Nephrology/Urology Flashcards

(114 cards)

1
Q

What test can be done to evaluate urine dipstick + for blood with UA with no RBCs?

A

Urine ammonium sulfate test

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2
Q

Is FeNa > 1 or < 1 in prerenal azotemia and AGN?

A

<1

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3
Q

What does alkalemia do to calcium?

A

Increases bound calcium therefore decreases ionized calcium leading to hypocalcemia

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4
Q

What is normal osmolality?

A

285 +/- 10

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5
Q

What is the formula to calculate osmolality?

A

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

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6
Q

What are the two ways ADH levels are regulated?

A

1) Osmoreceptors in the hypothalamus

2) Volume (stretch) receptors in the LA and blood vessels

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7
Q

What are the three categories of hyponatremia?

A

Hypoosmolar
Hyperosmolar
Isoosmolar

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8
Q

What are the three categories of hypoosmolar hyponatremia?

A

Hypovolemic
Euvolemic
Hypervolemic

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9
Q

What is the common etiology of euvolemic hyponatremia?

A

SIADH or thiazide diuretics

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10
Q

If a patient is hyponatremic, what would a urine Osm of > 250 represent as an etiology?

A

SIADH

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11
Q

If a patient is hyponatremic, what would a urine Osm of <200 represent as an etiology?

A

Psychogenic polydipsia

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12
Q

How does hypothyroidism affect ADH release?

A

Decreased cardiac output –> carotid baroreceptors

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13
Q

What is the max rate of hyponatremia correction over 24 hours? What is the risk?

A

10meq/L over 24 hours maximum, 0.5meq/L per hour

Concern for osmotic demyelination syndrome

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14
Q

What electrolyte abnormalities may induce nephrogenic DI?

A

Hypercalcemia

Chronic Hypokalemia

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15
Q

What common medication can cause nephrogenic DI?

A

Lithium

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16
Q

What is the test to differentiate between central and nephrogenic DI?

A

Water restriction test

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17
Q

What is the treatment of mild cases of central DI?

A

Thiazides
Salt restriction
Can give desmopressin in resistant cases

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18
Q

What is the treatment of nephrogenic DI?

A

Thiazide diuretics or amiloride

Sodium restriction

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19
Q

What is the typical volume status of a patient with DI?

A

Euvolemic

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20
Q

What is the effect of renin on aldosterone release?

A

Increases aldosterone release

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21
Q

What is the effect of spironolactone on aldosterone release?

A

Blocks aldosterone receptor

Increase K+

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22
Q

What is the effect of Trimethoprim on K+ levels?

A

Causes hyperkalemia due to interference in distal tubule and collecting duct

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23
Q

Which type of RTA is associated with hyperkalemia?

A

Type 4

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24
Q

What impact do the syndromes Liddle’s, Barters and Gitelman’s have on potassium levels?

A

Cause hypokalemia

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25
What are the three medicationss typically used to shift K+ into cells?
Insulin with glucose Sodium bicarb Albuterol
26
Which other electrolyte should always be replenished in hypokalemia?
Magnesium
27
What is the primary defect in Liddle's syndrome?
Upregulation of Na+ channel --> primary Na+ retention | Leads to decreased renin and aldosterone levels
28
What are renin and aldosterone levels like in Barters and Gittelman's syndrome?
Elevated due to sodium losses --> volume contraction --> elevated renin/aldosterone levels
29
Which kidney syndrome is often associated with hypercalciuria and nephrocalcinosis?
Bartter type 4
30
Where is the defect in Bartter syndrome?
Thick ascending loop of Henle
31
Where is the defect in Gitelman syndrome?
Na/Cl cotransporter in early distal tubule
32
Which diuretics to Bartter and Gitelman mimic?
Bartter --> loop diuretics | Gitelman --> Thiazide
33
What is the typical presentation of Gitelman's?
muscle spasms and weakness due to hypomagnesemia
34
T/F: Gitelman's and Barrter's both often cause hypertension
False
35
What are the magnesium findings in Gitelman's and Barrters?
Gitelman's --> Hypomagnesemia | Bartter's --> normal Mg
36
What study can be used to differentiate between diarrhea and RTA as an etiology of hypokalemia?
UAG | + in RTA, - in diarrhea (neGUTive)
37
What magnesium levels can lead to hypocalcemia?
Hypermagnesemia
38
What is the calculation of UAG?
Na+ - K+ - Cl-
39
What is the likely etiology of HAGMA with calcium oxalate crystals?
Ethylene glycol
40
What is the likely etiology of HAGMA with visual symptoms?
Methanol
41
What toxicity would one be worried about with long infusions of lorazepam?
Propylene glycol
42
What is the standard of care for toxicity with methanol or ethylene glycol?
Fomepizole and dialysis
43
What is the treatment of salicylate poisoning?
sodium bicarbonate
44
Why do most diuretics cause K+ wasting?
Inhibit Na+ reabsorption in the PCT leading to increased na+ reabsorption in the DT and increased K+ excretion
45
What is the difference of thiazides and loop diuretics on Ca excretion?
Loop diuretics increase Ca excretion | Thiazides decrease Ca excretion
46
Which type of RTA has alkaline urine?
Type 1 RTA
47
Which type of RTA has hyperkalemia?
Type 4 RTA
48
Which type of RTA can be caused by Fanconi syndrome?
Type 2 RTA
49
Which type of RTA is often associated with nephrocalcinosis?
Type 1
50
Which type of RTA may be caused by ingestion of amphotericin ?
Type 1
51
How soon after diagnosis of T1DM should albuminuria be screened for?
5 years
52
T/F: antibiotic therapy in strep infection can prevent PSGN
False | Abx CAN preven rheumatic fever
53
What is the typical latency period between acute strep infection and PSGN?
1-2 weeks
54
Is the C3 level typically low, normal or high in PSGN?
Low
55
What is the typical latency period between an infection and IgA nephropathy?
often concomitant with infection or a few days
56
Are C3 levels low, normal or high in IgA nephropathy?
Normal
57
On renal biopsy, what does HSP look identical to?
IgA nephropathy
58
What are C3 and C4 levels typically in MPGN?
Low
59
What is the anti-GBM disease with renal and pulmonary findings?
Goodpasture syndrome
60
What is found on renal biopsy of anti-GBM disease?
linear deposits of IgG and C3 in the GBM
61
What is the main therapy of Goodpasture syndrome?
Plasmapheresis
62
What is the most common presentation of SLE in children?
Nephritis
63
What are the 3 types of ANCA-associated focal necrotizing glomerulonephritis?
- Eosinophilic granulomatosis w/ polyangiitis - Granulomatosis w/ polyangiitis (Wegener granulomatosis) - Microscopic polyangiitis/polyarteriitis
64
What does a positive c-ANCE and anti-PR3 Ab indicate?
Wegener granulomatosis (Granulomatosis w/ polyangiitis)
65
What is the main difference between microscopic polyangiitis and granulomatosis w/ polyangiitis?
There is no granulomatous disease of the lungs with microscopic polyangiitis
66
c-ANCA and p-ANCA are often positive in what disease?
microscopic polyangiitis
67
What is the most common organism to cause infection in those with nephrotic syndroms?
Strep. pneumo
68
What is an important vaccine to give those with nephrotic syndrome?
Pneumococcal vaccine
69
Where are the two most common sites of thrombotic disease in nephrotic syndrome?
Renal vein | Sagittal sinus thrombosis
70
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
71
If nephrotic syndrome also presents with hypertension what is the more likely etiology?
FSGS
72
What is the most common diarrheal illness that precedes HUS?
E. coli O157:H7 producing Shiga-like toxin
73
What is the classic triad of HUS?
Thrombocytopenia Microangiopathic hemolytic anemia Acute renal failure
74
What is often seen on peripheral smear of HUS?
``` Burr cells (microangiopathy) Schistocytes and fragmented RBCs ```
75
T/F: Antibiotics should be used for EHEC causing HUS
False- antibiotics are contraindicated
76
What is the X-linked syndrome with microhematuria, sensorineural deafness and ocular defects?
Alport syndrome
77
What is the genetic transmission of thin basement membrane nephropathy?
Autosomal dominant
78
Which syndrome presents with infant onset nephrotic syndrome?
Denys-Drash syndrome
79
What are Denys-Drash syndrome patients at high risk for?
Ambiguous genitalia and Wilms tumor
80
What is the deficiency found in Fabry disease?
alpha-galactosidasse A
81
What is the gene involved with ARPKD?
PKHD1--> encodes fibrocystin
82
What is the common liver finding in ARPKD?
hepatic fibrosis
83
What is typically found on US for ARPKD?
Oligohydramnios leading to potter facies
84
What is Caroli disease? What renal disease can cause it?
Dilation of biliary tree --> caused by hepatic fibrosis in ARPKD
85
How to NSAIDs cause prerenal AKI?
Inhibit prostaglandins which typically are responsible for vasodilation
86
What would be the possible etiology of prerenal AKI if it developed following the initiation of ACEI?
Renal artery stenosis (fibromuscular dysplasia)
87
Why is the BUN:Cr ratio elevated in postrenal AKI?
urea diffuses back into the system
88
What is the most common cause of AKI?
ATN
89
What type of RTA does amphotericin cause?
Type 1
90
What is the effect of cisplatin on magnesium levels?
Magnesium in the urine, therefore hypomagnesemia
91
What renal syndrome does Mitomycin C cause?
HUS
92
T/F: AIN is directly proportional to the antitbiotic dose and duration
False
93
What is the most common cause of death in dialysis patients?
Cardiovascular disease
94
What is the treatment of choice for end stage renal disease in children?
Kidney transplant
95
What two medications are known to hypertrophy the gum?
Phenytoin | Cyclosporine
96
What is the most significant side effect of azathioprine?
Leukopenia
97
What is the main side effect of sirolimus?
Hyperlipidemia
98
What is the effect of maternal anti-SSA/SSB antibodies on the fetus during pregnancy?
Neonatal heart block
99
What type of kidney stones are common with Type 1 RTA? Why?
Calcium phosphate due to calciuria
100
Which type of stone if often associated with infection?
Struvite
101
What medication is given for uric acid stones?
Allopurinol
102
What are the two types of stones where alkalinization of the urine does not help?
Struvite | Calcium phosphate
103
What is the most common cause of hydronephrosis in children?
UPJ obstruction
104
What syndrome consists of abdominal muscle deficiency, cryptorchidism, dilation of prostastic urethra & bladder?
Prune belly syndrome
105
Is further imaging required for hypospadias?
No
106
What is the ventral curvature of the penis called?
Chordee
107
What is the most common cause of priapism?
Sickle cell disease
108
What is the likely diagnosis of a swollen, discolored hemiscrotum in a neonate?
Neonatal testicular torsion
109
What is the blue dot sign on a boy's testicle?
Blue nodule on top of testicle due to testicular appendage torsion. Resolves spontaneously.
110
What is the treatment of retractile testes?
NTD, eventually end up in the scrotum
111
When is referral appropriate for cryptorchidism?
after 6 months of age | Orchiopexy completed between 6-18 months
112
What is the common etiology of orchitis?
Viral mumps
113
When do hydroceles require surgical repair?
If they last past 1 year of life
114
Which side do varicoceles typically occur on? What age usually?
Usually adolescents | On left side