Renal Flashcards
Why are patients with chronic pancreatitis at increased risk of calcium oxalate stones?
Diarrhea –> volume depletion which increased quantity of calcium and oxalate in urine. Often have a metabolic acidosis which decreases urinary citrate. In fat malabsorption, calcium binds fat instead of oxalate leaving oxalate to precipitate in the urine.
Secondary causes membranous glomerulopathy
Hep B, Hep C, lupus, syphilis, about 25% of patients older than 65 will have a malignancy diagnosed within 1 year of diagnosis of membranous glomerulopathy. So all should undergo age appropriate screening at diagnosis.
When to immunosuppress in membranous glomerulopathy?
Need to rule out secondary causes. Then should wait at least 3-6months post initial diagnosis as up to 1/3 of patients have spontaneous remission
Heparin and hyperkalemia?
Heparin use is associated with decreased aldosterone synthesis. This then leads to hyperkalemia. IT is more likely in patients iwth CKD, on diabetes, on ACEi or ARBs
Pyroglutamic acidosis
presents with mental status changes and an increased anion gap in patients on chronic acetaminophen. Susceptible with critical illness, poor nutrition, CKD or liver disease
Conditions with reset osmostat mild hyponatremia
pregnancy, quadriplegia, chronic malnutrition, advanced age, tuberculosis, and psychiatric disorders
Lab test for primary membranous glomerulopathy
anti-phospholipase A2 Receptor (PLA2R) approaches 100% specificity for primary form
Treatment for atherosclerotic renovascular disease
ARB/ACEi - studies have not shown benefit to angioplasty/stenting in patients with stable kidney function on optimized medication regimen. There is some benefit in patients who cannot tolerate ACEi/ARBs, patients with flash pulmonary edema and resistant HTN despite maximal HTN therapies
Type 1 RTA
distal acidification defect. low bicarb, compensatory elevated chloride (leading to normal AG). Unable to acidify urine (so pH >6) and an elevated urine AG. Also hypokalemic
Most common disease associated with type 1 RTA
Sjogren Syndrome
Type 2 RTA
proximal defect in reclaiming bicarb. Normal AG metabolic acidosis, hypokalemia, glycosuria (Without hyperglycemia), low molecular weight proteinuria and phosphate wasting. DISTAL acidification is intact, so pH <5.5
Type 4 RTA
Associated with aldosterone deficiency or resistance. Hyperkalemic and urine pH <5.5
Subnephrotic proteinuria with no clinical symptoms
Likely FSGS
Nephrotic syndrome with greatest risk for VTE
Membranous glomerulopathy
Main causes of distal RTA’s in adults
autoimmune diseases (Sjogren’s RA), drugs (amphotericin) or toxin ingestion (toluene)
Factors that increase the Cr without decreasing the GFR
Trimethoprim, cimetidine, ketone bodies, cefoxitin and flucytosine. Cr increase usuall 0.1-0.2mg/dL, but can be up to 0.5mg/dL
Treatment of salicylate poisoning
Supportive care, often intubation as salicylates act in medulla and cause marked increase in minute ventilation. Alkalinzation of the urine with IV bicarb which traps the ionic form of salicylic acid in tubular fluid and enhances renal elimiation. OK even though alkalemic from respiratory status. HD for AMS, pulmonary/cerebral edema, renal failure and salicylate level >100
Recommended IVFs in post-obstructive diureses
Aim for replacing about 50% of the urine output volume with 0.45 or 0.9% NS
Simple renal cysts features on US and management
Round, thin, smooth, regular border. No septa, calcifications or solid components. Posterior enhancement on US. no Contrast enhancement or CT/MRI. Reassurance is all that’s needed <1% malignancy risk
Complex renal cysts features on US and management
Few septa, calcifications. No contrast enhancement on CT/MRI. If less than 3 CM Category II and reassurance is all that’s needed. If >3 cm, repeat imaging in 6-12 months (5-10% malignancy risk)
Cystic Mass features on US and management
Thick, irregular wall. Mulitple thick septa, often with calcifications. Enhancement on CT/MRI. Surgical excision of mass or nephrectomy. 90% malignant risk
When do you refer to urology for evaluation of abnormal prostate testing?
Men with PSA >7 or abnormal DRE should be referred to urology for possible biopsy. If PSA 3-7, it should be repeated in a few weeks and referred to urology if remains >3
Treatemtn for scleroderma renal crisis
ACEi regardless of current Cr at time of diagnosis
Treatment to reduce recurrence of calcium oxalate stones
Increase free water fluid intake, decrease sodium and animal protein intake, increase dietary calcium intake (binds GI oxalate),
