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Online Med Ed > Nephrology > Flashcards

Nephrology Flashcards

1
Q

tests to get in AKI

A

U/A
Protein/Cr ratio
Ultrasound
Best: biopsy - NEVER CORRECT

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2
Q

U/A in AKI

A

casts, hints, never definitive

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3
Q

Protein/Cr ratio in AKI

A

nephrotic syndrome

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4
Q

Ultrasound in AKI

A

hydro

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5
Q

what the nitrates in urine means

A

infection

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6
Q

what leukocyte esterase in urine means

A

infection

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7
Q

what RBCs in urine mean

A

hematuria

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8
Q

what no RBC’s but positive blood in urine mean

A

rhabdo (check myoglobin)

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9
Q

what eosinophils in urine mean

A

AIN

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10
Q

what RBC casts mean

A

glomerulonephritis

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11
Q

what WBC casts mean

A

pyelo

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12
Q

what muddy brown casts mean

A

ATN

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13
Q

what waxy urine casts mean

A

CKD

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14
Q

what hyaline casts in urine mean

A

nothing

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15
Q

post-renal failure path

A

obstruction: stone, cancer, BPH, neurogenic bladder

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16
Q

post-renal failure pt

A

abdominal pain and renal failure

distended or palpable bladder

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17
Q

post-renal failure dx

A

Foley catheter = large residuals

u/s = hydronephrosis

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18
Q

post-renal failure tx

A

catheter (relieves bladder outlet)

nephrostomy (relieves ureteral obstruction)

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19
Q

ATN path

A

tubules slough off, die
toxins: contrast, rhabdo
low flow: shock kidney

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20
Q

ATN pt

A

one of the above pathologies

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21
Q

ATN dx

A

u/a = waxy brown casts

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22
Q

ATN tx

A

oliguric phase: dialysis

polyuric phase: IVF

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23
Q

ATN ppx

A

vigorous hydration, reduce time in contact with toxin

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24
Q

indications for dialysis

A 
AEIOU
Acidosis
Electrolytes (Na/K)
Ingestion (toxins)
Overload (CHF, edema)
Uremia (pericarditis)
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25
Q

chronic kidney disease - hyperparathyroidism

A

cinacalcet

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26
Q

ckd - hyperphosphatemia

A

sevelamer

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27
Q

ckd - HTN

A

CCB
ACE-I
BB
Clonidine

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28
Q

ckd - vit D

A

Ca + vit D3

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29
Q

ckd - dialysis

A

hemodialysis TiW

peritoneal qHS

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30
Q

nephrotic syndrome

A

HTN
nephrotic range proteinuria
edema
hypercholesterolemia

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31
Q

nephritic syndrome

A

hematuria
HTN
oliguria

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32
Q

treatment of mild HypoNa

A

po

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33
Q

treatment of moderate HypoNa

A

IVF = NS

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34
Q

treatment of severe HypoNa

A

3% NaCl

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35
Q

treatment of mild hyperNa

A

po

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36
Q

treatment of moderate hyperNa

A

IVF = NS

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37
Q

treatment of severe HyperNa

A

IV = D5W

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38
Q

symptoms of mild hyper/hypoNa

A

asymptomatic

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39
Q

symptoms of moderate hyper/hypoNa

A

in between

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40
Q

symptoms of severe hyper/hypoNa

A

coma

seizures

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41
Q

sodium correction

A

no faster than 0.25mEq/hr

except if seizing or in a coma

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42
Q

osmotic demyelination syndrome path

A

rapid correction of sodium

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43
Q

osmotic demyelination syndrome pt

A

spastic quadriplegic (irreversible)

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44
Q

osmotic demyelination syndrome

A

central pontine myelinolysis

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45
Q

osmotic demyelination syndrome dx

A

clinical, sodium rises too fast

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46
Q

osmotic demyelination syndrome tx

A

none, prevention only

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47
Q

work-up for sodium

A

serum osm
urine Na
urine Osm

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48
Q

hypertonic serum osm

A

EtOH, glucose

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49
Q

isotonic serum osm

A

fats and proteins

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50
Q

hypotonic serum osm

A

continue

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51
Q

urine Na

A

surrogate for aldosterone

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52
Q

urine osm

A

surrogate for ADH

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53
Q

if hypervolemic + sodium dysfunction

A

give diuresis

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54
Q

if hypovolemic + sodium dysfunction

A

give fluids

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55
Q

if euvolemic + sodium dysfunction

A

TSH
cortisol
renal electrolytes
SIADH is dx of exclusion

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56
Q

SIADH path

A

hypothyroidism - TSH looks like ADH
lung lesions (small cell, pneumonia)
brain lesions
water, but not all, is retained -> decreased tonicity

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57
Q

SIADH pt

A

hyponatremia

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58
Q

SIADH dx

A

diagnosis of exclusion
U Na should be high (aldo off)
U osm should be high (ADH on)

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59
Q

SIADH tx

A

volume restrict

correct underlying disorder

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60
Q

symptomatic hyperCa pt

A

stones, bones, groans, and moans

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61
Q

symptomatic hyperCa dx

A

calcium and albumin

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62
Q

symptomatic hyperCa tx

A

IVF
bisphosphonates
calcitonin adjunct

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63
Q

hyperparathyroidism path

A

primary: adenoma
secondary: early CKD, physiologic response
tertiary: multiple adenomas from secondary

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64
Q

hyperPTH pt

A

hyperCa
pathologic fracture, decrease density
brown tumors

65
Q

hyperPTH dx

A 
calcium labs
- very increased PTH
- increase Ca
- decrease PO4
sestamibi scan 
- primary: single adenoma
- tertiary: multiple adenomas
66
Q

hyperPTH tx

A

parathyroidectomy

67
Q

hyperPTH f/u

A 
hypocalcemia post-op
- Perioral tingling
- Chvostek's sign
- Trousseau's sign
decrease tertiary hyperPTH with calcimetics
- cinacalcet
68
Q

hyperCa of malignancy path

A

mets cause bone destruction

increase Ca -> decrease PTH

69
Q

hyperCa of malignancy pt

A

malignancy with elevated Ca

70
Q

hyperCa of malignancy dx

A

calcium labs

  • very increased calcium
  • decreased PTH
  • increase PO4
  • decrease PTH-rp
71
Q

hyperCa of malignancy tx

A

tx underlying cancer

72
Q

hyperCa of malignancy PTH-rp path

A

squamous cell carcinoma of the lung

increase PTH-rp -> increase Ca -> decrease PTH

73
Q

hyperCa of malignancy PTH-rp pt

A

malignancy and elevated calcium

74
Q

hyperCa of malignancy PTH-rp dx

A 
calcium labs
- increase PTH-rp
- decrease PTH
- decrease PO4
increase Ca
75
Q

hypervitaminosis D path

A

granulomatous disease

76
Q

hypervitaminosis D pt

A

hypercalcemia, chest lesion (TB, sarcoid)

77
Q

hypervitaminosis D dx

A

calcium labs

  • increase Ca
  • decrease PTH
  • increase PO4
  • increase 1,25-vitD
78
Q

hypervitaminosis D tx

A

treat granulomatous disease

79
Q

hyperCa of immobilization path

A

old people in nursing homes

80
Q

hyperCa of immobilization pt

A

old person in nursing home

debility, bed-bound, or post-op

81
Q

hyperCa of immobilization dx

A

increase Ca
decrease PTH
increase PO4

82
Q

hyperCa of immobilization tx

A

mobilization

83
Q

familial hypercalcemia hypocalciuria path

A

higher set point of calcium

84
Q

familial hypercalcemia hypocalciuria pt

A

asymptomatic

family history of high Ca

85
Q

familial hypercalcemia hypocalciuria dx

A 
calcium labs
- increase Ca (11-12)
- normal PTH
- normal PO4
urine calcium decrease
86
Q

familial hypercalcemia hypocalciuria tx

87
Q

vitamin D labs and treatment - 25-VitD (D2)

A 
lab = CKD
med = osteoporosis
88
Q

vitamin D labs and treatment - 1,25 VitD (D3)

A 
lab = granulomatous disease
med = ckd
89
Q

hypoPTH path

A

iatrogenic (thyroidectomy is an error, PTH is physiologic)

90
Q

hypoPTH pt

A

tetany, Chvostek’s sign

perioral tingling, trousseau’s sign

91
Q

hypoPTH dx

A

decrease PTH
decrease Ca
neutral PO4

92
Q

hypoPTH tx

A

IV calcium

93
Q

pseudo-hypoPTH hormone path

A

PTH-insensitivity

94
Q

pseudo-hypoPTH hormone pt

A

asymptomatic

95
Q

pseudo-hypoPTH hormone dx

A

increase PTH
decrease Ca
increase PO4

96
Q

vitamin D deficiency path

A

dairy

sunshine

97
Q

vitamin D deficiency pt

A

osteopenia

Dexa scan -2.0

98
Q

vitamin D deficiency dx

99
Q

vitamin D deficiency tx

A

Ca + vit D
Vit D2 (25-VitD) 50000 q Week
bisphosphonates (osteoporosis)

100
Q

CKD path

A

kidney’s can’t win because they are dead

101
Q

CKD pt

A

frequent monitoring of electrolytes

102
Q

CKD dx

A

increase PTH
decrease Ca
decrease Phos

103
Q

CKD tx

A

calcimimetics - cinacalcet
phosphate binders - sevelamer
Ca + VitD3

104
Q

HyperK path

A 
hypoaldo (ACE, ARB, spironolactone)
artifact
iatrogenic
ESRD
ingestion + CKD
105
Q

hyperK pt

A

asymptomatic

106
Q

hyperK dx

A

potassium level

EKG = peaked t-waves, wide QRS

107
Q

hyperK tx

A

if EKG changes -> stabilize, temporize, and eliminate

if no EKG changes -> eliminate

108
Q

treatment of hyperK stabilize

A

IV calcium - no change in serum K or total K

109
Q

treatment of hyper K temporize

A

NaHCO3, D50+insulin

- decrease serum K, no change total K

110
Q

treatment of hyperK eliminate

A

kayexalate, diuretics, dialysis

- decrease serum K and total K

111
Q

hypoK path

A 
GI loss - vomiting or diarrhea
renal loss
- hyperaldosteronism
- diuretics (loops)
- large volume infusion
112
Q

hypoK pt

A

weakness, paralysis, loss of reflexes
or
asymptomatic

113
Q

hypoK dx

A

potassium level

EKG = U waves

114
Q

hypoK tx

A 
replete K
PO > IV
10mEq increase serum K by 0.1mEq
10mEq/hr by PIV
20mEq/hr by central line
115
Q

kidney stones pt

A

hematuria
colicky flank pain that radiates to groin
no fever or leukocytosis

116
Q

kidney stones dx

A

1st: U/A
best: non-contrast CT
other: U/s if pregnant, KUB if tracking disease

117
Q

kidney stones tx

A

If < 5mm: IVF + analgesia
if < 7mm: MET (CCB, α blocker)
if <1.5cm: lithotripsy (proximal), ureteroscopy (distal)
if >1.5cm: surgery
sepsis: nephrostomy (proximal), stent (distal)

118
Q

kidney stones f/u

A

strain and analyze stone

24hr urine for Ca, PO4, urate, oxalate

119
Q

calcium oxalate stone radio

120
Q

calcium oxalate stone risk

A

increase Ca
- vit D, PTH
increase oxalate
- decrease red meat, increase fruits & vegetables, increase vitC

121
Q

Mg ammonium phosphate (struvite) stone radio

122
Q

struvite stone risk

A 
pH increase (alkalotic urine)
proteus -> urea splitting
123
Q

uric acid stone radio

124
Q

uric acid stone risk

A

gout, tumor lysis

  • allopurinol (before)
  • rasburicase (after)
125
Q

cystine stone radio

126
Q

cystine stone risk

A

genetic disorder

127
Q

simple cyst pt

A

incidental - another test

small, no loculations, no septations

128
Q

simple cyst tx

129
Q

complex cyst pt

A 
flank mass
peel
pain
hematuria
\+ loculations + septations
130
Q

complex cyst dx

A

CT scan or u/s (pregnant)

biopsy (only if suspicion of cancer is low)

131
Q

complex cyst tx

132
Q

renal cell carcinoma pt

A

flank mass, flank pain, hematuria
cancer (decrease Hgb)
paraneoplastic (increase Hgb, EPO)
hematogenous spread of mets

133
Q

renal cell carcinoma dx

A

CT scan or U/s (pregnant)

134
Q

renal cell carcinoma tx

A

nephrectomy (excisional biopsy)

135
Q

AD polycystic kidney disease path

A

adults, autosomal dominant

136
Q

ADPKD pt

A

cysts -> flank mass
infection -> pyelo
bleed -> hematuria

137
Q

ADPKD dx

A

CT scan or U/s (pregnant)

biopsy

138
Q

ADPKD tx

A

supportive -> dialysis or transplant

139
Q

ADPKD f/u

A

pancreases -> pancreatitis
liver -> hepatitis
brain = SAH
- MRI, CTA

140
Q

AR polycystic kidney disease path

A

autosomal recessive

entire kidney replaced by cysts

141
Q

ARPKD pt

A

renal failure day 1 of life
flank mass
anuric

142
Q

ARPKD dx

A

u/s

biopsy = radially oriented cysts

143
Q

ARPKD tx

A

supportive -> death

transplant

144
Q

respiratory acidosis path

A

hypoventilation

145
Q

respiratory acidosis pt

A

opiates -> pinpoint pupils, track marks
Asthma/COPD -> wheezing
OSA -> fat, daytime somnolence

146
Q

respiratory acidosis dx

A

decrease pH, increase pCO2

147
Q

respiratory acidosis tx

A

no next step

148
Q

respiratory alkalosis path

A

hyperventilation

149
Q

respiratory alkalosis pt

A

pain, anxiety
hypoxemia
fast RR

150
Q

respiratory alkalosis dx

A

increase pH, decrease pCO2

151
Q

respiratory alkalosis tx

A

no next step

152
Q

metabolic alkalosis path

A

hyperaldosteronism

153
Q

metabolic alkalosis pt

A 
volume deplete (diuresis, dehydration, NG tube suction, emesis)
other (chloride non-responsive)
154
Q

metabolic alkalosis dx

A

increase pH, increase pCO2

155
Q

metabolic alkalosis tx

A

urine chloride

  • UCL < 10 -> fluids
  • UCL >10
  • -HTN: RAS, Conn’s
  • -no HTN: Bartter, Gitelman
156
Q

metabolic acidosis path

A

gap vs. nonGap

157
Q

metabolic acidosis pt

A

noncontributory

158
Q

metabolic acidosis dx

A

decrease pH, decrease pCO2

159
Q

metabolic acidosis tx

A

AG >12 -> + anion gap
- MUDPILES: Methanol, Uremia, DKA, Propylene glycol, Iron/isoniazid, Lactic acid, Ethanol, Salicylates
AG <12 -> no anion gap
- urine AG: + -> renal tubular; negative -> diarrhea

Online Med Ed (18 decks)

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