R4 Flashcards
Calcefic uremic arteriophaty(calciohlaxis) CM?
Painful nodule or ulcer
Skin necrosis
Common in adiposity area like the trunk
Intact pheripherial pulse(unlike atherosclerosis-related one)
Soft tissue calcification on imaging
Biopsy: arterial calcification/occlusion and subintimal fibrosis.
Risk factor?
ESRD Hypercalcemia and hyperphosphatemia Hyperparathyroidism Obesity/DM warfarin(vitamin K increase synthesis of serum protein that prevents calcification)
Serum Magnesium and calciphylaxis?
magnesium prevent extracellularly Ca accumulation—so hypomagnesemia increase the risk
serum Glucose and ESRD?
ESRD decrease insulin clearance –recurrent hypoglycemia risk
the first thing to evaluate in the hyperkalemic patients?
Review medication
aldosterone level in case of persistent hyperkalemia
nuro-complication of hyperkalemia?
paraesthesia
paralysis
Hyperglycemia and hyperkalemia?
glucose > 300 is a risk for hyperkalemia
sign and symptom of Hypercalcemia?
Neuropsychiatric(confusion,stupor and comma)
GI distress
Muscle weakness
Nephrogenic DI–Excessive diuresis–Hypovoluma-AKI
Relation to lung ca?
SCLCa–PTH like peptide(hypercalcemia)
managment?
depend on serum Ca level and presence of a symptom
Serum ca> 14/presence of symptom?
Acute managment
Normal saline hydration plus calcitonin
Avoid loop diuretics unless fluid overloaded(HF)
Long term managment
Biposponate(zoledronic acide,pamidronate)
Moderate(12-14)?
No immediate managment required unless symptomatic
Treat similarly as sever calcimia
asymptomatic or Ca<12?
No immediate managment required
Avoid thiazide, lithium, volume depletion, and prolonged bed rest
Symptoms of hypocalcemia?
Confusion or memory loss. Muscle spasms. Numbness and tingling in the hands, feet, and face. Depression and hallucinations. Muscle cramps. Weak and brittle nails. Cramping Trousseau sign Chovestik sign
Effect of serum PH on Ca level?
H and Ca compet to bind to albumin
Affect the free ionized Ca
Acidosis–Low Ca bind to albumin–Hypercalcimia
Alkalosis–High ca bind to albumin–Hypocalcemia
Effect of serum PH on Po4 level?
Acidosis–Increase movement of PO4 to EC–Hyperphosphatemia
Alkalosis—decrease movement of PO4 to EC–Hypophosphatemia
A positive troussue sign is characterized by?
the appearance of a carpopedal spasm which involves flexion of the wrist, thumb, and MCP joints along with hyperextension of the IP joints.
The Chvostek sign?
a contraction of ipsilateral facial muscles subsequent to percussion over the facial nerve
Drug to be avoided in AKI?
Metformin_-pricipitate LA
ACEI/ARB–worsen AKI
High dose aspirin
GI loss and hypokalemia?
UGI(Vomiting)–metabolic alkalosis–renal K loss
LGI(Diarrhea)–Contain High K–direct K loss
Hypokalemia symptoms?
Muscle twitches. Muscle cramps or weakness. Muscles that will not move (paralysis) Abnormal heart rhythms. Kidney problems.
Serum potassium level in accelerated hematopoiesis?
Hypokalemia
clinical features of crystal-induced AKI?
Usually asymptomatic nausea/flank or abdominal pain AKI<7 days of exposure(usually 24-48 hr) Hematuria, Pyuria and crystal Increase risk in volume depletion and CKD
Risk factor?
Acyclovir(usually High dose IV) Sulphonamide Methotrexate Ethylene glycol Protease inhibitor Uric acid(TLS)
managment?
Drug discontinuation
Volume repletion
Loop diuretic
mechanism?
less water-soluble crystal–Precipitate in RT–tubular obstruction and direct toxicity
Cerebral aneurysm and ADPKD?
Increase by age(20% at age 60)
Polycystins protein(defected protein in ADPKD) defect also affect vascular integrity
The presence of HTN(Due to renal ischemia, increase renin secretion) facilitate aneurysm progression and risk of rapture.
How to D/T AKI from prerenal cause and ATN?
D/T mechanism
BUN/Cr ratio?
P–>20
ATN–10-15
Urine Na?
P–<20
ATN–>40
fractional Na excretion?
p–<1%
ATN>2%
urine osmolarity?
P–>500
ATN–<300
Urine specific gravity?
P–>1.020
ATN–<1.020
Microscopy?
P: bland
ATN–Muddy brown cast
Ca level and AKI?
AKI–Hyperphosphatemia–hypocalcemia
Except in the case of AKI due to MM–Hypercalcemia
Diabetic nephropathy feature?
Hypocalcemia
Shrunken kidney
Proteinuria
Mixed cryoglobulinemia CM?
Highley associated with Hep C(can be in HIV, HBV)
Palpable purpura in lower extremity
Pheripherial neuropathy
Liver involvement(hepatomegaly and Increase TA)
Arthralgia
Systemic symptoms
Glomerulonephritis
pathogenesis?
vasculitis characterized by IC deposition in small and medium sized vessels
Diagnosis?
Cryoglobulins(Imunoglobuline precipitate in cold To)
Contain rheumatoid factor and polyclonal IgG
biopsy: Small vessel leukocytoclastic vasculitis
Therapy?
Treat underlying cause
another disease that causes arthralgia, glomerulonephritis, and hypocomplementimia?
SLE(but common in young women, malar/discoid non-palpable rash and ANA positive)
Another disease that can cause leukocytoclastic vasculitis?
Microscopic polyangiitis(but normal complement and Panca +)
urge incontinence symptoms?
sudden, overwhelming, and frequent need to void
managment?
Lifstyle4 modification
Bladder training
Antimuscarinic drug
a renal complication of cyanide toxicity?
Metabolic acidosis
AKI
contrast-induced nephropathy risk factor?
Age >75
CKD
Reduced renal perfusion(e.g hypotension)
High contrast load
Clinical manifestation?
an acute rise in creatinine 24-48 hr
gradual return to baseline
pathogenesis?
ATN(muddy brown cast)
Renal vasoconstriction cause prerenal azotemia
Prevention?
Periprocedural normal saline
Use lower amount contrast
Hold NSAID
Why does a patient with nephrotic syndrome have a risk of MI and stroke?
Hyperlipidemia(TG and cholesterol)–atherosclerosis risk
hypercoagulability state
CM of Addison disease?
Hyperkalemia metabolic acidosis Hyponatremia(secondary to SIADH for hypovolumia) hypoglycemia eosinophilia
