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Step 2 > Renal > Flashcards

Renal Flashcards

1
Q

Classic findings include skin rash, fever, and eosinophilia, with UA showing many WBCs and WBC casts.

A

Drug-induced Allergic interstitial nephritis

(NSAIDs, Zosyn, PPIs, cephalosporins, penicillins, sulfonamides, diuretics, rifampin, phenytoin, allopurinol)

Tx = d/c offending agent

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2
Q

Kidneys normally compensate for intravascular volume depletion (vomiting, diarrhea) by secreting vasodilatory ____ which dilate the afferent arteriole to maintain GFR & renal perfusion.

A

prostaglandins (via ↑ COX production)

PDA: Prostaglandins Dilate Afferent

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3
Q

NSAIDs inhibit COX →
Resulting in renal afferent arterial _____ →
pre-renal azotemia (>20:1)

A

vasoconstriction

(Cox = vasodilation)

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4
Q

Kidney biopsy is used to diagnose ____ renal causes of acute kidney injury.

A

Intrinsic

(use if pt has: hematuria, proteinuria)

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5
Q

Patients with acutely elevated creatinine & clinical signs of obstruction require imaging (preferably ____) to assess for hydronephrosis.

A

renal ultrasound

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6
Q

Alcohol bingeing can lead to acute alcohol myopathy and ______, especially when combined with cocaine abuse.

A

rhabdomyolysis

(cx: AKI s/t dehydration & pigment-induced nephropathy)

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7
Q

Hypovolemic shock can cause what type of AKI?

A

acute tubular necrosis (ATN)

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8
Q

A BUN/Cr ratio of ___ is usually seen in Acute Tubular Necrosis (ATN)

A

10-15

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9
Q

Acute Tubular Necrosis (ATN) findings that support its diagnosis are:

BUN/Cr ratio 10-15

Urine Osm ____ mOsm/L
(but never __ mEq/L

Urine Na >__
FE­­­­Na ­­> __%

A

300-350 (but never <300)

> 20

> 2%

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10
Q

Broad casts are seen in patients with _____

A

chronic kidney disease (CKD)

*made in dilated tubules of enlarged nephrons that have undergone compensatory hypertrophy s/t ↓ renal function.

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11
Q

Waxy casts, which are shiny and translucent, are seen in patients with _____

A

chronic kidney disease (CKD)

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12
Q

Red blood cell casts are indicative of (3)

A

Glomerular disease (glomerulonephritis)
Vasculitis
HTN emergency

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13
Q

White blood cell (WBC) casts are seen in cases of (3)
*white = TAP

A

Allergic Interstitial nephritis
Pyelonephritis
Transplant Rejection

*are definitive evidence that urinary WBCs originate in the kidney

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14
Q

Fatty casts are seen in conditions causing ____.

A

Nephrotic syndrome

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15
Q

Hyaline casts are composed almost entirely of protein and are non-specific; these may be seen in asymptomatic individuals and in patients with ___

A

pre-renal azotemia

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16
Q

Muddy Brown cast are indicative of ____.

A

ATN

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17
Q

Granular Cast are seen in cases of (3)

Granular = GAP

A

Glomerular disease (glomerulonephritis)
ATN
Pyelonephritis

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18
Q

A [lab workup] is typically collected when a precise measure of renal function is needed (ex: renal transplant evaluation, preparation for hemodialysis).

A

24-hour creatinine clearance

*not required in most cases of AKI work-up

19
Q

present with insidious onset of flank pain and systemic symptoms (fever, weight loss), typically in patients with a recent h/o UTI (1-2m ago) or extrarenal infection (bacteremia).

Renal and perinephric ___

A

abscesses

(+/- pyuria, bacteriuria, micro-hemturia, or proteinuria)

Pyelonephritis happens shortly after UTI not weeks later.

20
Q

Prerenal AKI in an acute CHF exacerbation is most likely s/t Cardiorenal Syndrome, which involves:

↑ ___ & Renal venous pressures
resulting in
↓ ___

A

↑ CVP (R 💛 pre-load)

↓ GFR

21
Q

High-dose intravenous ___ can cause crystalluria with renal tubular obstruction.

A

acyclovir

  • giving IVFs with the drug can help ↓ risk of AKI
22
Q

ACE inhibitors temporarily reduce GFR due to dilation of renal efferent arterioles and should not be initiated in the setting of ____.

A

AKI

23
Q

Contrast-associated acute kidney injury is characterized by a rise in serum creatinine ____ after intraarterial contrast administration followed by a gradual return to baseline.

A

24-48 hours

(prevent by giving IVFs before)

24
Q

Most cases of renal failure result in
[electrolyte abnormality]
due to reduced renal phosphorus excretion.

A

hypocalcemia

25
Q

Patients who have acute renal failure and _____ often have an underlying malignancy.

A

hypercalcemia

(ex: Multiple Myeloma)

bc acute renal failure is supposed to cause hypocalcemia

26
Q

multiple myeloma (MM) induced hypercalcemia can cause AKI due to clogging of the renal tubules with calcium deposits or _____.

A

immunoglobulin light chains

(classically presents with anemia, bone pain, hypercalcemia, and acute renal failure)

27
Q

Elevated ____ is likely the major driver of AKI in cardiorenal syndrome.

A

central venous pressure

(leads to elevated renal venous pressure and congestion.
This reduces the glomerular capillary filtration gradient)

28
Q

Acute renal allograft rejection is predominantly T-cell mediated and usually occurs within the first ___ following transplant.

A

6 months

29
Q

Acute renal allograft rejection
results in an asymptomatic rise in serum creatinine.

The diagnosis is confirmed by renal biopsy showing ___ of the intima.

Treatment is with _____.

A

lymphocytic infiltration
high-dose IV glucocorticoids

30
Q

____ results from excessive immunosuppression in renal allograft recipients and leads to tubulointerstitial nephritis.

Renal biopsy reveals intranuclear ____ and a mixed lymphocytic and neutrophilic infiltrate.

A

BK virus reactivation

intranuclear inclusions

(cx: ureteral stenosis/obstruction)

31
Q

Acute toxicity to ____ involves vasoconstriction of the afferent and efferent renal arterioles, leading to prerenal AKI and hypertension.

A

calcineurin inhibitors (tacrolimus)

immunosuppresor in Kidney Transplant pt

32
Q

metformin is renally cleared, the drug should be discontinued in ___

A

renal insufficiency/ AKI

33
Q

Hepatorenal syndrome has acute renal failure (Cr >1.5) with a very low urine sodium level (<10 mEq/L), and an absence of blood, casts, or protein in urine. Creatinine does not improve with ___.

A

intravenous fluid resuscitation

34
Q

Angiotensin II causes arteriolar vasoconstriction of ___ and systemic vessels, which improves GFR and blood pressure

A

efferent

ACE: AngII Constricts Efferent

35
Q

Benign prostatic hyperplasia can cause an obstructive uropathy that presents as a slowly rising creatinine level.
A ___ examination, which should be performed in all patients being evaluated for creatinine elevation or CKD

A

renal ultrasound

36
Q

70% of cases with interstitial nephritis are caused by drugs such as (8)

Discontinuing the offending agent is the treatment.

A

NSAIDs
Cephalosporins
Penicillins (Pip-Tazo) / Sulfonamides (TMP-SMX)
allopurinol
PPI
rifampin
phenytoin

37
Q

High-dose intravenous ____ can cause crystalluria with renal tubular obstruction.

Administering fluids with the drug can help reduce the risk of AKI.

A

acyclovir

38
Q

What antibiotic can cause acute tubular necrosis, usually after >5-7 days of use.

A

Aminoglycosides (amikacin, gentamicin)

39
Q

Nonsteroidal anti-inflammatory drugs inhibit prostaglandin synthesis, which can cause ___.

A

prerenal azotemia/AKI
afferent vasoconstriction

(worse if pt is already volume down)

40
Q

Evaluation of neonatal acute kidney injury includes a ____.

A

renal and bladder ultrasound (RBUS)

41
Q

Acute ____ can cause hematuria, AKI, fever, and flank pain.

Most common in patients with analgesic overuse or sickle cell anemia.

A

papillary necrosis

42
Q

HRS occurs due to _____, decreased vascular resistance (SVR), and local renal vasoconstriction with decreased perfusion.

A

splanchnic arterial dilation

43
Q

The most common inciting factors of HRS include (2)

A

SBP
gastrointestinal bleeding

Step 2 (55 decks)

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