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Step 3 UW /FA > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Urine sodium with prerenal azotemia? low or high?

A

LOW!

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2
Q

Whats a Uwave on EKG? When would u see this? 2 common causes & the acid base disorder they are associated with?

A

Uwave is the additional wave after the flattened Twave seen w/HYPOkalemia.

2common causes: laxative abuse = metabolic acidosis & vomiting or NG suction = metabolic alkalosis

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3
Q

IgA Nephropathy whats another name for this? sx?

A

aka Berger Disease sx: painless recurrent hematuria, recent viral respiratory infection, Proteinuria

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4
Q

Polyarteritis Nodosa(PAN) initial test? dx?

A

initial: ESR for inflammation markers, Hepatitis B & C(associated with 30% of PAN) dx: Bx of sural nerve or the kidney, angiography showing “beading”

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5
Q

RTA type 4

whats the defect? cause?

tx?

A

defect in aldosterone deficiency or RESISTANCE – hypoaldosteronism, ACE/ARB, urinary tract obstruction, heparin

TX: replace aldo if needed, Nabicarb supp or K wasting diuretics

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6
Q

Clinical indications for emergent dialysis?

A

AEIOU = acidosis, electrolyte/hyperkalemia specifically, ingestion of toxins, Overload volume, Uremic symptoms/encephalopathy

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7
Q

4 common causes of SIADH

A

any problems with CNS, any lung disease, cancer, medications(sulfonylureas, SSRIs, carbamazepine)

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8
Q

Polyarteritis Nodosa(PAN) tx?

A

tx: cyclophosphamide & steroids

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9
Q

Slight elevations of Cr above normal(1.5-2.5) means a loss of _______% of renal function at a minimum.

A

60-70%

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10
Q

Pt is Hyperkalemic with ECG changes(peaked Twaves &/or wide QRS)…. what do u give & why?

A

Ca-gluconate = stablize cardiac membranes & prevent arrhythmias

B-ag, insulin w/glucose & Na-bicarb = temporary treatment to move K into cells

Loop diuretics, dialysis or Kayexalte = removes K from body

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11
Q

Evaluation of Hyponatremia:

Serum Na <290, patient is hypervolemic with a UNa<20

A
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12
Q

What can you do to prevent contrast induced renal failure?

A

Pt who can still get contrast with renal failure will have a Cr between 1.5-2.5. Give NS + N-acetylcysteine + bicarb

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13
Q

3 common causes of hypervolemic hyponatremia? tx?

A

congestive heart failure(CHF), nephrotic syndrome, cirrhosis tx: treat underlying cause

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14
Q

Whats this?

A

Kimmelstiel-Wilson lesion = seen w/diabetic nephropathy – BM thicking due to non-enzymatic glycosylation causing hypoperfusion and loss of albumin

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15
Q

Churg-Strauss Syndrome best initial test? dx? tx?

A

Best initial test: CBC for eosinophilia count, MPO-ANCA dx: bx tx: Glucocorticoids, if no response add cyclophosphamide

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16
Q

What is Calciphylaxis?

A

type of extraskeletal calcification = calcification of blood vessels and skin vessels clotting and necrosis. See with ESRD, hyperparathyroidism, milk-alkali syndrome tx by increasing dialysis and normalizing Ca lvls

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17
Q

Hypomagnesia always presents with hypo—- & cardiac arrhythmias.

A

hypocalcemia

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18
Q

How do you treat rhabdomyolysis?

A

Bolus NS, mannitol diuresis(decrease contact time of myoblin with tubule) & Alkalinization of urine to help precipitate myoglobin + EKG(hyperkalemia induced arrhythmia)

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19
Q

Why do you get elevation of BUN with prerenal azotemia? (i want mechanism)

A

low volume = increased ADH –> ADH increases urea transport activity =D

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20
Q

Henoch-Schonlein Purpura sx?

A
  • Raised, nontender, purpuric skin lesions(particularly on buttocks) - abdominal pain - possible bleeding - joint pain - renal involvment **seen in a kid
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21
Q

What type of casts would you see with Acute tubular necrosis(ATN)?

A

“muddy brown” or granular

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22
Q

What is the mechanism of contrast induced renal failure?

A

Contrast is directly toxic to the kidney tubule and causes vasoconstriction of the afferent arteriole. ==> decreased perfusion = rapid increase in Cr & decreased in urine Na.

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23
Q

What is associated with Focal Segmental Glomerulonephritis(FSGN)?

A

HIV, heroine use, more common in african americans

*scarring of the podocytes w/effacement causing decreased filtration

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24
Q

Causes of non anion gap metabolic acidosis: HARDASS

A

Hyperalimentation

Addisons disease

RTA- kidneys not removing acid properly

Diarrhea - loss of bicarb

Acetazolamide - loss of bicarb

Spironolactone

Saline infusion - elevated Cl causes Cl & bicarb to be eliminated in the urine

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25
Q

What is Allergic/Acute Interstitial Nephritis(AIN)?

A

Hypersensitivity reaction to medications. Look for UA with WBCs, fever and rash. *use Wright Stain or Hansel Stain of the urine to detect eosinophils.

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26
Q

Central DI sx? tx? What will giving DDAVP do?

A

sx: low urine osmolality, low urine sodium, increased urine volume + NO CHANGE IN URINE OSMOLALITY WITH WATER DEPRIVATION. Giving DDAVP: decrease in urine vol, increase urine osmolality. tx: Give DDAVP or vasopressin

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27
Q

RTA type 2

whats the defect? causes?

tx?

A

proximal defect in bicarb reabsorption – caused by MM, amyloidosis, fanconi syndrome, aminoglycosides, ifosfamide, cisplatin & acetazolamide

tx: tx cause & replace whats missin

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28
Q

Goodpastures Syndrome sx?

A

cough, hemoptysis, SOB, lung shit

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29
Q

Addisons Disease cause? electrolyte sx? tx?

A

hyponatremia due to insufficient aldosterone production. sx: hyponatremia, hyperkalemia, mild metabolic acidosis tx: alosterone replacement(fludrocortisone)

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30
Q

Evaluation of Hyponatremia:

Serum Na <290, patient is hypovolemic with a UNa>20

A
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31
Q

Evaluation of Hyponatremia:

Serum Na <290, patient is hypervolemic with a UNa>20

A
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32
Q

Hemolytic Uremic Syndrome(HUS) sx? tx?

A

HUS = ART *anemia(intravasular hemolysis) *renal probs(elevated Cr) *Thrombocytopenia tx with plasmapheresis in severe cases. **DO NOT GIVE ABX as they may worsen

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33
Q

Treatment of Mild, Moderate & chronic SIADH?

A

mild: fluid restriction Mod: NA, loops, ADH blockers(conivaptan, tolvaptan) *do not correct Na more than 10-12 mEq/L in the first 24 hr Severe: Demeclocycline to block ADH on kidney.

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34
Q

What is Nephrogenic Systemic Fibrosis? When would you see this?

A

skin fibrosis in response to the MRI contrast agent Gadolinium in patients with ESRD or severely low GFR (<30). Proliferation of dermal fibrocytes, leading to hardened areas of fibrotic nodules developing in the skin and in some cases joint and skin contractions.

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35
Q

What is Rhabdomyolysis? What do you see with kidneys?

A

large-volume muscular necrosis –> Myoglobin from muscles is toxic to kidney tubules = UA with blood, Elevated Urine myoglobin, elevated CPK level, increased K & decreased Ca.

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36
Q

What type of casts will you see with prerenal azotemia?

A

Hyaline Casts

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37
Q

What are some causes of Postrenal Azotemia?

A

Stone in bladder or ureters, bilateral strictures, cancer of the bladder, prostate cancer, cervical cancer or neurogenic bladder

38
Q

Which type of hypernatremia is diabetes insipidus?

A
39
Q

Cryoglobulinemia best initial test? most accurate?

A

initial: serum cryoglobin component leves, compliment levels low (especially C4) most accurate: bx

40
Q

Pt with a UA showing envelope-shaped oxalate crystals. What did this person do? How do you tx them?

A

prob suicide by ingestion of antifreeze(ethylene glycol). Treat with Ethanol or Fomepizole + immediate dialysis

41
Q

Polyarteritis Nodosa(PAN) sx?

A

sx: SYSTEMIC vasculitis involving EVERY ORGAN EXCEPT lungs. (myalgias, GI bleed + ab pain, purpuric skin lesions, stroke, renal shit, uveitis, neuropathy) *multiple nonspecific findings + fever and weight loss with multiple motor and sensory neuropathy with pain = dx key!

42
Q

Post-streptococcal Glomerulonephritis(PSGN) sx?

A

recent illness followed by “tea/cola colored” urine, periorbital edema, HTN.

43
Q

List some causes of Hyperkalemia

A

*metabolic acidosis from transcellular shift out of cells *adrenal aldosterone deficiency(addisons disease) *BB *digoxin tox *insulin deficiency (DKA) *diuretics(spironolactone) *ACEi, ARBs *prolonged immobility, seizures, Rhabdomyolysis, or crush injury *T4 RTA *renal failure preventing K secretion

44
Q

Nephrogenic DI sx? tx? What will giving DDAVP do?

A

sx: low urine osmolality, low urine sodium, increased urine volume + NO CHANGE IN URINE OSMOLALITY WITH WATER DEPRIVATION. Giving DDAVP: no change in urine volume, no change in urine osmolality. tx: correct underlying cause such as hypokalemia, hypercalcemia & in the meantime use TZD.

45
Q

causes of metabolic acidosis

A

MUDPILES: methanol, uremia, DKA, Paracetamol, INH, Lactic Acidosis, Ethylene Glycol, ASA

46
Q

When correcting hyponatremic you should correct no more than — mEq/L/hr and a goal increase of no more than — mEq/L per day.

A

When correcting hyponatremic you should correct no more than 0.5 mEq/L/hr and a goal increase of no more than 8-10 mEq/L per day.

47
Q

What will you see on a EKG for hypokalemia?

A

U-waves = extra wave after the T wave

48
Q

RTA type 1

whats the defect? causes?

tx?

A

distal tubular defect in H excreation caused by AI disorders, hypercalcinuria, amphotericin B, ifosfamide or genetic

TX: K-bicarb supplementation

*often get kidney stones

49
Q

IgA Nephropathy tx?

A

no proven effective therapy! - give steroids for worsening proteinuria - ACEi - Fish oil MAY delay progression

50
Q

Effects of hyperkalemia on EKG

A

1st peaked Twaves then loss of P waves then widened QRS

51
Q

What blood stuff would you see with a cholesterol embolism?

A

on skin = livedo reticularis blood = low C3 &C4 + eosinophilia

52
Q

tx of severe hyperkalemia(you have EKG abnormalities)

A

Ca-gluconate IV to protect the heart, insulin + glucose IV & kayexalate

53
Q

What is Acute Tubular Necrosis(ATN)?

A

death of the tubular cells of the kidney due to either hypoperfusion or various toxic injuries to the kidney(aminoglycosides, amphotericin, chemo, contrast)

54
Q

Evaluation of Hyponatremia:

Serum Na <290, patient is euvolemic with a UNa>20, UOsm<100

A
55
Q

Churg-Strauss Syndrome sx? whats another name for this?

A

(aka Eosinophilic Granulomatosis with Polyangiitis) sx: asthma, cough, eosinophilia + renal abnormalities

56
Q

Thrombotic Thrombocytopenic Purpura(TTP) sx? tx?

A

TTP = FAT RN *fever *anemia(intravasular hemolysis) *Thrombocytopenia *renal probs(elevated Cr) *Neurological abnormalities tx with plasmapheresis in severe cases. steroids

57
Q

Wegeners Granulomatosis with Polyangiitis best initial test? dx? tx?

A

initial: C-ANCA or anti-proteinase 3-ANCA dx: bx tx: cyclophosphamide + steroids

58
Q

Cryoglobulinemia sx?

A

hx of hepatitis C with renal involvement, joint pain, purpuric skin lesions + low compliment & cryoglobins(igm)

59
Q

Pt has AIN for >48hrs. What do you do?

A

give them steroids

60
Q

Henoch-Schonlein Purpura best initial test? dx?

A

initial: physical exam! dx: bx showing IgA deposits but it is not necessary to make dx

61
Q

Microscopic Polyangiitis sx? dx? tx?

A

necrotizing vasculitis w/o granulomas

sx: lung + renal vasculitis, no eosinophils or asthma. just lung and kidneys
dx: NO GRANULOMAS on bx, MPO-ANCA present,
tx: steroids + cyclophosphamides

62
Q

Pt with UA showing uric acid crystals. Whats the most common cause of this? How do you treat?

A

MCC = tumor lysis syndrome due to chemotherapy(often for lymphoma). tx: hydration, allopurinol & rasburicase(breaks down uric acid)

63
Q

kidney stones

A

5mm

64
Q

PSGN vs IgA nephropathy

differences…

A

PSGN = 3 weeks after URI or skin infection, ASO+, low C3

IgA = normal compliment & 1-2 days after URI or GI infection

65
Q

Under what circumstances is dialysis essential?

A

hyperkalemia, metabolic acidosis, uremia with encephalopathy, fluid overload, uremia with pericarditis, drug intoxication that requires dialysis(lithium, ethylene glycol, ASA), uremia induced malnutrition

66
Q

Goodpastures Syndrome Best initial test? dx? tx?

A

best initial: Anti-basement membrane Abs

Most accurate: bx = crescentic glomerulonephritis

Tx: plasmapheresis + steroids

67
Q

4 main blood symptoms of uremia & how to treat them

A
  1. hyperphosphatemia: Ca-acetate, Ca-carbonate phosphate binders 2. hypermagnesemia: restrict intake 3. Anemia: EPO 4. Hypocalcemia: Vita D replacment
68
Q

Nephrotic Syndrome sx?

A

Hyperproteinuria, hypoprotemia, hyperlipidemia(lipoprotein lost in urine = not available to uptake LDL & VLDL), Edema, Thrombosis(due ot loss of antithrombin 3, PC & PS)

69
Q

Evaluation of Hyponatremia:

Serum Na <290, patient is euvolemic with a UNa>20, UOsm>100

ddx?

A
70
Q

How do BB cause hyperkalemia?

A

Normal Na/K ATPase lowers blood K. BB decrease the activity of the Na/K ATPase, causing K levels to increase.

71
Q

Urine sodium with intrarenal failure? high or low?

A

high >40

72
Q

4 common causes of euvolemic hyponatremia?

A

SIADH, hypothyroidism, psychogenic polydipsia, hyperglycemia

73
Q

In what age group do u see minimal change diseaese? treatment?

A

children <10 MC, treat w/steroids > cyclohosphamide

74
Q

What is Prerenal Azotemia? What are some causes?

A

hypoperfusion of the kidneys leading to failure. May be due to: hypotension, Hypovolemia, Low oncotic pressure, CHF, Constrictive Pericarditis, Renal Artery Stenosis

75
Q

Post-streptococcal Glomerulonephritis(PSGN) tx?

A

Penicillin for infection, control HTN and fluid overload with diuretics

76
Q

Henoch-Schonlein Purpura tx?

A

no specific tx = will resolve on its own! *give steroids if proteinuria worsens with the use of ACEi

77
Q

Alport Syndrome sx? dx? tx?

A

sx: congenital problem with eye and ear + deafness & renal failure in 2nd decade of life. no dx & no specific tx

78
Q

Hypermagnesemia sx? tx

A

sx: muscular weakness, loss of DTRs tx: restrict intake, NS to promote diuresis +/- dialysis depending on severity

79
Q

What is associated with membranous nephropathy? What deposits and where?

A

adults, cancer(especially lymphoma), HBV

*Antibody-immune complex deposition resulting in compliment driven podocyte injury = spike & dome

80
Q

What is associated with Membranoproliferative glomerulonephritis? Where and what are the deposits?

A

hepatitis C, SLE & decrease in C3/C4

*Immune-complex and/or complement protein deposition in the mesangium and subendothelium of the capillaries = Tram track

81
Q

Causes of Anion gap metabolic acidosis: MUDPILES

A

Methanol

Uremia

DKA

Propylene glycol

Iron or INH

Lactic acidosis

Ethylene glycol/oxalic acid

Salicylates(late)

82
Q

What is the mechanism of hypocalcemia with rhabdomyolysis?

A

damaged muscle releases SERCA. SERCA takes up Ca lowering the blood level of Ca.

83
Q

tx of moderate hyperkalemia(no EKG abnormalities)

A

insulin +glucose, Bicarb to shift K into cells when acidosis is the cause, Kayexalate PO.

84
Q

Hyperglycemia causes an _____ drop in Na by ___ for each ___ points of glucose.

A

ARTIFICAL, 1.6, 100

85
Q

Wegeners Granulomatosis with Polyangiitis sx?

A

“C-disease” Upper respiratory problems(sinusitis, otitis), lung problems(cough, hemoptysis, abnormal CXR), Systemic vasculitis(joint, skin, brain, GI probs) + renal involvement

86
Q

How do NSAIDs cause kidney damage?

A

*directly toxic and cause papillary necrosis *Allergic Interstitial nephritis = WBC + eosinophilia *Nephrotic Syndrome *afferent arteriolar vasoconstriction & decreased perfusion to the glomerulus = worsening renal function

87
Q

Post-streptococcal Glomerulonephritis(PSGN) best initial test? dx?

A

initial: Anti-streptyolysin O, anti-DNase, Anti-hyaluronidase & low compliment lvls dx: bx! but not done routinely bc blood test are often sufficient. bx would show IgG depo + C3

88
Q

Electrolyte abnormalities with SIADH

A

high urine Na(>20), High urine Osm(>100), Low serum Osm(<290), Low serum uric acid, normal BUN, normal Cr, normal Bicarb

89
Q

Evaluation of Hyponatremia:

Serum Na <290, patient is hypovolemic with a UNa<20

A
90
Q

Cryoglobulinemia tx?

A

tx: treat hep C + rituximab

91
Q

3 common causes of hypovolemic hyponatremia? tx?

A

Diuretics(elevated urine Na), GI loss of fluids/vomiting/diarrhea(low urine Na), Skin loss of fluids/burns/sweating(low urine Na) tx: correct cause and replace with NS

Step 3 UW /FA (19 decks)

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