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*Review TD 2020 > Nephrology + Urology > Flashcards

Nephrology + Urology Flashcards

1
Q

amount of Na and Cl in NS

A

154 mEql/L

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2
Q

Insensible Losses?

A

300-500 ml/m2/day

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3
Q

Anion Gap met acidosis DDX

A 
Methanol
Uremia
DKA/other ketoacidosis
Paraldehyde/paracetamol/acetaminophen
Iron/Isoniazid/IEM
Lactic acidosis
Ethanaol/ethylene glycol
Salicyclates/ASA
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4
Q

Marker of acid excretion in the urine

A

NH4+

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5
Q

Urinary anion gap - equation and what is it normally?

A

Na + K - Cl
should be negative
if not - urine is not being acidified

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6
Q

what is normal urine pH

A

~6.0

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7
Q

Types of RTA

A 
Type 1 - distal
= impaired H+ secretion
hypokalemia
hypercalciuria
renal stones

Type 2 - proximal (faconi - cystinosis)
=impaired bicarb reabsorption
hypokalemia

Type 4
= decreased aldosterone secretion/aldosterone resistance
HYPERkalemia

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8
Q

Type 2 RTA - main cause

A

cystinosis

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9
Q

Hypertension

- cutoffs for 1-13yo

A
  • elevated:
    >/= 90th % to < 95th %
    OR
    120/80 to < 95th %
- stage 1 htn:
>/= 95th % to < 95th % + 12
OR 
130/80 to 139/89
(whichever is lower)
  • stage 2 htn:
    >/= 95th % + 12
    OR
    >/= 140/90
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10
Q

Hypertension

- cutoffs for >13yo

A
  • elevated:
    120/<80 to 129/<80
  • stage 1 htn:
    130/80 to 139/89
  • stage 2 htn:
    >/= 140/90
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11
Q

what are BP cutoffs based on

A

sex
age
height

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12
Q

Mgmt: elevated BP

A

1) lifestyle
2) repeat BP in 6 mo
- if elevated at 6mo, do UE + LE BP, lifestyle, recheck in 6mo
- if elevated at 12mo, do ABPM + dx evaluation

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13
Q

Mgmt: Stage 1 htn

A

1) lifestyle
2) recheck in 1-2 weeks
- if stage 1 at 1-2w, do UE + LE BP, lifestyle, recheck in 3mo
- if stage 1 at 3mo, do ABPM + dx evaluation + start tx

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14
Q

Mgmt: Stage 2 htn

A

1) UE + LE BP + lifestyle
2) recheck within 1 week
- if stage 2 at recheck, do ABPM + dx evaluation + start tx

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15
Q

Diagnostic evaluation for elevated BP/htn

A 
U/A
BUN, Cr, lytes
Lipid Profile
Echo
Fundoscopy
Renal U/S if <6yo
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16
Q

medical treatment for hypertension

A

ACEi
ARB
CaCh blocker
thiazide

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17
Q

What type of htn when can you not play sports

A

stage 2

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18
Q

Hypertension

- most common cause

A

Babies: vascular (RAS, CoA, RVT, ARPCK)

<6yo: Renovascular

> 6yo: Essential

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19
Q

most common cause of Type 1 RTA

A

idiopathic

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20
Q

which type of RTA can have nephrocalcinosis

A

Distal/type 1

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21
Q

What type of RTA is Fanconi syndrome

A

Type 2

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22
Q

Investigations for End organ damage

A

1) Echo
2) Retinal examination
3) Albumin-to-creatinine ratio (1st AM)

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23
Q

Screening investigation for new dx of htn?

A

U/A
Chem: BUN, Cr, lytes
Lipid profile
Renal U/S if <6yo

if obese:
HbA1C (DM)
AST, ALT (NAFLD)
Fasting lipid panel

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24
Q

VCUG: what does it dx

A

Degree of VUR

PUV

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25
Q

best test for: PUV

A

VCUG

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26
Q

best test for: UPJ

A

MAG-3 lasix or DPTA lasix

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27
Q

best test for: renal scarring

A

DMSA scan

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28
Q

best test for: overall kidney funcion

A

GRF

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29
Q

UPJ obstruction: where is it

A

as ureter coming out of kidney

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30
Q

Multicystic dysplasic kidney

- describe both kidneys

A

NON functioning kidney (cysts - no renal tissue)
One solitary functioning kidney

15% will have contralateral VUR

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31
Q

Orthostatic proteinuria

  • how to dx
  • tx
A

Dx: 3 consecutive first AM urine pn: negative
normal serum albumin
(need to show

no tx

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32
Q

What can cause transient proteinuria

A

Exercise
Fever
Infecton

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33
Q

Nephrotic syndrome

  • age
  • characteristics
  • mgmt
A
  • Age 2-10 yo
  • Heavy proteinuria
  • Generalized edema
  • Hypoalbuminemia
  • Hypercholesterolemia

Normal BP and kidney fn
Can have hematuria
Normal C3
Actually decreased effective circulation

Mgmt

  • Steroids: prednisone 60mg/m2/day for 4-6 weeks and then wean
  • Edema: albumin/lasix
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34
Q

What is steroid resistant nephrotic syndrome

A

no response to steroids
or
relapse after 2 weeks

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35
Q

Nephrotic syndrome

complications

A

Infection
Hypercoagulable state/thrombosis
Hyperlipidemia
Fluid overload

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36
Q

Hematuria

- ddx

A

Hypercalciuria with nephrolithiasis
IgA nephropathy
PSGN
Exercise

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37
Q

Nephrotic dx

A

24 hour urine collection:
protein > 3.5g/day
>50mg/kg/day
>40mg/m2/hr

one time urine protein to creatinine
>200mg/mmol

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38
Q

Nephritic syndrome

  • dx
  • other features
A

DX:
gross hematuria
hypertension
RBC or granular casts

Common:
proteinuria
azotemia (incr BUN/Cr)
edema

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39
Q

IgA nephropathy
features
labs

A

young adults
microscopic hematuria
gross hematuria when sick

Normal C3 and C4
IgA increased in 50%

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40
Q

Low C3 ddx

A 
lupus
PSGN
MPGN
C3 glomerulopathy
shunt nephritis
endocarditis
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41
Q

renal mass newborn ddx

A

MCDK
Hydronephrosis
Renal vein thrombosis

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42
Q

PIGN

  • peak age
  • classic presentation
  • labs
A

5-15yo

presentation:
- gross hematuria
- edema
- hypertension
after GAS infection (cellulitis, pharyngitis)

low C3
normal C4
ANA negative
ASOT may be elevated

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43
Q

PIGN
when do the following resolve:

gross hematuria
proteinuria
low C3
microscopic hematuria

A

gross hematuria: 1-2 weeks
proteinuria: 1-2 weeks
low C3: 6-8 weeks
microscopic hematuria: up to 1 year

44
Q

HSP

  • other name
  • presentation
  • labs
  • prognosis
  • followup
A

Henoch-Schonlein Purpura
IgA vasculitis

joint + abdo pain
rash
renal involvement
(hypertension)

Normal C3
Elevated IgA
Microscopic hematuria, macroscopic hematuria
Albuminuria
Mixed nephritic-nephrotic syndrome (severe cases)
normal CBC and coats

Usually self limited
Monitor for 6 months w urine dipstick and ACR

45
Q

Hemolytic uremic syndrome

- triad

A
  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • renal insufficiency
46
Q

Alport syndrome

  • inheritance
  • clinical features
  • associations
A

X linked
(females can have mild)

  • microscopic hematuria
  • hypertension
  • proteinuria
  • renal failure by 2-3 decade
  • hearing loss
  • anterior lenticonus
47
Q

Prune belly syndrome

- triad

A

1) Abdo wall musculature partial/complete absence
2) B/L cryporchidism
3) urinary tract malformation (hydronephrosis/ureter, bladder distension, urinary tract obstruction, VUR)

48
Q

Chronic kidney disease

- stages

A

1: >90%
2: 60-90%
3: 30-60%
4: 15-30%
5: <15%

49
Q

Indications for dialysis

A

A: Acidosis
E: electrolytes anomalies:
(HYPERKALEMIA),Hyperphosphatemia
I: Intoxication: methanol,Ethylene glycol, ASA
O: fluid overlaod
U: uremia symptoms (encephalopathy, pericarditis, seizures, bleeding)

50
Q

First steps in mgmt of likely testicular torsion

A

NPO
Surgical consult

(don’t wait doing US if likely torsion)

51
Q

Ddx Torsion

A

—Testicular torsion
—Torsion of the appendix testis or appendix epididymis — Infectious epididymitis/epididymo-orchitis
Inguinal hernia

52
Q

Key features of testicular torsion

A
  • sudden severe pain
  • tender throughout testis
  • can be high riding
  • can be transverse lie
  • often absent cremasteric reflex
  • can have a recite hydrocele
53
Q

Nuclear cystogram

- what does it look for

A

VUR

not PUV

54
Q

What scan provides info on renal filtration function and drainage

A

MAG3 diuretic Renal Scan

55
Q

MAG3 diuretic Renal Scan

A

Provides info on filtration function & drainage from urinary collecting system

56
Q

DMSA Renal Scan

A

Only provides information on function

57
Q

Congenital Adrenal Hyperplasia

  • inheritance
  • most common type
A

Autosomal recessive

21-hydroxylase deficiency

58
Q

Role of hydrocortisone in CAH

A

to restore cortisol & suppress further virilization by providing negative feedback to the hypothalamus and pituitary gland

59
Q

What hormones do the testes excrete in sexual development

A

Sertoli: AMH
Leydig: testosterone

60
Q

3 potential anomalies for hypospadias

A
  1. Foreskin is incomplete ventrally
  2. Urethral meatus not at tip of penis
    • Ventral 􏰀proximal meatus􏰁
  3. Erections curve downward (AKA chordee)
61
Q

most common fetal anomaly

A

Congenital Hydronephrosis

62
Q

Antenatal hydronephrosis:

when to do ultrasound

A

3rd trimester APD

7-10mm: in first 3 months

> 15mm: in first 2 weeks

63
Q

Causes of high grade congenital hydronephrosis

A

High grade VUR
UPJO
UVJO
PUV

64
Q

UPJO presentation

A

Sig hydronephrosis without hydroureter

65
Q

PUV

  • where is abnormality
  • presentation
  • key sign on US
A 
bladder outlet obstruction
- Bilateral sig hydroureter and hydronephrosis in a Male
- 
distended thick walled bladder
*key hole sign
66
Q

VUR

A

sig hydroureter and hydronephrosis

67
Q

First line investigation for kidney stones

A

Renal bladder ultrasound

second line: CT

68
Q

Kidney stones: mgmt

A

Analgesics +/- α blockers (tamsulosin)

69
Q

Hx calcium oxalate stones: how to prevent

A
  • Add lemon or orange juice to water
  • Increase fluid intake
  • Reduce sodium intake
70
Q

most common type of kidney stone

A

calcium oxalate

71
Q

Imaging for UTI

A

RBUS for first febrile UTI < 2yo

VCUG (or NC in female) for those w/ an abnormal RBUS or if have a 2nd febrile UTI

72
Q

When to refer to nephrologist or urologist for UTI

A

VUR IV-V or significantly abnormal RBUS findings

73
Q

acute tubular necrosis

  • secondary to
  • most common cause
  • presentation
  • recovery phase
A
  • secondary to hypoxic or nephrotoxic event
  • most common cause AKI
  • edema, elevated Cr/BUN and decreased UO
  • recovery phase: diuretic phase
74
Q

Pathophys of cerebral salt wasting

Clinical presentation

A

some kind of brain injury leads to renal Na wasting - > hyponatremia and volume depletion
and ADH turns on

hypovolemia
concentrated urine

75
Q

How to treat hyponatremia

A

if <120 and sx present, Treat with 3% saline until symptoms resolve

then
slow correction < 0.5mmol/l/hr or =10- 12mmol/day

76
Q

what lab to do to look for cystinosis

A

Leukocyte cysteine

77
Q

Investigation for older child w hydonephrosis

A

Nuclear scan with Lasix washout

78
Q

how to diagnose UPJO

A

Renal Diuretic scan – DTPA Lasix scan

79
Q

Diabetic nephropathy

  • dx
  • tx
A

First morning urine showing albumin:creatinine ratio (ACR) >2.5mg/mmol on two occasions

Treatment: ACE inhibitors

80
Q

Nephrotic syndrome

- treatment starting dose

A

60mg/m2 for 6 weeks (max 60mg)

then start to wean slowly

81
Q 
Nephritis table
low C3, renal limited
low C3, systemic
N C3, renal limited
N C3, systemic
A

low C3, renal limited: PIGN
low C3, systemic: SLE
N C3, renal limited: IgA nephropathy
N C3, systemic: HSP, Alports

82
Q

PIGN/PSGN

- mgmt

A
  • Fluid and salt restriction
  • Furosemide (1-2mg/kg/day)
  • Short-acting or long-acting antihypertensive medications: Nifedipine/Hydralazine or Amlodipine
  • AKI management - <1% will require dialysis
  • Antibiotics, if associated with GAS infection
83
Q

anti epileptic that causes bilateral renal calculi

A

topiramate

84
Q

MCKD - associations (3)

A
  • hypetension
  • contralateral VUR
  • Wilms
85
Q

Simple cyst - mgmt

A

follow

no investigations if simple

86
Q

Barter syndrome

A 
hypokalemia, 
alkalosis, 
hyperaldosteronism,
 polyuria, polydipsia, 
hypercalciuria and 
salt wasting

** like giving somone too much Lasix!!! (hypoK, met alkalosis, increased Ca in urine, polyuria)

87
Q

most common cause of microscopic hematuria

A

Hypercalciuria

88
Q

most common cause of gross hematuria

A

cystitis

89
Q

struvite stone - cause

A

UTIs caused by urease-splitting organisms

90
Q

how to diagnose Hypercalciuria

- initial investigates

A

24 hr urinary calcium excretion

Initial evaluation = urine culture, then spot urine for hypercalciuria with a calcium: creatinine ratio in culture-negative patients

91
Q

what vaccine to give to someone with nephrotic syndrome

A

23 valent pneumococcal
(at least 8 weeks after the last dose of the 13-valent pneumococcal conjugate vaccine)

should be >3 months off prednisone

92
Q

When to refer inguinal hernia

A

right away

93
Q

when to refer for undescended testes

A

by 6-9 months

won’t descend after 4 mo

94
Q

Protein on dip stick - false positive

A 
concentrate urine
exercise 
fever
gross hematuria
semen
95
Q

when is a renal cyst not simple

A

calcifications
loculations
septae
thickened walls

96
Q

hypertensive crisis - how to treat

A 
IV hydralizine bolus
IV Labetalol bolus or infusion
IV nicardipine infusion
IV Sodium Nitroprusside (venodilator)
IV Nicardipine (calcium channel blocker)
97
Q

How fast to correct Na

A

6-8 per day

98
Q

Potassium - what do you need in labs

A

Serum and urine K

Serum and urine osmolarity

99
Q

How to tell if aldosterone is working appropriately

A

TTKG
hypokalemia - expect TTKG <5
hyperkalemia - expect TTKG >8
- if this is not the case it means aldosterone is not working

100
Q

Hyperkalemia - EKG

A

Peaked T waves
Shortening of the QT

Prolonged PR
Widening of QRS

101
Q

Hematuria - dx

A

5 or more RBC per HPF in 3 consecutive samples

102
Q

False positive hematuria

A 
myogloburia, hembloginuria
drugs
toxins
food
urate crystals
103
Q

membranoproliferative GN

A

looks like PIGN initially
but C3 persists
and you may have elevated Cr

104
Q

benign familial hematuria

A

Autosomal dominant

microscopic hematuria, occasional gross
proteinuria and HTN unusual

FAMILIAL
(FHX)

105
Q

Definition of AKI

A

Acute decrease in GFR causing increase in serum Cr

*Review TD 2020 (16 decks)

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