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Nephrology Flashcards

1
Q

What is Pre-renal Azotemia?

A

Decrease in renal blood flow and/ or decrease in Glomerular hydrostatic pressure

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2
Q

Causes of Pre-renal Azotemia?

A
  • Hypovolemia
  • Hypotension
  • Renal artery stenosis/fibromuscular dysplasia
  • Decreased cardiac output
  • Medications that interfere with glomerular filtration (ACEIs, NSAIDs)
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3
Q

What is Intrinsic Renal Disease?

A

Damage to the renal parenchyma

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4
Q

Causes of Intrinsic Renal Disease?

A
  • Glomerular Disease
  • Tubular-interstitial Disease
  • Vascular Disease
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5
Q

Causes of Glomerular Disease?

A

Rapidly Progressive Glomerulonephritis:

  • Type I: GoodPasture
  • Type 2: Post-streptococcal Glomerulonephritis, Lupus nephritis, IgA nephropathy
  • Type 3: Small vessel vasculitides (Wegner’s)
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6
Q

Causes of Tubular-Interstitial Disease?

A
  • Acute Tubular Necrosis: Muddy Brown Casts
    (From Ischemic or Nephrotoxic Insults)
  • Acute Interstitial Nephritis
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7
Q

Causes of Vascular Disease of the kidney?

A
  • Intrarenal Vascular Occlusion: Renal artery thrombosis, HUS/TTP
  • Intrarenal Vasculitis: Small vessel vasculitis (Wegener’s)
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8
Q

What is Post-Renal Azotemia?

A

Renal failure due to urine obstruction

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9
Q

Causes of Urine Obstruction?

A
  • Urethral obstruction by BPH
  • Nephrolithiasis (kidney stones in urethra or impacted at bladder neck)
  • Obstruction due to neoplastic invasion/extension (e.g. neoplasia of cervix, prostate, bladder)
  • Bilateral obstruction of ureters (e.g.retroperitoneal fibrosis—ureters are retroperitoneal structures)
  • Bilateral obstruction of kidneys (e.g.bilateral staghorn stones)
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10
Q

Most Common Clinical Manifestions of Acute Kidney Injury?

A
  • Weight Gain
  • Edema
  • Oliguria
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11
Q

What type of acute renal injury has the following urine findings:

  • Minimal/no Proteinemia
  • Possible Hyaline Casts
  • Osmolarity >500
  • BUN/Cr: > 20
  • Fractional Execretion of Sodium < 1%
A

Prerenal Azotemia

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12
Q

What type of acute renal injury has the following urine findings:

  • Mild Proteinemia
  • Pigmented Granular Casts
  • Osmolarity < 350
  • BUN/Cr: < 20
  • Fractional Execretion of Sodium > 1%
A

Tubular Intrinsic Renal Disease

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13
Q

What type of acute renal injury has the following urine findings:

  • Mild Proteinemia AND Leukocytes
  • WBCs, WBC casts, RBCs, Eosinophils
  • Osmolarity < 350
  • BUN/Cr: < 20
  • Fractional Excretion of Sodium > 1%
A

Acute Interstitial Nephritis

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14
Q

What type of acute renal injury has the following urine findings:

  • Severe Proteinemia
  • RBCs AND RBC casts
  • Osmolarity > 500
  • Fractional Excretion of Sodium < 1%
A

Acute Glomerulonephritis

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15
Q

What type of acute renal injury has the following urine findings:

  • Minimal/No Proteinemia
  • Crystals, RBCs, WBCs
  • Osmolarlity < 350
  • Fractional Excretion of Sodium > 1%
A

Postrenal Azotemia

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16
Q

Treatment for Acute Kidney Injury?

A
  • Treat underlying cause
  • Treat fluid imbalances
  • Treat electrolyte imbalances
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17
Q

Definition of Chronic Kidney Disease?

A
  • GFR < 60

- Urinary Albumin Excretion > 30

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18
Q

Causes of Chronic Kidney Disease?

A
  • Type II Diabetes Mellitus
  • Hypertension
  • Chronic Glomerulonephritis
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19
Q

Lab Findings in Chronic Kidney Disease?

A
  • Elevated BUN & Cr
  • Increased K+& phosphate
  • Decreased Na+& Ca2+
  • Normochromic, normocytic anemia
  • Metabolic acidosis
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20
Q

Therapy to reduce Proteinuria in Chronic Kidney Disease?

A

ACE- Inhibitors or ARBs

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21
Q

Therapy to treat Anemia in Chronic Kidney Disease?

A

Erythropoietin Stimulating Agents

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22
Q

Dietary Modifications in Chronic Kidney Disease?

A
  • Low Phosphorous Diet/ Phosphorous Binders
  • Vitamin D analogs-> Decrease PTH levels
  • Low Potassium Diet-> Treat Hyperkalemia
  • Protein Restriction (Advanced CKD)
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23
Q

Therapy to treat Metabolic Acidosis in CKD?

A

Sodium Bicarbonate

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24
Q

Indications of emergent dialysis?

A

AEIOU

  • Acidosis
  • Electrolyte abnormalities
  • Ingestion of toxins
  • Overload of fluid
  • Uremia
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25
Medications that cause Acute Interstitial Nephritis?
- Penicillin derivatives (methicillin, ampicillin) - NSAIDs - Allopurinol - Sulfa-derived Diuretics (thiazides, furosemide) - Cephalosporins - Proton pump inhibitors - Sulfonamide antibiotics (sulfamethoxazole) - Sulfasalazine (used to treat Crohn disease, UC, RA) - Rifampin
26
Other toxins that cause Acute Interstitial Nephritis?
- Cadmium - Lead - Copper - Mercury - Toxins from some mushroom
27
Diseases/Conditions that cause Acute Interstitial Nephritis?
- Infections (Strep. Legionella) - Sarcoidosis - Amyloidosis - SLE - Myoglobinuria - High uric acid levels
28
Kidney biopsy in Acute Interstitial Nephritis will show?
Infiltration of Inflammatory Cells and Tubular Cell Necrosis
29
Complications of Acute Interstitial Nephritis?
- Acute tubular necrosis - Acute or chronic renal failure - Renal papillary necrosis
30
Clinical Presentation of Minimal Change Disease?
Young Child w/ massive proteinuria. May have recent respiratory infection
31
Treatment of Minimal Change Disease?
- Oral Prednisone
32
Indications for a kidney biopsy to diagnose Minimal Change Disease?
- In Adults | - In Children refractory to steriods
33
Light and Electron Microscopy Findings in Minimal Change Disease?
- Light Microscopy: Normal | - Electron Microscopy: Effacement of Podocytes
34
Lab Findings in the Minimal Change Disease?
- Hyperlipidemia - Hypoalbuminemia - Heavy proteinuria
35
Risk Factors for Focal Segmental Glomerulosclerosis?
- Minority (African Americans) - Obesity - Sickle cell disease - AIDS (HIV)  - IV drug abuse (heroin) and Interferon treatment - Chronic kidney disease (secondary to congenital absence or surgical removal)
36
Symptoms of Nephrotic Syndrome?
- Edema - Foamy urine - Hypertension - Dyspnea
37
Treatment for FSGS?
- Corticosteriods (Prednisone) | - Calcineurin Inhibitors (Cyclosporine, Tacrolimus)
38
Clinical Presentation of FSGS?
- Hyperlipidemia - Hypoalbuminemia - Hematuria - High levels of proteinuria
39
What type of nephritic/nephrotic syndrome is associated with the following conditions? Henoch Schönlein purpura Cirrhosis Celiac disease Inflammatory disorders (e.g. sarcoidosis and IBD)
IgA Nephropathy
40
Clinical Presentation of IgA Nephropathy?
- Hemoturia - Flank Pain - Low Grade Fever
41
Diagnostic test for IgA Nephropathy?
Kidney Biopsy
42
Light and Electron Microscopy Findings?
- Light Microscopy: Mesangial widening | - Electron Microscopy: Mesangial proliferation and Immune complexes
43
Urine analysis findings in IgA nephropathy?
- Hemoturia (RBCs and RBC casts) | - Proteinuria
44
Treatment for IgA Nephropathy?
- ACE- Inhibitors/ ARBs | - Glucocorticoids (Severe)
45
Causes of secondary Membranous Nephropathy?
- Hepatitis B, syphilis - Systemic lupus erythematosus  - Solid tumors (esp. carcinomas)
46
Medications that cause Membranous Nephropathy?
- Penicillamine - High-dose captopril - NSAIDs (eg, diclofenac) - Parenteral gold salts (eg, gold sodium thiomalate)​
47
Urinalysis in Membranous Nephropathy?
- Nephrotic-range proteinuria - Oval fat bodies, lipid droplets, fatty casts - Microscopic hematuria - Glucosuria despite normal blood glucose levels*
48
Clinical Presentation of Membranous Nephropathy?
- Anorexia - Fatigue - Malaise - Edema w/o HTN
49
Complication of Membranous Nephropathy?
- DVT in extremities | - Renal Vein Thrombosis
50
Light and Electron Microscopy Findings in Membranous Nephropathy?
Light Microscopy: - Basement Membrane and Capillary wall thickening Electron Microscopy: - Spike and dome appearance from Subepithelial deposits of IgG and C3 - Podocyte Effacement
51
Treatment for Membranous Nephropathy?
- ACE-Inhibitors/ ARBs | - Anticoagulation (Patients w/ Serum Albumin < 3)
52
Membranproliferative Glomerulonephritis is associated with which conditions?
- Autoimmune disease - Hepatitis B & C - Lupus - Bacterial endocarditis
53
Lab Findings of Membroproliferative Glomerulonephritis?
- Hematuria | - Hypocomplementemia
54
Electron Microscopy findings in Membroproliferative Glomerulonephritis?
- Type I: Tram-track appearance due to basement membrane splitting - Type II: Dense intramembranous deposits
55
Treatment of Membroproliferative Glomerulonephritis?
- Corticosteroids w/ Aspirin, Dipyridamole | * Treatment slows progression but will progress to renal failure*
56
Cause of Post-Streptococcal Glomerulonephritis?
Strep pharyngitis or impetigo infection 2-4 weeks prior
57
Clinical Presentation of Post-Strep GN?
- Gross Hematuria (Tea colored urine) - Hypertension - Edema (Periorbital)
58
Urine Findings in Post-Strep GN?
- Hematuria with dysmorphic red cells - ± Red blood cell casts - Pyuria - Proteinuria (nephritic range, <3.5 g/day)
59
Lab Findings in PSGN?
- Transient Decrease in GFR - Increased BUN and Creatinine - Hypocomplementemia (C3)
60
Electron microscope findings of PSGN?
- Starry sky, Lumpy bumpy - Subepithelial dome shaped deposits of C3, IgG, IgM - In a diffuse, finely granular pattern
61
Treatment of PSGN?
Supportive Care - Fluid & sodium restriction - Loop diuretics for HTN, edema - K+, PO43- restriction as necessary
62
Treatment for Rapidly Progressive Glomerulonephritis?
- Steriods - Plasmapheresis - Cytotoxic Agents
63
Clinical Presentation of RPGN?
- Nephritic Syndrome - Sudden Renal Failure - Olgiuria
64
Characteristics of the 3 types of RPGN?
- Type 1: Anti-GBM antibodies - Type 2: Immune Complex Deposition - Type 3: Absence of Immune Complexes
65
Definite Diagnostic test for RPGN?
Kidney Biopsy
66
Lights Microscopy Findings in RPGN?
Crescents in Glomeruli
67
Clinical Triad of Goodpasture Syndrome?
- Pulmonary Hemorrhage (Hemoptysis) - Anti-GBM antibodies - RPGN (Hematuria, edema)
68
Treatment for Goodpasture Syndrome?
- Steriods - Plasmapheresis - Cyclophosphamide
69
Kidney Biopsy findings in Goodpasture Syndrome?
Linear Pattern with immunofluorescence
70
Stones that occur when a patient develops an upper urinary tract infection with a urease-producing organism such as Klebsiella or Proteus?
Struvite stones
71
Uric acid stones occur in patients with which conditions?
- Gout - Diabetes Mellitus - Chronic Diarrhea - Increased Uric Acid Production
72
Signs and Symptoms of renal stones?
- Renal Colic - Hydronephrosis - Infection - Gross Hematuria
73
Abdominal X-ray will show most renal stones except?
- Uric acid Stones | - Very small stones
74
Urinary pH of > 6 indicates which type of kidney stone?
Struvite Stones
75
Urinary pH of < 5 indicates which type of kidney stone?
Uric Acid Stones
76
Best diagnostic imaging for kidney stones?
Noncontrast Abdominal/Pelvic CT
77
Treatment for Nephrolithiasis with small stones (<5mm)?
Analgesics (NSAIDs) and Hydration until stones passes
78
Treatment for Nephrolithiasis with large stones (>8mm)?
- Extracorporeal shockwave lithotripsy | - Percutaneous nephrolithotomy.
79
Best diagnostic tests for diabetic nephropathy?
Albumin to creatinine ratio on spot urine test (>300 mg/day)
80
Characteristics of Diabetic Nephropathy?
- Persistent Albuminuria | - Progressive GFR decline
81
Kidney Biopsy Findings in Diabetic Nephropathy?
- Nodular Sclerosis (Kimmelstiel-Wilson nodules)
82
Treatment for Diabetic Nephropathy?
- Maintain Glucose Control | - ACE- Inhibitors/ ARBs to slow progression
83
What is Diabetes Insipidus?
The body's inability to reabsorb water from the urine
84
What is Central Diabetes Insipidus?
Decreased ADH synthesis from the hypothalamus or Decreased ADH release from the posterior pituitary
85
Causes of Central Diabetes Insipidus?
- Idiopathic: destruction of the ADH-secreting cells in the hypothalamus - Trauma - Tumors - Anorexia nervosa
86
What is Nephrogenic Diabetes Insipidus?
The kidneys are resistant to ADH
87
Conditions that cause Nephrogenic Diabetes Insipidus?
- Hereditary renal diseases - Drugs - Hypokalemia - Hypercalcemia
88
Drugs that cause Nephrogenic Diabetes Insipidus?
- Lithium - Demeclocycline (tetracycline antibiotic) - Cidofovir (antiviral) - Foscarnet (antiviral) - Amphotericin (antifungal)
89
Urinalysis Findings in Diabetes Insipidus?
- Urine osmolality will be < Serum osmolality - Urine specific gravity <1.006 - Urine osmolality < 200 osmol/kg - Serum osmolality >290 osmol/kg
90
Low urine specificity and low serum osmolarity indicates?
Psychogenic Polydypsia
91
Water deprivation test findings of Diabetes Insipidus?
No change in urine osmolality after water deprivation
92
Results of DDVAP for Central and Nephrogenic Diabetes Insipidus?
Central: Increased Urine Osmolality Nephrogenic: No change in Urine Osmolality
93
Treatment for Central Diabetes Insipidus?
Desmopressin (Synthetic ADH)
94
Treatment for Nephrogenic Insipidus?
- Treat Underlying Condition - Hydrochlorothiazide - Indomethacin - Amiloride (Lithium induced DI)
95
Diagnostic Criteria for Diabetes Mellitus?
- Fasting Serum Glucose > 126 - HbA1C > 6.5% - Random Blood Glucose > 200 w/ symptoms
96
Lab Findings in Type 1 DM?
- Autoantibodies against Pancreatic islets | - Low or inappropriate normal C-Peptide
97
Complications of Hyperglycemia?
- Nephropathy - Neuropathy - Vascular Damage - Diabetic Ketoacidosis
98
Treatment for Type I DM?
Insulins - Long acting insulin (Lantus) - Rapid acting (Lispro) at meals
99
Clinical Presentation of Diabetes Mellitus?
- Polyphagia - Polydipsia - Polyuria
100
Screening Recommendations for patients with Diabetes Mellitus (Type 1 &2)?
- Albumin/creatinine ratio minimum yearly - Hemoglobin A1c every 3 months - Annual eye and foot exams
101
Risk Factors for Type II DM?
- Obesity - Sedentary lifestyle and physical inactivity - History of gestational diabetes - Family history of diabetes - Coexisting hypertension and dyslipidemia - Increasing age - Certain ethnic groups (African-Americans, Native Americans, Asian Americans, Pacific Islanders)
102
Adverse effects of Metformin?
- GI upset - Vitamin B12 Deficiency - Lactic Acidosis
103
Contraindications of Metformin?
Renal insufficiency (leads to lactic acidosis)
104
Adverse effects of Sulfonylureas (Glipizide) and Meglitinides (Repaglinide)?
- Hypoglycemia | - Weight Gain
105
Adverse effects of Chlorpropramide (sulfonylurea)?
- Disulfiram-like reaction | - Hyponatremia
106
How do GLP-1 agonists (Exenatide, Lixisenatide) treat diabetes?
- ↓ Inappropriate glucagon release - ↑ Glucose-dependent insulin release - ↓ Gastric emptying → ↑ satiety → ↓ food intake → weight loss
107
Adverse effects of GLP-1 agonists?
GI Upset
108
Contraindications of GLP-1 agonists?
- Gastroparesis - History of Pancreatitis - MEN 2A or 2B - Medullary thyroid cancer history
109
Complications of DPP-4 Inhibitors (Linagliptin, Saxagliptin)?
- Upper Respiratory Infection | - UTI
110
Contraindications of Thiazolidinediones (Pioglitazone, Rosiglitazone)?
- Bladder Cancer - CHF - Active Liver Disease - Fractures
111
Adverse effects of Alpha Glucosidase Inhibitors?
- Flatulence | - Diarrhea
112
Screening recommendations for Diabetes Mellitus?
Every 3 years for Adults (40-70 yrs old) who are overweight or obese.
113
Diagnostic Criteria for Pre-Diabetes?
- A1C of 5.7% to 6.4% - FPG between 100 mg/dL to 125 mg/dL  - 2-hour plasma glucose of 140 to 199 mg/dL via OGTT
114
Clinical Presentation of Diabetic Ketoacidosis?
- Abdominal Pain - Vomiting - Fruity odor breath - Profound Dehydration
115
Respiratory compensation for the metabolic acidosis in DKA?
Kussmaul Respirations (deep, rapid breathing)
116
Diagnostic Criteria of DKA?
- Elevated glucose (>250 mg/dL) - Anion gap metabolic acidosis (bicarbonate < 15mEq/L, pH < 7.30, AG > 17) - Urine strongly positive for glucose and ketones
117
Treatment for DKA?
- Normal saline - Potassium - Insulin and glucose - Treatment of the precipitating event as appropriate (infection, intoxication, etc)
118
Why should fluid resuscitation be done slowly in DKA?
To prevent cerebral and pulmonary edema

Internal Medicine (15 decks)

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