Nephrology Flashcards
Best diagnostic test for monoclonal gammopathy of renal significance (MGRS)
Kidney biopsy
Consider dx if has MGUS with renal involvement
Isovolemic hypotonic hyponatremia with urine osm <100 is indicative of what?
Excessive water intake (psychogenic polydipsia) or poor solute intake
In DI or nephrogenic DI, serum sodium is usually normal or elevated
Diabetic nephropathy findings
Proteinuria after longstanding diagnosis (>8 years)
Kidney biopsy not required, treat with ACE
Secondary causes of hypoaldo/hyperkalemia
Heparin (unfractionated and LMWH)
RTA type 4
RAS inhibitors
Primary adrenal disease
Clinical findings in ANCA vasculitis
Prodromal malaise, arthralgia, myalgia, skin findings with hematuria, proteinuria and AKI
Differential diagnosis for RPGN
1) Pauci-immune staining (ANCA-associated)
2) Linear staining (anti-GBM)
3) Granular staining (lupus nephritis)
Confusion, AGMA, negative lactate with history of chronic liver/kidney disease or poor nutrition
Pyroglutamic acidosis
AGMA, intermittent confusion, slurred speech, ataxia, short bowel syndrome
D-lactic acidosis
Treatment for acute hyponatremia
3% normal saline (100 mL bolus)
Ecstasy induces hyponatremia via ADH release and often induces patients to drink large volumes of water
Treatment for recurrent calcium stones
thiazide diuretics
Induces sodium resorption (via dehydration) which induces passive calcium resorption and thus reduced urinary calcium
Fluid choice for alcoholic ketoacidosis
dextrose and normal saline
Dextrose to induce insulin secretion and reduce ketone formation. Isotonic saline is for rehydration.
Treatment for edema with nephrotic syndrome
Loop diuretics
Add thiazide or potassium-sparing diuretic (e.g. metolazone) if suboptimal response to maximum tolerated loop diuretic dose.
Decreasing GFR requires increased diuretic dose
Risk factors for secondary FSGS
Premature birth, obesity
Subnephrotic proteinuria, typically no clinical findings
Secondary FSGS is attributed to hyperfiltration injury in setting of reduced renal mass –> adaptive podocyte injury and segmental sclerosis
Differentiate between saline-responsive and saline-resistant metabolic alkalosis
Responsive: urine chloride < 15
- consider volume contraction, GI loss, surreptitous vomiting
Resistant: urine chloride >15
- consider hyperaldosteronism, Cushing, Bartter and Gitelman
Preferred vascular access for G4 CKD
Central»_space; peripheral (e.g. PICC)
Cutoffs for potassium wasting
Urine potassium > 20 mEq/24hr, spot U potassium >20 mEq/L, spot urine potassium/creatinine >13 mEq/g
In poor nutritional states (rare in hypokalemia), Urine potassium would be < 20
Infection-related GN with cellulitis present at the same time. Organism?
Staph - more likely to induce IRGN at the time of the infection
Strep species typically have a 1-4 week delay between primary infection and GN
Phosphate binders
Sevelamer (non-calcium binder), preferred
Aluminum hydroxide - useful for very short-term treatment of symptomatic hyperphosphatemia. May side effects.
Cinacalcet - calcimimetic that decreases PTH, used for ESRD
Infectious associations with Membranous GN, Membranoproliferative GN, FSGS
Membranous: Hep B
Membranoproliferative: Hep C
FSGS: HIV
Hypertension, Gout, CKD with history of working as a mechanic.
Lead nephropathy
Causes chronic tubulointerstitial nephritis
Negative urine AG suggests what in NGMA?
GI loss
UAg: Urine Sodium + Urine Potassium - Urine Chloride
Teratogenic medications in renal transplant patients
Mycophenolate mofetil
Sirolimus
Everolimus
Calcineurin inhibitors (cyclosporine/tacro) have been well tolerated in pregnancy
Treatment for hepatorenal syndrome type 1
Vasoconstriction (octreotide, midodrine) and IV albumin
Also discontinue diuretics, restrict sodium, restrict water if hyponatremic
Definitive therapy is transplant, TIPS is used for selected patients (e.g. active variceal bleeding)
HRS T1 - onset w/in 48 hours, elevated Cr (>0.3 above baseline), other etiologies ruled out, bland urine sediment, low UNa
When are thiazide diuretics less effective?
GFR <30
Good for initial therapy for HTN, less effective in CKD
Features of cisplatin-induced renal injury
AKI Polyuria Tubular injury Hypomagnesemia Proximal (Type 2) RTA Fanconi
Follow up interval for simple cysts
None, reassurance is appropriate (malignancy risk <1 %)
Features of simple cyst:
- round, thin, smooth, regular border
- no septa, calcifications, or solid components
- posterior enhancement on U/S
- no contrast enhancement on CT/MRI
No follow up imaging is indicated
Findings in calcineurin inhibitor nephrotoxicity
Decreased GFR Hyperkalemia Hyperuricemia Hypophosphatemia Hypomagnesemia
Consider if CYP450 inhibitor s are being prescribed with tacro/cyclosporine
Urine findings for following stone types
1) Calcium oxalate
2) Uric acid
3) Struvite
4) Cystine
1) Envelope-shaped crystals.
- Hx of hyperparathyroidism, RTA, or malabsorption
2) Rhomboid crystals, radiolucent stones.
- Hx of gout or myeloproliferative disorders
3) Staghorn calculi, coffin-lid crystals
- Hx of recurrent UTI
4) Hexagonal yellow/green crystals, branched calculi
- AR, multiple stones
