Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STEP2 > Renal > Flashcards

Renal Flashcards

1
Q

Renal CC hx/pe

A

Hematuria
Flank pain
Abdominal mass

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

Hypernatremia path, etiologies, presentation, dx, tx**

A

Usually 2/2 water loss, not Na gain

Hyperaldosteronism: inhibits ADH
Central / nephrogenic DI
Dehydration
Diarrhea

People who don’t drink enough: babies, demented folks

MS changes
Weakness
Doughy skin

Na >145

NS ==> D5W 1/2 NS once euvolemic
NS 1st prevents cerebral edema by normalizing slowly

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

Hyponatremia path/etiology, presentation, ddx/workup, tx

A

2/2 ADH increase, usually from hypovolemia

MS change
Hyporeflexia
Cramps

Measure serum osmolality:

  • Hypertonic (>295) measure for glucose, mannitol, contrast overload
  • Isotonic (280-295) ==> measure for glucose, lipid, protein, mannitol overload

-Hypotonic (AKI, CKD)
=hypervolemic & UNa cirrhosis, CHF, nephrotic
#euvolemic ==> psychogenic polydypsia, SIADH, hypothyroid, secondary adrenal insufficiency
@hypovolemia & UNa >10 ==> diuretics, primary adrenal insufficiency, RTA, metabolic alkalosis
@hypovolemia & UNa diarrhea, bleeding, vomit, burns

Water restriction: hypervolemia & euvolemia
Normal saline: euvolemia
*unless severe ==> hypertonic saline
*Slowly @ avoid central pontine myelinolysis!!!

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

Hyperkalemia etiologies**, presentation, dx, tx

A
  • Spurious: hemolyzed blood draw
  • Reduced excretion: renal insufficiency, type IV RTA, drugs: ACE-I, spironolactone/triamterene,amiloride, NSAIDs, trimethoprim*
  • Cellular shift: lysis, rhabdo, exercise, insulin deficiency, acidosis, hyperosmolarity, drugs: beta-blockers, digitalis, succinylcholine

Colic
Areflexia
N/V/weakness

K+ > 5

-Repeat blood draw
-ECG: tall peaked T waves, QRS prolongation, PR prolongation, loss of P waves ==> sine waves ==> V-fib
**If: ECG changes and/or >6.5
1st: Calcium gluconate (stabilizes cardiac membrane)
Then:
bicarb / insulin + glucose / beta-2-agonist [albuterol] (drives K+ into cells)
Kayexalate [sodium polysterene sulfate] (removes K+)
**If no ECG change of K just sodium polysterene sulfate
-Dialysis if above fails

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

Hypokalemia etiologies, presentation, dx, tx

A
  • Cellular shift: insulin, beta-agonists, alkalosis
  • GI loss: diarrhea, laxative, vomiting
  • Renal loss: type I RTA, hypomagnesemia, mineralcorticoid excess, hyperaldosteronism, bartter’s, gittleman’s, drugs: loops/thiazide diuretics, gentamicin, amphotericin
  • Persistent hypomagnesemia (prevents K+ reabsorption)

Weakness
Cramps
Hyporeflexia

K+ < 3.6

IV K+
Mg repletion = essential
(Monitor ECG & K+ closely)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypercalcemia etiologies, presentation, dx, tx*

A 
CHIIMPANZEES:
Calcium supplement
*Hyper:  -thyroid & -parathyroid [most common]
Iatrogenic:  thiazides, TPN & Immobility*
Milk-alkali syndrome
Paget's
Adrenal insufficiency & Acromegaly
*Neoplasm
ZE (e.g. MEN-1)
Excess vit A
Excess vit D
Sarcoid & other granulomatous diseases

Stones
Bones: osteopenia & fracture
Groans: anorexia, constipation*
Tones: weakness, fatigue, MS change

Ca++ > 10.2
Order: ionized calcium, albumin, PTH, vitamin D

Immediate: normal saline +/- calcitonin
Long term/malignancy: bisphosphonate (zalendronate etc.)
If no other options: Furosemide ==> increase Ca++ excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hypocalcemia etiology, presentation, dx*, tx

A

PhD-V-CAB-R:
Pancreatitis
Hypoparathyroidism
Hypomagnasemia
DiGeorge (baby in tetany)
Vitamin D deficiency
Blood loss requiring transfusion* (citrate in transfusion binds ionized calcium)
*Rhabdomylosis (calcium precipitates with phosphate release)
*Chronic kidney disease (low 1 alpha hydroxylation of vitamin D)
*Alkalosis (increases albumin affinity for ionized calcium, thus decreasing active ionized form)
*False hypocalcemia 2/2 hypoalbuminemia (i.e. proteinuria) ==> measure ionized only

Cramps
Hyperactive tendon reflexes
Tetany
Parasthesias
Chvostek:  spasm 2/2 facial nerve tap
Trousseau:  carpal spasm 2/2 BP cuff

Ca < 8.5
Order: ionized calcium, albumin, PTH, vitamin D
ECG: prolonged QT
==> if PTH high, consider vitamin D or renal disease
==> if PTH low-normal, consider thyroid or parathyroid or other…

Calcium & Mag repletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hypomagnesemia etiologies, presentation, dx, tx

A

Intake: malnutrition (alcoholics!), bowel surgery, TPN
Loss: diuretics, diarrhea, vomiting, hypercalcemia
Other: DKA, pancreatitis

Hyperactive reflex
Tetany
MS change

ECG: prolonged QT or PR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Respiratory acidosis labs & ddx

A

pH 40

Narcotics
Lung disease
Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Metabolic acidosis labs & ddx

A 
pH < 7.4 & pCO2 8-12 = Na + (Cl + HCO3) 
C-MUDPILES
Chronic renal failure
Methanol
Uremia
DKA
Paraldehyde
INH (isoniazid?)
Lactic acidosis (2/2 shock, CO ingestion) 
Ethylene glycol
Salicylates (aspirin)

Non-gap acidosis:
Diarrhea
RTA
Hyperchloremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Type 1 RTA path, presentation, dx, tx

A

Inability to excrete H+ @ distal tubule ==> hyperexcretion of Na, Calcium, K, phosphate ==> non-anion gap acidemia, hypovolemia, hypokalemia, nephrolithiasis, nephrocalcinosis
2/2 multiple myeloma, autoimmune, amphotericin B

Renal stones

UpH >6
Hypokalemia
Hyperchloremic
Non-gap acidosis: 8-12, pH <40

Sodium bicarb & phosphate salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Type 2 RTA path, presentation, dx, tx

A

Inability to reabsorb HCO3- @ proximal tubule ==> K+ & Na+ losses ==> non-gap acidemia

Multiple myeloma
Rickets & osteomalacia result over time
*No stones like type 1 RTA!

Hypokalemia
Hyperchloremia
Non-gap acidosis

Thiazides
*Don’t give bicarb! It will be excreted.
Na+ restriction to increase proximal reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Type 4 RTA path, presentation, dx*, tx

A

Hypoaldosteronism or tubular resistance to aldosterone (diabetics etc.) ==> decreased Na+ reabsorption & decreased H+ & K+ secretion @ distal tubule ==> HYPERkalemic non-gap metabolic acidosis

Diabetics
Intrinsic renal disease
No stones

Hyperkalemia*
Non-gap acidosis

Mineralcorticoid replacement
Furosemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pre-renal AKI path, presentation, dx, tx

A

Hypovolemia, renal artery stenosis, drugs (ACE-i, NSAIDs) ==> prostaglandin efferent arteriole dilation & RAAS efferent arteriole constriction to maintain GFR, thus BUN stays high

Hypovolemia (orthostatic hypotension)

BUN:Cr >20:1
Urine:  hyaline casts
FeNa < 1%
UNa < 20
Urine osmolality > 500

Fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Uremia sequelae*

A

Pericarditis ==> pericardial rub

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

Intrinsic AKI path, presentation, ddx/dx*, tx

A

nephron injury 2/2 ATN, nephritis, embolic, rhabdo, drugs (NSAIDs, aminoglycosides)

Hematuria
Tea-colored urine
Foamy urine

Red casts: glomerulonephritis
White casts/eosinophils: AIN
Granular, muddy brown casts: ATN

BUN:Cr < 20:1, usually 10:1 because intrinsic injury prevents BUN reabsorption (ATN)**
FeNa > 1% (ATN)
UNa > 20
Urine osmolality < 300

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Postrenal AKI path, presentation, dx, tx

A

Outflow obstruction 2/2 prostate disease, malignancy, stones

Distention
Bladder tenderness

White casts

Catheter
Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dialysis indications

A 
AEIOU
Acidosis
Electrolyte abnormalities
Ingestion
Overload
Uremia (pericarditis, encephalopathy, etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CKD path, presentation, dx*, tx

A

> 3 months of GFR < 60
2/2 HTN, diabetes, nephritis, polycystic kidney disease

Uremia: malaise, anorexia, pericarditis, CNS change

Azotemia (elevated BUN & Cr)
Fluid overload
Metabolic acidosis
Anemia of chronic disease (2/2 decreased epo)
Hypocalcemia (2/2 decrease 1 alpha hydroxylation of vitamin D)
Hyperphosphatemia

Fluid restriction
ACE-i / ARBs
Epo analogs etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Polycystic kidney disease path, association

A

Bilateral cysts in kidney, spleen, liver, pancreas
Adult-onset: autosomal dominant (30-ish)*
Youth-onset: autosomal recessive

*Cerebral aneurysm!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Goodpasture’s path, presentation, dx*, tx

A

Cytotoxic antibody against GBM ==> rapidly progressing

Young men
Hematuria w/ dysmorphic cells & hemoptysis
No upper respiratory involvement (sinusitis, like Wegener’s)

Light: CRESCENT formation
Immunoflouresence: linear GBM deposits
Sputum: Hemosiderin-filled macrophages

Steroid pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nephritic syndrome general path, presentation*

A

Inflammatory infiltration @ endothelial or mesangial areas ==> “tram tracking” 2/2 endothelial proliferation

PHAROH
Proteinuria (mild)
Hematuria (frank)
Azotemia
RBC casts
Oliguria
Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Nephritic syndrome ddx

A 
Post-infectious glomerulonephritis
IgA nephropathy / Berger's
Wegener's
Goodpasture's
Alport's
SLE nephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Post-infectious glomerulonephritis path, presentation, dx, tx

A

2-6 weeks post ANY infection (usually group A beta-hemolytic strep) ==> C3 complement deposition (?)

PHAROH

Low C3*
ASO elevation
RBC casts
Light:  hypercellular, lumpy bumpy
EM:  IC humps
Immuno:  granular* antibody deposition in GBM

Diuretics ==> self-resolving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

IgA nephropathy name, path, presentation, dx*, tx

A

Berger’s*

2/2 GI or respiratory infection or Henoch-Schonlen purpura

Young male w/ PHAROH
Usually 2/2 URI or gastroenteritis

IgA deposits
Normal C3

Corticosteroids ==> can progress to ESRD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Nephrotic syndrome general path, presentation, risks, dx, tx

A

Non-inflammatory. Immune complex deposits occur @ sub-epithelial space, out of reach of circulating inflammatory cells

Edema
Foamy urine (lipids + protein)

HYPERCOAGULABLE, esp. renal vein thrombosis*
Atherosclerosis 2/2 hyperlipidemia*
Strep pneumo infection

Proteinuria > 3.5 g/day
Hypoalbumenemia 
Hyperlipidemia
Relatively normal Cr
Renal biopsy

Protein & salt restriction
ACE-i (decrease proteinuria)
Pneumo 23 vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Minimal change disease presentation, dx, tx

A

Children, Hodgkins**, thrombotic events

Nephrotic >3g/day protein in urine
Edema
Hypoalbuminemia
Light microscope: normal
EM:  fusion of foot processes

Steroids ==> resolves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Focal segmental glomerulosclerosis presentation*, dx, tx

A

Blacks, HIV, drug users, obese

Nephrotic >3g/day protein in urine
Edema
Hypoalbuminemia
Microscopic hematuria
Light microscope:  tuft sclerosis & foot process fusion

Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Membranous nephropathy other names, presentation*, dx, tx

A

Membranous glomerulonephritis

White adults
Most commonly associated with any malignancy other than minimal change w/ Hodgkins**

Nephrotic >3g/day protein in urine
Edema, hypoalbuminemia
EM: Spike & dome deposition of C3 & IgG

Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Lupus nephritis presentation, dx, tx

A

Lupus

Nephrotic & nephritic
Mesangial proliferation
Subendothelial & subepithelial complex deposits

Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Renal amyloidosis path, dx, tx

A

Plasma cell (multiple myeloma) or inflammatory (2/2 RA, TB etc.)

Nodular glomerulosclerosis
Apple-green amyloid deposits on Congo red stain under polarized light*

Prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Membranoproliferative nephropathy path*/dx/tx

…is this the same as membranous glomerulonephritis above??

A

Multiple types (?)
IgG against C3 convertase causes C3 deposition in GBM
HCV, SLE

“Tram-tracking”: double-layered BM
Low C3

Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Kidney stone presentation, general dx, general dx, general tx… ddx w/ tx

A

Intense flank pain radiating to genitals

Alkaline urine (except uric acid stones)
CT: gold standard bc some stones radiolucent
*Ultrasound: pregnant & children

Analgesia & fluid if 5mm 
24 hour u/a if repeated event
------------------------
Calcium oxalate: 
-most common; idiopathic, hyperparathyroidism
-radiopaque, alkaline urine
-envelope shaped*
-hydration, thiazides to decrease urine Ca+ excretion*, decrease Na+ intake*, normal to high calcium intake, decreased protein & oxalate*

Struvite (Mg-PO4)

  • Urease-producing Proteus
  • radiopaque, alkaline urine, STAGHORN
  • surgical removal

Uric acid

  • gout etc.
  • RADIOLUCENT, acidic urine
  • K+bicarb or K+citrate alkalization of urine*

Cystine

  • AA transport defect
  • radiopaque, hexagonal crystals, +cyanide nitroprusside test
  • hydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Polycystic kidney presentation, dx, tx

A

Pain, hematuria
Adult onset about 30
Palpable kidney

Ultrasound or CT

HTN control ==> dialysis ==> transplant

35
Q

Hydronephrosis path, presentation, dx, tx*

A

Dilation of renal calyces 2/2 obstruction, often BPH ==> progresses to renal failure

Asymptomatic
Pain
Decreased urine output
UTI hx
BPH hx
Hypertension, sepsis

Cr bump
Ultrasound or CT showing dilation of calyces

Surgery and/or catheter placement

36
Q

Vesicoureteral reflux path, hx, dx, tx

A

Reflux of bladder urine backward ==> can progress to hydronephrosis & calyx damage

UTIs

Voiding cystourethrogram (especially if young child presenting with UTI)
Grade 1-2: no dilation
Grade 3-4: ureteral & pelvic dilation

Prophylactic TMP-SMX until resolved
Surgery if severe

37
Q

Cryptorchidism path, risk, hx, dx, tx

A

Undescended testicle x1 or x2

Testicular cancer

Low birth weight, other syndromes

Can’t pull into scrotal sac

Orchioplexy

38
Q

Hydrocele path, hx, pe, dx, tx*

A

Failure to close processus vaginalis ==> abdominal fluid leaks into scrutum

Painless

Transilluminating balls

*If persisting beyond 12 months, close to reduce hernia risk

39
Q

Varicocele path, hx, pe*, dx, tx

A

Dilated pampiniform plexus

Dull aching pain
Worsened with valsalva*
Bag of worms in scrotum

U/S

Surgery if big or symptomatic

40
Q

Epididymitis path/hx/pe/dx/tx

A

Epididymis infection usually 2/2 STD

Tender, relieved by lifting (+ Prehn sign)

UA, culture
U/S: increased flow to testes

Abx

41
Q

Testicular torsion path/hx/pe/dx/tx

A

Torsion of testes

Intense pain, not relieved by lifting (- Prehn’s)
U/S: decreased flow to testes

Surgery

42
Q

Erectile dysfunction presentation, dx, tx

A

DM
Atherosclerosis
HTN
Meds: beta-blockers, SSRIs

*Nocturnal or morning wood & situational dependence = psychological
Check for hypogonadism: prolactin, testosterone, gonadotropin
Check anal tone

Sildinafil etc.

43
Q

BPH path, dx*, tx

A

Estrogen-sensitive enlargement of central zone

Digital rectal:  uniformly smooth, firm
\+
UA & culture:  r/o hematuria, UTI
\+
Creatinine:  r/o obstruction
==> if blood, do biopsy! 
==> if obstructed, to renal ultrasound

Alpha-blocker (terazosin) to relax prostate
5-alpha-reductase inhibitor (finasteride) to reduce dihydrotestosterone
Surgery if severe

44
Q

Prostate cancer presentation w/ cord met warning signs*,

A 
Urinary retention
Back pain
Constitutional
Regional lymphadenopathy
*Hyperreflexia, LE weakness, incontinence

DRE with asymmetric nodule
Usually non-tender (tender = prostatitis)
*Elevated PSA ==> biopsy + CXR + bone scan

Controversial…

45
Q

Prostate routine screening

A

Yearly DRA after 50 years old

46
Q

Hematuria ddx*

A 
I PEE RBCSx2
Infection
Polycystic kidney disease
External trauma (urethra damage = blood early void)*
Exercise
Renal glomerular disease
BPH
Cancer (bladder > renal)* (bladder = blood/clot @ end void)*
Stones
Sickle cell trait:  painless hematuria
47
Q

Bladder cancer presentation, dx, tx

A 
Smoking
Schistosomiasis
Analine dye
Hematuria
Urinary frequency/urgency

Biopsy

Chemo unless diffuse ==> cystectomy

48
Q

Renal cell carcinoma path, presentation, dx, tx

A

Adenocarcinoma of tubular epithelium ==> spreads to IVC, lung, bone

Hematuria
Flank pain
Fever
Palpable kidney
Anemia
L-sided varicocele (L gonadal blockage before draining into L renal vein whereas R gonadal drains into IVC) ==> unresolving when recumbent

Ultrasound or CT

Surgery / chemo

49
Q

Testicular cancer presentation, dx, tx*

A

Male 15-34
Painless nodule on testis

Ultrasound
Tumor markers: beta-hcg and alpha-feto-protein (?)
NO BIOPSY: highly malignant and could seed by biopsying

Radical orchiectomy without biopsy!

50
Q

Rhabdo labs**

A

Elevated: CPK, K+
Decreased: Ca++
Urinalysis: blood (2/2 myoglobin)
Urine sediment: few RBCs

51
Q

Contrast nephropathy hx, tx*

A

Patient types: diabetics, baseline Cr > 1.5

Aggressive hydration
Non-ionic contrast
Acetylcysteine

52
Q

Simple renal cyst dx*, tx

A

CT: symmetric, non-loculated, non-enhancing

No treatment

53
Q

Diabetes insipidus path, presentation, dx**, tx*

A

Nephrogenic: ADH insensitivity 2/2 hypercalcemia, hypokalemia, meds (lithium, amphotericin, foscarnet, cidofivir, demecocycline)

Polydipsia
Polyuria* ==> ddx: DI, primary/psychogenic polydipsia, DM

Euvolemic hypernatremia
Decreased urine osmolality (dilute urine)
Water deprivation test: if urine osmolality increases significantly ==> primary polydipsia, if not, central vs nephrogenic DI
ADH analog test (arginine vasopressin or desmopressin DDAVP) ==> if urine osmolality increases ==> central DI

Salt restriction
Remove offending agent
DDAVP if central

54
Q

Winter’s formula purpose & formula*

A

Testing appropriate respiratory compensation to metabolic acidosis

pCO2 = 1.5[HCO3] + 8

55
Q

UTI dx, tx**

A

Uncomplicated:
-healthy patients w/ dysuria
++ dipstick: +esterase (pyuria) & +nitrite (Enterobacteriaceae coli)
==> TMP/SMX, nitrofurantoin, or fosfomycin

Complicated:
-comorbidities, pregnant, catheter
-requires dipstick & culture
==> floroquinolone or ceftriaxone

56
Q

Cholesterol embolization presentation*, dx

A

Recent vascular procedure

Blue, mottled LE skin
Livedo reticularis

Renal failure
Urine: WBC

57
Q

Most common cause of death in dialysis patients*

A

Cardiac

58
Q

Early post-op renal transplant dysfunction ddx, dx, tx

A

Acute rejection ==> lymphocytic infiltration ==> IV steroids

Cyclosporine toxicity ==> measure levels

Ureteral obstruction

ATN

59
Q

Aspirin ingestion dx*

A

Mixed anion gap metabolic acidosis + respiratory alkalosis (2/2 tachypnea)

60
Q

Ethylene glycol ingestion dx

A

Anion gap metabolic acidosis

Calcium renal stones (envelope shaped)

61
Q

CO inhalation acid-base path*

A

CO displaces O2 from Hb & shifts unloading curve such that O2 doesn’t unload ==> anaerobic metabolism ==> lactic acidosis

62
Q

Renal vein thrombosis hx/pe

A

Nephrotic syndrome

Abrupt onset fever, abdominal pain, hematuria

63
Q

Allergic interstitial nephritis (AIN) presentation*, dx, tx

A

Arthralgia
Rash
Renal failure
Drugs: sulfonamide, TMP, penicillin, cephalosporin, rifampin, allopurinol, NSAIDs, diuretics, captopril

Renal failure (Cr bump)
WBC casts
Urine eos

64
Q

Prostatitis presentation*, dx, tx

A

UTI: dysuria
+pronounced systemic symptoms: fever, chills
“Boggy, tender” prostate

Dipstick + mid-stream urine culture
Only suprapubic catheter if necessary; AVOID catheter

TMP/SMX or floroquinlone 4-6 weeks

65
Q

Metabolic alkalosis compensation formula use & formula*

A

For metabolic alkalosis to determine if respiratory compensation is correct

PaCO2 = (0.9 x Bicarb) + 16 +/-2

66
Q

Hyponatremia ddx workup**

Reconcile this with above entries??

A

Hyperosmolar > 290 serum osmolality
==> renal failure or diabetes

Normal or hypoosmolar < 280
Urine Osmolality < 100 ==> primary polydipsia or beer potomania (malnutrition)
Urine Na > 25 ==> hypovolemia, CHF, cirrhosis
Urine Na < 25 ==> SIADH, adrenal insufficiency, hypothyroid

67
Q

Acute tubular necrosis hx, dx*

A

Hypovolemia

Muddy brown cast
FeNa > 2%
UNa > 20

68
Q

Urine casts & correlating diagnoses**

A 
RBC: glomerulonephritis
Fatty:  nephrotic
WBC:  AIN & pyelonephritis
Muddy brown:  ATN
Broad/waxy:  chronic renal failure
69
Q

Vomiting acid-base pathology*

A

Loss of HCl & KCl in vomit
HCO3- absorbed for each H+ vomited
RAAS tries to restore volume but reabsorbs HCO3
H+ exits cell to reverse alkalosis, K+ enters
==> hypochloremic hypokalemic metabolic alkalosis

70
Q

Renal artery stenosis path, presentation**, dx*, tx

A

2/2 to fibromuscular dysplasia in young or atherosclerosis in old

Renal bruit
HTN
Headache

Hypokalemia

STENTING

71
Q

Anemia 2/2 ESRD dx, tx*

A

Normocytic, normochromic anemia 2/2 EPO insuffiency

Trial Fe supplement first
Once Hb < 10 or Hct < 30 ==> EPO

72
Q

EPO supplementation s/e*

A

Worsened HTN (common)
Headache
Flu-like symptoms

73
Q

Post-op oliguria tx*

A

Bladder scan ==> catheterize if obstruction ==> assess for intrinsic or pre-renal if not

74
Q

ESRD tx*

A

Living related donor > transplant for survival

75
Q

Pyelonephritis path, presentation, dx, tx

A

Gram-negative, usually

Fever, chills
CVA tenderness

Dipstick & culture required**
*ultrasound to assess for obstruction or abscess IF empiric therapy fails

Start empiric therapy, oral or IV: floroquinolone or ceftriaxone*

76
Q

Dialysis bleeding issue**/tx

A

Uremia ==> causes platelet dysfunction ==> only increased bleeding time

DDAVP

77
Q

Diarrhea acid-base path*

A

Loss of HCO3- in diarrhea ==> non-anion gap, hypernatremic metabolic acidosis

78
Q

Bartter & gittleman dx

A

Hypokalemic metabolic acidosis

79
Q

Cryoglobulinemia hx/pe/dx*

A

Arthralgia
HCV

Palpable purpura
Hepatosplenomegaly

Glomerulonephritis

80
Q

Glomerular structure

A

Afferent arteriole ==> endothelium ==> GBM ==> visceral epithelial podocytes ==> urinary space

81
Q

Alport’s syndrome path, presentation, dx, tx

A

Hereditary glomerulonephritis

Young boys
Intermittent hematuria
Sensineural deafness & vision problems
Progresses to renal failure

EM: GBM “splitting”

Transplant

82
Q

Rapidly progressive glomerulonephritis (RPGN) path, dx*

A

2/2 goodpasture’s, wegener’s, microscopic polyangiitis

Light: CRESCENT formation

83
Q

Analgesic nephropathy path, presentation, dx

A

Renal ischemia 2/2 NSAIDs ==> papillary necrosis

Hematuria

Non-dysmorphic reds (glomerular injury causes dysmorphic reds)

STEP2 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions