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Medicine > Renal > Flashcards

Renal Flashcards

1
Q

hemodialysis vs transplant in ESRD

A

transplant is +++ in all parameters

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2
Q

HTN + hyokalemia

A
  • Decreased renin, increased aldosterone –> primary hyperaldo (tumor, B/L adrenal hyperplasia)
  • Increased renin, inc aldo –> 2ndry hyperaldo (renovascular HTN, malignant HTN, renin tumor, diuretics, cirrhosis)
  • dec renin, dec aldo –> non-aldo causes (CAH, corticosterone-producing adrenal tumor, Cushing’s, exogenous mineralocorticoids
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3
Q

Renal SEs ACEis

A

-decreased GFR –> hyperkalemia, elevated creatinine

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4
Q

Renal SEs thiazide diuretics

A

hypokalemia, hyponatremia, hyperuricemia, elevated glucose

can decrease effective arterial volume to kidney and cause secondary hyperaldosteronism

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5
Q

SIADH

A
  • excess ADH –> water retention and natiuresis –> volume expansion, hyponatremia, w/o edema
  • Causes: Neoplasm (esp lung, prostate, bladder), CNS disorder, pneumonia, ventilators, meds, postop
  • chronic hyponatremia can be asymptomatic. Acutely –> neuro Sx
  • Hypourecemia, low BUN, low/nml Cr
  • Tx: fluid restriction, correct underlying cause. Can use hyper tonic saline if refractory, but SLOWLY (myelinolysis)
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6
Q

Winter’s formula and implications

A
  • Expected PaCO2 for metabolic acidosis = 1.5 * [HCO3] +8 +/- 2
  • If not as expected, have another primary resp problem.
  • If higher than expected, have a primary respiratory acidosis (i.e. respiratory failure)!! NB: asthmatic whose PaCO2 normalizes w/o treatment = BAD SIGN
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7
Q

Salicylate OD

A

-primary resp alkalosis AND primary met acidosis

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8
Q

Anion gap

A

Na+ - (Cl + HCO3)

Nml = 5-15

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9
Q

Causes of normal AG met acidosis

A 
HARD ASS:
Hyperalimentation
Addison's
RTA
Diarrhea
Acetazolamide
Spironolactone
Saline Infusion
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10
Q

Causes of elevated AG met acidosis

A 
MUDPILES:
Methanol (formic acid)
Uremia
DKA
Propylene glycol
Iron tablet or INH
Lactic acid
Ethylene glycol
Salicylates (late. Also causes resp alkalosis)
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11
Q

Effects of alkalosis

A

Decreased cerebral blood flow
Left shift in O2/Hg dissociation decreases O2 delivery
Arrhythmias
Tetany, seizures

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12
Q

Effects of alkalosis

A

Decreased cerebral blood flow
Left shift in O2/Hg dissociation decreases O2 delivery
Arrhythmias
Tetany, seizures

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13
Q

HTN + hyokalemia

A
  • Decreased renin, increased aldosterone –> primary hyperaldo (tumor, B/L adrenal hyperplasia)
  • Increased renin, inc aldo –> 2ndry hyperaldo (renovascular HTN, malignant HTN, renin tumor, diuretics, cirrhosis)
  • dec renin, dec aldo –> non-aldo causes (CAH, corticosterone-producing adrenal tumor, Cushing’s, exogenous mineralocorticoids
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14
Q

Renal SEs ACEis

A

-decreased GFR –> hyperkalemia, elevated creatinine

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15
Q

Renal SEs thiazide diuretics

A

hypokalemia, hyponatremia, hyperuricemia, elevated glucose

can decrease effective arterial volume to kidney and cause secondary hyperaldosteronism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SIADH

A
  • excess ADH –> water retention and natiuresis –> volume expansion, hyponatremia, w/o edema
  • Causes: Neoplasm (esp lung, prostate, bladder), CNS disorder, pneumonia, ventilators, meds, postop
  • chronic hyponatremia can be asymptomatic. Acutely –> neuro Sx
  • Hypourecemia, low BUN, low/nml Cr
  • Tx: fluid restriction, correct underlying cause. Can use hyper tonic saline if refractory, but SLOWLY (myelinolysis)
17
Q

Winter’s formula and implications

A
  • Expected PaCO2 for metabolic acidosis = 1.5 * [HCO3] +8 +/- 2
  • If not as expected, have another primary resp problem.
  • If higher than expected, have a primary respiratory acidosis (i.e. respiratory failure)!! NB: asthmatic whose PaCO2 normalizes w/o treatment = BAD SIGN
18
Q

Salicylate OD

A

-primary resp alkalosis AND primary met acidosis

19
Q

Anion gap

A

Na+ - (Cl + HCO3)

Nml = 5-15

20
Q

Causes of normal AG met acidosis

A 
HARD ASS:
Hyperalimentation
Addison's
RTA
Diarrhea
Acetazolamide
Spironolactone
Saline Infusion
21
Q

Causes of elevated AG met acidosis

A 
MUDPILES:
Methanol (formic acid)
Uremia
DKA
Propylene glycol
Iron tablet or INH
Lactic acid
Ethylene glycol
Salicylates (late. Also causes resp alkalosis)
22
Q

Effects of acidosis

A 
Right shift in O2/Hg dissociation increases O2 delivery
CNS depression
Dec pulmonary blood flow
Arrhythmias
Decreased CO
Hyperkalemia
Kussmaul's breathing (acute)
23
Q

Effects of alkalosis

A

Decreased cerebral blood flow
Left shift in O2/Hg dissociation decreases O2 delivery
Arrhythmias
Tetany, seizures

24
Q

Metabolic alkalosis

A
  • Two events: initial alkalosis (loss of H+ or increased HCO3 (e.g. volume contraction) + maintenance of alkalosis (kidney problem)
  • Two types: saline sensitive (urine chloride 20) has ECF expansion
  • Tx: Saline + K if ECF contracted. Address cause/give spironolactone if ECF expanded.
25
Q

ECF contracted (saline sensitive) Met alkalosis

A
  • (Urine Cl <10)
  • Vomiting, NG suction
  • Diuretics (decreased volume increases bicarb concentration)
  • Villous adenoma of colon, diarrhea with high Cl content
  • Tx: Saline + K
26
Q

ECF expanded (Saline-resistant) met alkalosis

A
  • (Urine Cl >20)
  • 2/2 adrenal d/os (primary hyperaldo). mineralocorticoids cause volume expansion and Cl wasting
  • Others: Cushings, severe K deficiency, Bartters, Diuretic abuse
  • Tx: underlying cause/give spironolactone
27
Q

Compensation formula Respiratory Acidosis

A
  • Acute (takes 12-24 hrs): HCO3 inc by 1 per 10 inc in PCO2

- Chronic (takes days): HCO3 up 4 for every 10 inc in PCO2

28
Q

Respiratory Acidosis (Clinical, Causes, Tx)

A
  • Somnolence, confusion, myoclonus, asterixis. Acute: Headaches, confusion, papilledema (increased ICP)
  • Causes: pulmonary disease, NM diseases (e.g. MG), CNS malfunction, drug-induced hypoventilation, resp muscle fatigue
  • Tx: Airway!, CO2 (caution in “CO2 retainers,” Tx resp disease, clear toxins, bronchodilators, intubate if necessary
29
Q

Compensation formula Respiratory Alkalosis

A
  • Acutely, for each 10 dec in PCO2, HCO3 dec by 2

- Chronically, for each 10 dec in PCO2, HCO3 dec by 5

30
Q

Respiratory Alkalosis (Clinical, Causes, Tx)

A
  • Decreased Cerebral blood flow: lightheadedness, dizziness, anxiety, paresthesias, perioral numbness, Tetany (can be confused with hypocalcemia), arrhytmias (severe)
  • Causes: Anxiety, PE, pneumonia, asthma, sepsis, hypoxia, mechanical ventilation, pregnancy, cirrhosis, salicylate toxicity, hyperventilation
  • Tx: treat underlying cause, inhale CO2
31
Q

Type 1 RTA

A
  • Distal
  • Defect in CT H+ excretion
  • Urine pH >5.5 –> inc risk of kidney stones, nephrocalcinosis
  • hypokalemia, normal AG met acidosis
  • Causes: autoimmune (sjogrens, SLE), transporter defects, cirrhosis, nephrocalcinosis, renal transplant, sickle cell, Toxins (toluene, lithium, ampho B), IV bisphosphonates
32
Q

Type 2 RTA

A
  • Proximal
  • Urine pH can be s syndrome, amyloidosis, multiple myeloma, Paroxysmal noceturnal hemoglobinuria, Toxins (HAART, Ifosfamide, lead, cadmium)
33
Q

Angioedema

A
  • Edema in face, mouth, lips, tongue, glottis, larynx (can compromise airway)
  • Most common acquired: ACEis. Lead to buildup of bradykinin –> edema
  • Management: check for airway obstruction, use epinephrine if necessary, trach if necessary
34
Q

Uremic Pericarditis

A
  • Occurs in 6-10% of renal failure pts
  • BUN > 60
  • Does not usually present with EKG changes of pericarditis (diffuse ST elevation)
  • Tx: hemodialysis
35
Q

AKI (definition, urine output, etiology classes)

A
  • rapid decline in kidney function w increase in Cr (twofold) and 50% decreased GFR
  • Can be oliguric, nonoliguric, anuric
  • Prerenal: Volume loss/sequestration, decreased CO, hypotension. NSAIDS, ACEi, cyclosporins
  • Postrenal: intra (crystals, proteins), extra (pelvis/ureter, bladder/urethra)
  • Renal: Glomerulonephritis, vascular (large, small), interstitial, ATN
36
Q

Prerenal failure

A
  • always oliguric
  • BUN/Cr >20:1
  • Urine >500 mOsm
  • FENA < 1%, UNa <20
  • Reversible, but can progress to ischemic AKI if hypoperfusion lasts

Medicine (7 decks)

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