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internal medicine-emma holiday > nephrology > Flashcards

nephrology Flashcards

1
Q

the decrease in sodium… what do you do?

  1. hypovolemic hypoNa
  2. hypovolemic hypoNa
  3. Euvolemic hypoNa

correct?

A

gain of water…. check osm then check volume status

  1. hypovolemic hypoNa- CHF, nephrotic, cirrotic
  2. hypovolemic hypoNa- diuretics or vomiting + free water
  3. Euvolemic hypoNa- SIADH (check CXrR if smoker) addisons, hypothyroidism

correct w/ NS if hypovolemic, 3% saline only if seizures or Na<120. otherwise fluid restric + diuretics

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2
Q

overcorrecting low sodium

A

central pontine myelinolysis

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3
Q

increased sodium… correct?

A

loss of water… replace water w/ D5W or other hypotonic fluid

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4
Q

overcorrecting high sodium

A

cerebral edema

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5
Q

numbness, chvostek, or troussaeu, prolonged QT interval

A

decreased Ca

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6
Q

bones, stones, groans, psycho. shortened QT interval

A

increased calcium

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7
Q

paralysis, ileus, ST depression, U waves… tx?

A

decreased potassium….. tx w/ K but make sure patient can pee

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8
Q

peaked t waves, prolonged PR and QRS, sine waves….tx?

A

increased potassium….. tx w/ Ca-gluconate then insulin +glc, kayexalate, albuterol and sodium bicarb

last resort- dialysis

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9
Q

metabolic alkalosis… what do you do next?

A

check urine chloride

> 20- hyperaldo (conns), barter’s or gitelmans
<20 Vomiting/NG suction, antiacids, diuretics

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10
Q

non-anion gap metabolic acidosis

A

diarrhea, diuretic, RTAs (I, II and IV)

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11
Q

RTA and how to tx?

  1. cause- lithium/amphB/SLE/sjorgens/analgesics
  2. urine pH>5.4
  3. hypoK, kidney stones= cannot excrete H+
A

Type I distal- tx w/ replete k and oral bicarb

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12
Q

RTA and how to tx?

  1. fanconi’s syndrome, myeloma, amyloid, vit D def, autoimmune
  2. hypo K
  3. osteomalacia– cannot reabsorb Bicarb
A

type II proximal- tx w/ replete k, mild diuretic, bicarb won’t help

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13
Q

RTA and how to tx?

  1. > 50% caused by diabetes, addisons, sickle cell, any cause of aldo def.
  2. hyper K
  3. hyper Cl
  4. high urine [Na] even w/ salt restriction
A

type IV hyperrenin-hypoaldo- tx w/ fludrocortisone

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14
Q

Muddy brown casts in a pt w/ ampho, AG, cisplatin or prolonged ischemia? tx?

A

ATN

tx w/ fluids, avoid nephrotox and dialysis of indicated

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15
Q

protein, blood and Eos in the urine + fever and rash who took trim-sulfa 1-2 wks ago? tx?

A

AIN

tx w/ stop offending agent; add steroids if no improvement

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16
Q

army recruit or crush victim w/ CPK of 50k + blood on dip but no RBCs. test? tx?

A

rhabdomyolysis
1st test- check potassium or ekg
tx w/ bicarb to alkalinize urine to prevent precipitation

17
Q

enveloped shaped crystals on UA? tx?

A

ethylene glycol intox

tx w/ dialysis or NaHCO3 if pH <7.2

18
Q

bump in creatinine 48-72 hr s/p cardiac cath or ct scan? prevent?

A

contrast nephropathy

prevent by hydrating before or giving bicarb or NAC

19
Q

indications for emergent dialysis

A

A- acidosis
E- electrolyte imbalance–> particularly high K >6.5
I- intoxication –> particularly antifreeze,Li’
O- overload volume–> sxs of CHF or pulmonary edema
U- uremia –> pericarditis alt. mental status

20
Q

patient peeing protein….

  1. best 1st test?
  2. definition of nephrotic syndrome?
  3. MC in kiddos?
  4. MC in adults?
  5. Assoc. w/ heroin use and HIV
  6. Assoc w/ chronic hepatitis and low complement?
  7. if nephrotic patients suddenly develops flank pain?
  8. other random causes?
A
  1. best 1st test- repeat test in 2 weeks, then quantify w/ 24hr urine
  2. definition of nephrotic syndrome- >3.5g protein/24hrs, hypoalbuminemia, edema, hyperlipidemia (fatty/waxy casts)
  3. MC in kiddos- minimal change dz-fusion of foot processes, tx w/ ‘roids
  4. MC in adults- membranous- thick cap walls w/ subepi spikes
  5. Assoc. w/ heroin use and HIV- focal-segmental-mesangial IgM deposits. limited response to steroids
  6. Assoc w/ chronic hepatitis and low complement- membranoprolif-tram track BM w/ subendo deposits
  7. if nephrotic patients suddenly develops flank pain- suspect renal vein thrombosis! 2/2 peeing out ATIII, protein C and S. Do CT or U/S stat!!!
  8. other random causes?- orthostatic, bence jones in MM, UTI, preggos, fever, CHF
21
Q

flank pain radiating to groin + hematuria

A

kidney stones

22
Q

best test for kidney stones

A

CT

23
Q

kidney stones… types:

  1. most common
  2. kid w/ family hx of stones
  3. chronic indwelling foley and alkaline pee?
  4. if leukemia being treated w/ chemo?
  5. If s/p bowel resection for volvulus?
A
  1. most common- calcium oxalate. tx w/ HCTZ
  2. kid w/ family hx of stones- cysteine-cannot resorb certain AA
  3. chronic indwelling foley and alkaline pee- Mg/AI/PO4=struvite. proteus, staph, pseudomonas, klebsiella
  4. if leukemia being treated w/ chemo- uric acid tx by alkinizing the urine + hydration
  5. If s/p bowel resection for volvulus- pure oxylate stone,Ca not reabsorbed by gut.. pooped out
24
Q

kidney stones…tx

  1. stones <5mm
  2. stones>2cm
  3. stones 5mm-2cm
A
  1. stones <5mm- will pass spontaneously. just hydrate
  2. stones>2cm- open or endoscopic surgical removal
  3. stones 5mm-2cm- extracorporal shock wave lithotropsy
25
Q

CKD…#1 cause…#2 cause?

A

DM and HTN

26
Q

1 cause of death in CKD pt?

A

cardiovascular dx

ldl target<100

27
Q

so your patients is peeing blood:

  1. best 1st test?
  2. painless hematuria?
  3. terminal hematuria + tiny clots
  4. dysmorphic RBCs and RBC casts
  5. definition of nephritic syndrome?
A
  1. best 1st test- urinanalysis
  2. painless hematuria- bladder/kidney cancer until proven otherwise
  3. terminal hematuria + tiny clots- bladder cancer or hemorrhagic cystitis (cyclophosphamide)
  4. dysmorphic RBCs and RBC casts- glomerular source
  5. definition of nephritic syndrome?- proteinuria, hematuria, edema, and azotemia
28
Q

so you are peeing blood?

  1. 1-2 days after runny nose, soar throat & cough
A

Berger’s Dz- IgA nephropathy

29
Q

so you are peeing blood?

  1. 1-2weeks after sore throat or skin infxn?
    - best 1st test?
    - what do you see?
A

post-strep GN-smoky/cola urine,

best 1st test- ASO titer

subepithelial IgG humps

30
Q

so you are peeing blood?

hematuria + hemoptysis

A

goodpastures’ syndrome- Abs to collagen IV

31
Q

so you are peeing blood?

Hematuria + deafness

A

alport syndrome- XLR mutation in collagen IV

32
Q

so you are peeing blood?

kiddo s/p viral URI w/ Renal failure + abd. pain, arthralgia and purpura… tx?

A

Henoch-Schonlein Purpura. IgA

tx- supportive tx +/- steroids

33
Q

so you are peeing blood?

kiddo s/p hamburger and diarrhea w/ renal failure, MAHA and petechiae….. tx?

A

HUS-E.Coli )127H7 or shigella

dont’s x w/ ABX- releases more toxin

34
Q

so you are peeing blood?

cardiac patient s/p ticlopidine w/ renal failure. MAHA, decreased plts, fever and AMS. tx?

A

TTP
tx w/ plasmapheresis. dont’ give plts

can tell from DIC b/c PT and PTT are normal in HUS/TTP

35
Q

so you are peeing blood?

c-ANCA, kidney, lung and sinus involvement… tx?

A

wegner’s granulomatosis

  • most accurate test is bx
  • tx w/ steroids or cyclophosphamide
36
Q

so you are peeing blood?

p-ANCA, renal failure, asthma and eosinophilia….tx?

A

churg strauss

  • best test is lung bx.
  • tx w/ cyclophosphamide
37
Q

so you are peeing blood?

p-ANCA, NO lung involvment, Hep … tx?

A

polyarteritis nodosa.

  • affects small/med arteries of every organ except the lung
  • tx w/ cyclophosphamide

internal medicine-emma holiday (9 decks)

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