NEPHROLOGY Flashcards
The first step in the diagnostic evaluation of hyper- or hypocalcemia is to ensure that the alteration in serum calcium levels is not due to abnormal ______ concentrations.
ALBUMIN
So the first step in the diagnostic evaluation of hypercalcemia is to check albumin concentration
Vasoconstricts EA increasing GFR
ANP, ANGIOTENSIN II, NOREPINEPHRINE
rish for osmotic demyelination syndrome (ODS) is increased in ____
Chronic hyponatremia
What type RTA has predisposition to stone formation?
Distal (Type) I
Significant bacteriuria with urologic abnormality, renal transplant, diabetes, sepsis or older male
complicated UTI.
Classic ECG changes in hyperkalemia
o Tall, peaked T waves (5.5-6.5 mM),
o Loss of P waves (6.5-7.5 mM)
o Widened QRS (7-8 mM)
Syndrome that mimic THIAZIDE DIURETICS.
- Genetic defect in the distal tubule
- Defect in Na-Cl cotransporter in the distal tubule
GITELMAN SYNDROME
Bilaterally small kidneys supports the diagnosis of CKD , EXCEPT:
o Diabetic nephropathy
o Amyloidosis
o HIV nephropathy
o Polycystic kidney disease
What causes intracellular shift of potassium?
Insulin
Beta agonist
Alkalosis
most common site of renal stone impaction
Ureterovesicular junction
What type of RTA?
- decreased aldosterone
- Assoc with Diabetes
- low (acidic) urine pH
- (-) stones
- high potassium
- Tx: Fludrocortisone
Type IV (Hypoaldosteronic) RTA
Examples of High anion gap metabolic acidosis
“MUDPILES”
Methanol
Uremia
DKA
Paraldehyde
Iron or INH
Lactate
Ethylene glycol
Salicylates
What type of RTA?
- Inability to reabsorb HCO3
- Assoc with Multiple myeloma and Amyloidosis
- low (acidic) urine pH
- (-) stones
- low potassium
- Tx: HCO3 + K+ tabs + diuretics (HCTZ)
Type II (Proximal) RTA
Vasodilates AA increasing GFR
ANP, Prostaglandin
Syndrome characterized with:
- Chloride-resistant metabolic alkalosis
- Hypokalemia
- Hypomagnesemia
- Decreased urinary calcium excretion
- Hypocalciuric so no increased risk for kidneys stones or nephrocalcinosis
GITELMAN SYNDROME
Syndrome characterized with:
- Chloride-resistant metabolic alkalosis
- Hypokalemia
- Normal serum magnesium (may be low)
- Increased urinary calcium excretion
(hypercalciuric so at risk for kidney stones or nephrocalcinosis
BARTTER SYNDROME
CKD definition
Abnormality of kidney structure or function, present for >3 months, with implications for health
syndrome that is MINERALOCORTICOID-LIKE
- ENaC upregulation
- (+) HTN
LIDDLE’S SYNDROME
Premenopausal non-pregnant women with acute onset dysuria, frequency, urgency without vaginal discharge
acute uncomplicated cystitis.
vasodilates EA decreasing GFR
ACEI/ARB
Healthy women with fever, chills, flank pain and costovertebral angle tenderness with nausea and vomiting
acute uncomplicated pyelonephritis
The most common causes of intrinsic AKI
sepsis, ischemia, and nephrotoxins
What is the best treatment for type I RTA?
HCO3 and Potassium replacement
What electrolyte abnormality can occur?
- GI loss: diarrhea (most common)
- Renal loss: osmotic diuresis, excess urea, mannitol
- Diabetes insipidus
Presents with change in sensorium
Hypernatremia
mainly has an effect in the efferent arteriole causing increase Glomerular Filtration Rate but with compensatory Na reabsorption
ANGIOTENSIN
Severe hyponatremia may present with ____
seizures, cerebral edema, coma, death
The combined use of NSAIDs with ACEIs or ARB poses high risk for AKI. True or false.
True
facilitate dilation of the Afferent arteriole causing increase GFR but no Na + reabsorption (net effect is Na + loss and volume loss)
ANP (Prostaglandins)
What treatment do you recommend if with hyperkalemic ECG changes?
Calcium gluconate IV
Favors CHRONIC kidney disease
- History of kidney disease, hypertension, abnormal urinalysis, edema
- Small kidney on renal ultrasound
- Anemia, hyperkalemia, acidemia
- Urinalysis with broad cast
syndrome that mimics LOOP DIURETICS.
- Genetic defect in the thick ascending limb of the Loop of Henle
- Defects in Na-K-2Cl co-transporter, K or Cl channels result in lack of concentrating ability
Often presents with sensorineural deafness, triangular facies with drooping mouth, large eyes
BARTTER SYNDROME
Criteria for AKI
- Increase in sCr (serum creatinine) by > 0.3 mg/dl (>26.5 umol/l) within 48 hours;
- Increase in sCr from baseline within 1 week;
- Urine volume <0.5 ml/kg/h for 6 hours
- Anuria: Complete absence of urine formation (<100 mL)
- Oliguria: 24-h urine output <400 mL
Favor AKI instead of CKD
- Return of renal function to normal with time
- Anemia, hyperkalemia, acidemia
- Sudden decrease in urine output
What causes extracellular shift of potassium?
Hyperosmolarity
Exercise
Cell lysis
Acidosis
What type of RTA?
- Inability to secrete H+
- associated with Sporadic and Hep B or C
- High (basic) urine pH
- (+) stones
- low potassium
- Tx: HCO3 + K+ tabs
Type I (Distal) RTA
Bartter or Gitelman syndrome?
Increased renal PGE2 production
BARTTER SYNDROME
Vasoconstricts AA decreasing GFR
NSAIDs
The “gold standard” diagnostic test for nephrolithiasis
helical CT without contrast
STAGES OF CHRONIC KIDNEY DISEASE
absolute indications for dialysis
- Acidosis, intractable
- Electrolyte imbalance (hyperkalemia), intractable
- Intoxication
- Overload (volume), intractable
- Uremi
treatment regimen recommended for UTI in men
7- to 14-day course of a fluoroquinolone or TMP-SMX is recommended
ECG changes in hypokalemia
U waves
