Renal Flashcards
What is the mechanism of action of loop diuretics?
Inhibition of Na-K-2Cl cotransporter in the loop of henle. Side effects are hypokalemia, metabolic alkalosis, volume contraction
What are the findings in SIADH?
Hypotonic Euvolemic status
Hyponatremia, Normal K and acid base status; Serum osmolality is <275 mosm/kg/h2O; urine osmolality is >100 mosm/kg/h2O; Urine Na >40 meq/L
What is the treatment for SIADH?
Fluid restriction and salt tabs; for severe hyponatremia it is hypertonic (3%) saline
How beta adrenergic agonist cause hypokalemia?
Beta adrenergic agonists such as epinephrine stimulate Na/K Atpase pumps to drive K intracellularly.
What are the most common causes of hyperkalemia?
Disorders or medications that disrupt RAAS axis. Chronic Kidney Disease, Meds such as NSAIDS, ACEi, ARBs, K sparing diuretics,
What are different types of renal tubular acidosis?
Type 1 RTA is due to impaired H+ excretion by alpha intercalated cells in the distal tubule. Hypokalemia is present and urine pH >5.5’
Type 2 RTA is due impaired HCO3- reabsorption in the proximal tubule, Urine pH <5.5;
Type 4 RTA is due to reduced aldosterone activity leading to impaired excretion of H+ and K in the collecting duct. Hyperkalemia and urine pH <5.5
What is the diagnostic criteria for hepatorenal syndrome?
Renal hypoperfusion, Absence of tubular injury, absence of RBC, proteinuria, casts, No improvement with fluid resuscitation
What are the examples of splanchnic vasoconstrictors?
midodrine, octreotide, norepinephrine
What are some of the different types of casts found in renal dysfunction?
Muddy brown casts in ATN; RBC casts in glomerulonephritis; WBC casts in interstitial nephritis and pyelonephritis; Fatty casts in Nephrotic syndrome; Broad and waxy cast in Chronic renal failure
What is the pharmacological treatment for Urge urinary incontinence?
Anticholingeric medication such as oxybutynin and tolterodine
What is the pharmacological treatment of overflow urinary incontinence?
cholinergic medication such as Bethanechol
What are imaging test of choice for kidney stones?
ultrasound or non contrast CT of abdomen and pelvis
What is the effect of anticholinergic medications on urinary bladder?
Anticholinergic meds result in impaired detrusor muscle contraction by blocking the parasympathetic action induced by the acetylcholine via muscarinic receptor.
What type is kidney stones are radiolucent?
uric acid stones. treatment is hydration and alkalinization
How to reduce the risk of contrast induced nephropathy?
hydration with Isotonic saline or Sodium bicarbonate
