) fosfomycin single dose only

3) TMX-Sd 3days only but avoid if sulfa allery or local resistance rate ≥20%
4) Quinolones only used when above meds fail or can’t be used

152
Q

How to manage Pyelonephritis in non pregnant?

A

Before giving ABx, obtain sample for urine culture and then adjust Abx as needed

1) If Outpatient—-> PO Quinolones
2) If Inpatient—-> (IV Quinolones) Or Aminoglycosides ± Gentamicin

153
Q

How to approach Hematuria (>3RBC) which is non glomerular and asymptomatic?

A

Consider: U/S renal

Urine culture and Urine Ca:Cr ratio

154
Q

How to approach Hematuria (>3RBC) which is glomerular origin?

A

Cbc
Complement
Creatinine

155
Q

How to approach Hematuria (>3RBC) which is non glomerular and symptomatic?

A

1) If renal stones with flank pain —> US
2) if trauma Hx —> CT scan abdomen

3) If UTI sxs whether sterile or unsterile pyuria —-> urine culture and Abx
4) if Perineal / Meatal Irritation —-> Reassurance

156
Q

How Kidney compensate in Met-Acidosis

A

Increase Anhydrase activity

Increase Chloride and Acid excretion

157
Q

How HTN occur in AD-PKD and Name the chemical involve in cyst formation

A

HTN due to increase renin

increase vasopressin which grow the cyst

158
Q

Important point Renal artery stenosis

A

In Renal artery stenosis—> affected kidney will have high Renin due to low perfusion and unaffected kidney has decreased renin( as high pressure due to activation of RAAS by affected kidney will suppress RAAS of unaffected kidney)

159
Q

Triad of Analgesics nephropathy

A

Present as Tubulointerstitial nephritis or hematuria due to papillary necrosis

Urine D/R shows hematuria or sterile pyuria or mild proteinuria

Ct shows small kidneys with B/L renal papillary calcification

160
Q

How to manage Uremic coagulapathy?

Due to platelet problem not due to clotting problem

A

Desmopressin
cryoprecipitate

Conjugated estrogen
No platelets transfusion

161
Q

What are the indications of Urgent DIALYSIS? Part 1
(AEI)OU

What are the indications of Urgent DIALYSIS?

A

Acidosis —-> metabolic ph <7.1 refractory to medical therapy

  • Symptomatic hyperkalemia viz ecg changes Or k >6.5 refractory to medical therapy
  • Volume overload refractory to diuretic
162
Q

What are the indications of Urgent DIALYSIS? Part 2 (MALE

A

Uremic bleeding, encephalopathy or pericarditis

Ingestion viz methanol, aspirin, lithium ethylene glycol
Valproate and carbamazepine

163
Q

What are the cause of ASYMPTOMATIC BACTERIAURIA in female?

A

Pregestational DM

Hx of UTI

Multiparty

164
Q

What are the labs findings of SIADH?

A

Low Serum sodium and Sr Osmolality <275

Increase (Urine sodium >40 and Ur osmolality >100osm/kg)

Low Uric acid

Normal Sr.k and ABGs

Internal Medicine (14 decks)

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