onlinemeded-nephrology Flashcards
tests to r/o AKI etiologies: pre-renal vs post-renal vs intrarenal
pre: Urine lytes
post: Renal U/S, CT
intra: UA, bx
cut offs for CKD stages
1: >90
2: 60-89
3: 30-59
4: 15-29
5: <15
at what stage of CKD do you start to have sxs?
stage III
at what stage do you start preparing for HD with AV fistula/vein mapping
stage IV to have HD by V
HD vs PD
HD: 3x/week, 4 hours, need prep
PD: qnightly when sleeping, 6-8 hours, cheaper
complications of CKD
anemia
secondary hyperparathyroidism/ mineral bone dz
volume overload
metabolic acidosis
what can you take to prevent secondary hyperparathyroidism in CKD?
sevelamer- phos binder- dec P –> dec PTH
cinacelet- calcimimetic- inc C –> dec PTH
treatment for mild, mod, severe hypernatremia
mild: po H20
mod: NS
severe: D5W
treatment of mild, mod, severe hyponatremia
mild: dz specific (depends on vol status)
mod: NS
severe: 3% saline
hypertonic hyponatremia- think..
DM
causes of euvolemic hyponatremia
RTA
Addison’s
Thyroid
SIADH
causes of hyperkalemia
Low aldosterone- ACEI/ARB
Ingestion and CKD
ESRD
Iatrogenic
Artifact in lab- hemolysis
hyperkalemia on EKG
peak T waves
wide QRS
manage hyperkalemia
calcium gluconate- if EKG changes
Shift K into cells: Insulin + D50; Na bicarb; beta agonists
Reduce body K: loop diuretics, kayexelate, dialysis
hypokalemia etiologies
GI losses (diarrhea, vomiting)
Renal losses ( hyperaldosterinism, diuretics, barter/gitelman)
best way to replete K
po>IV
peripheral IV<10mEq/hr
Central IV<20 mEq/hr
give 10 mEq for every 0.1 increase
if refractory –> check Mg
best imaging for kidney stones
non contrast CT
- unless pregnant- US
treatment of kidney stones based on size
<5 mm: IVF, pain meds
in between: lithotripsy
> 3 cm: surgery (proximal LAP vs distal PAN)
which kidney stones opaque and which lucent
opaque: calcium ox, struvite
lucent: cystine, uric acid
complex cysts dx
UA, CT
complex cyst vs RCC- which has biopsy?
complex cyst- NOT RCC
extra-renal of ADPKD
berry aneurysm
pancreatitis
liver dz
for metabolic alkalosis, what to order and how to interpret
urine chloride
if <10: volume responsive (etiologies: diuretic, dehdyration, emesis)
>10: not vol responsive - measure HTN (if hypertensive- hyperaldo; if not barters, gitelmans)
if labs show low Ca and low albumin, what should you do?
Calcium can correct itself to normal ranges? come backt o this
