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Nephrology > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What should you think of if a urine dipstick is heme-positive but the microscopic examination is negative for RBCs?

A

Myoglobinuria

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2
Q

How do you confirm myoglobinuria?

A

Urine ammonium sulfate test - precipitates hemoglobin (Hgb) but not myoglobin

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3
Q

What are some clinical situations that can cause an elevated BUN:Cr?

A

Can indicate prerenal azotemia:

  • Low flow and increased reabsoprtion
  • heart failure
  • cirrhosis
  • nephritic syndrome
  • or true intravascular volume depletion

Can result from increased protein breakdown:

  • increased protein uptake
  • GI bleed
  • TPN
  • or catabolic states (corticosteroid intake)
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4
Q

What does an FEna <1 usually signify?

A

early AGN; prerenal azotemia

FEna = [(Una x Pcr) / (Ucr x Pna)] x 100; cannot be used if diuretics have been used

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5
Q

Total body water (TBW) varies and depends upon what factors?

A
  1. Gender

2. Percentage of body fat

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6
Q

What are the 2 important regulators of ADH secretion from the posterior pituitary?

A
  1. Osmoreceptors in the hypothalamus

2. Volume (stretch) receptors in the left atrium (and possibly in the pulmonary veins) and blood vessels

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7
Q

How do you calculate maintenance fluids and electrolytes for a 24-hour period?

A

Fluids:

  • First 10 kg: 100cc/kg
  • Second 10 kg (10 kg-20kg): 50 cc/kg
  • Remaining weight >20 kg: 20cc/kg

Electrolytes:

  • NaCl: 2-3 mEq/100 ml per 24 hours
  • K: 1-2 mEq/100 ml per 24 hours
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8
Q

What causes hyperosmolar hyponatremia?

A

Osmotic shift due to glucose and mannitol, diluting plasma Na+

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9
Q

For each 100-increment increase in glucose over 100mg/dL, how do you correct the serum Na?

A

For each 100-increase in glucose over 100mg/dL, the [Na+] decreases by 1.6

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10
Q

What are the causes of low-volume, hypoosmolar hyponatremia?

A

Loss of both water and Na+, but more Na+ than water:

  • Diuretics
  • GI losses (vomiting, diarrhea)
  • Third spacing fo fluid
  • Adrenal insufficiency (Addison disease)
  • Sodium-losing nephropathies
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11
Q

What are the causes of high-volume, hypoosmolar hyponatremia?

A

Patients typically have dependent edema and possibly JVD

  • Edema forming states: heart failure, cirrhosis, and nephrotic syndrome
  • Kidney failure: acute or chronic
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12
Q

What are the most common drugs that cause SIADH (Syndrome of Inappropriate Antidiuretic Hormone)?

A
  • NSAIDs
  • SSRIs
  • Carbamazepine and oxcarbazepine
  • Psychotropic drugs (Haloperidol, amitriptyline)
  • IV Cyclophosphamide
  • Vincristine and vinblastine
  • Cisplatin
  • Ecstasy
  • Chlorpropamide
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13
Q

Which endocrinopathies must be rules out in all patients with hyponatremia?

A

Hypothyroidism and glucocorticoid deficiency

  • Can have low serum osmolalities and high urine osmolalities
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14
Q

What is the suggested rate of correction for severe hyponatremia?

A

Never exceed 10 mEq/L over 24 hours; 0.5mEq/L per hour

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15
Q

Under what conditions is osmotic demyelination syndrome most likely to occur?

A

Chronic, severe hyponatremia (Na <115 for >2 days) whose sodium is corrected rapidly (>10 mEq/L over 24 hours)

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16
Q

What does hypernatremia indiciate?

A

Water deficit

17
Q

What is the usual serum Na in a patient with DI who has access to water?

A

Normal or borderline-high serum sodium levels

18
Q

What K derangement can be seen in Cushing syndrome?

A

Hypokalemia

19
Q

Know the effects of NSAIDs on serum K.

A

NSAIDs decrease renin release, thus increasing K+ concentration.

NSAIDs make hyporeninemic states worse.

20
Q

Addison disease causes what type of K derangement?

A

Hyperkalemia

21
Q

What are important causes of pseudohyperkalemia?

A

Hemolyzed specimen, thrombocytosis (>450k), LEUKOCYTOSIS (>100k)

22
Q

What ECG changes are seen with hyperkalemia?

A

peaked T wave and short QT interval, progressive lengthening of PR and QRS intervals, loss of P wave+QRS widening into sine wave, v fib or cardiac standstill.

23
Q

What is special about the treatment of hyperkalemia in patients taking digoxin?

A

Do not give IV calcium to a patient taking Digoxin, can enhance effect of med

24
Q

What must be checked in all patients with renal potassium wasting?

A

Magnesium; comorbid magnesium deficiency causes renal potassium wasting

25
Q

When hypokalemia is associated with HTN and alkalosis, what is the probably cause?

A

Hyperaldosteronism

26
Q

How can you distinguish among Liddle’s, Bartter’s, and Gitelman’s?

A

Liddle’s: Na retention, ENaC mutation, decreased renin/aldosterone, p/w HTN and hypokalemic metabolic alkalosis

Bartter’s: loss of Na, Cl, Ca, Mg in urine, loop diuretic like, *hypercalciuric and normal Mg

Gitelman: milder than Barters, hypocalciuric and hypomagnesia

27
Q

What is the correction factor used for serum calcium in patients with hypoalbuminemia?

A

For each 1g/dL decrease in albumin, increase sCa by 0.8 mg/dL

28
Q

What are the most common causes of asymptomatic hypercalcemia?

A

Thiazide diuretics Primary hyperparathyroidism (esp if h/o neck radiation)

29
Q

What effect does respiratory rate have on pH? How quickly does this occur?

A

RR responds immediately to pH changes

30
Q

What is the calculation used to determine the serum osmolality? The osmolal gap?

A

Osm = 2 * [Na] + (BUN/2.8) + (glucose/18)

OG = Osm(meas) - Osm(calc)

31
Q

Which poisonings cause an increased OG and normal AG?

A

isopropyl alcohol, ethanol, acetone ingestion

32
Q

What are the causes of HAGMA?

A

MUDPILES

33
Q

Which abnormality is sometimes noted in the urine of patients who have ingested ethylene glycol?

A

Calcium oxalate crystals in urine

34
Q

What are the potential PE findings in a patient who has ingested methanol?

A

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35
Q

What is the treatment of methanol and ethylene glycol ingestions?

A

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36
Q

What are the 2 main causes of NAGMA and hypokalemia?

A

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37
Q

Know the 4-step method for solving acid-base disorders.

A

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38
Q

When look at a blood gas result, how do you determine which acid-base disorder is the primary disturbance?

A

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39
Q

What happens to a patient’s serum bicarbonate level when acid anions accumulate in the blood?

A

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Nephrology (2 decks)

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