Renal Flashcards
What are the causes of hypovolemic hypotonic hyponatremia?
diuretics, adrenal insufficiency, vomiting
diarrhea, sweating, burns
What are causes of euvolemic hypotonic hyponatremia?
thiazides, glucocorticoid deficiency, hypothyroid, SIADH
What are the causes of hypervolemic hypotonic hyponatremia?
CHF, liver disease, nephrosis
What are some of the signs of uremia?
Mental status change, pericardial rub, metallic breath
What is the difference between DK and HHNK?
DKA- type 1, rapid onset, glucose less than 600, bicarb low, anion gap low, pH less than 7.3, alert to obtunded
HHNK - type 1 and 2, gradual onset, glucose above 1200, bicarb normal, anion gap normal/variable, more sick and obtunded
What are the treatment protocols for a hyperglycemia crisis?
IVF with NS, IV insulin, if pH < 6.9, bicarb, serum K+, check glucose every 60 mins,
Describe the pros/cons of renal dialysis vs. transplantatin
transplant: better survival and quality of life, resolution of anemia, bone disease, return of endocrine, sexual functions etc, autonomic retinopathy improves,
Describe the workup for hypocalcemia
Low serum calcium - measure PTH
If PTH low/normal - parathyroidectomy, autoimmune, infiltrative disease (metastatic disease, wilson’s disease, hemochromatosis)
If PTH elevated - (endocrine) vitamin D deficiency, chronic kidney disease; (inflammatory) pancreatitis, sepsis (oncology) tumor lysis
Describe the workup for a patient with hypertension and hypokalemia
if aldosterone and renin levels increased – > secondary hyperaldosteronism (renal hypertension, diuretic use)
If renin low but aldosterone elvated – > primary hyperaldosteronism (aldosterone producing tumor)
if both aldosterone and renin levels decreased – > non aldosterone causes (cushing syndrome, congenital adrenal hyperplasia)
Describe the presentation of hypokalemia including EKG findings
weakness, fatigue, muscle cramps
in severe cases, flaccid paralysis, tetany, rhabdo,
EKG - broad flat T waves, U waves, ST depression, PVCs
Describe the findings of hyperkalemia including EKG findings
peaked T waves, widening of QRS, development of sinusoidal pattern
What are potential side effects of diuretics?
metabolic alkalosis, hypokalemia
What is the presentation, lab findings, treatment and complications of Hereditary Spherocytosis?
hemolytic anemia, jaundice, splenomegaly
lab findings: spherocytes, increased osmotic fragility
treatment: folic acid, blood transfusions, splenectomy
complications: pigment gallstones
What are some of the causes of primary adrenal insufficiency?
autoimmune, infectious, hemorrhagic (meningococcemia), cancer
What is the clinical presentation of adrenal insufficiency? (acute and chronic)
acute - shock, abdominal tenderness, nausea, vomiting, hyponatremia, hyperkalemia
chronic - fatigue, weakness, GI, weight loss, vitiligo, anemia, eosinophilia
How is adrenal insufficiency diagnosed?
ACTH and serum cortisol
primary : low cortisol, high ACTH
secondary : low cortisol, low ACTH
What kind of stones are envelope shaped associated with?
Oxalate stones
What kind of stones are coffin shaped crystals associated with?
Struvite - proteus infections forming staghorn calculi and repetitive urinary infections
What kind of stones are hexagon shaped crystals associated with?
Cysteine - caused by amino acid transport abnormality
What is the typical presentation of a patient with analgesic nephropathy?
headaches with painless hematuria (papillary necrosis)- analgesics also induce chronic tubulointerstitial damage (WBC casts)
What is the treatment of choice for uric acid stones?
potassium citrate (alkalizes urine)
What are the long term sequelae of hypertension on the kidneys?
nephrosclerosis causing fibrosis of the arterioles
Describe the presentation of drug induced interstitial nephritis
fever, rash arthralgias
What are some of the risk factors for renovascular hypertension?
elevation in serum Cr. after starting ace, recurrent flash pulmonary edema, severe hypertension in patients with atherosclerosis, onset of severe hypertension after age 55
How is resistant hypertension defined?
persistent after 3 meds (one of which is a diuretic)
A young African American male presents with painless hematuria. He likely has..
sickle cell
What patterns of renal injury have an elevated BUN/Cr ratio?
obstructive uropathy, prerenal
What is the treatment for acute kidney transplant rejection?
IV steroids
Patients with nephrotic syndrome are at increased risk for…
atherosclerosis due to alterations in lipid metabolism
A patient presents with flank pain, poor urine output with intermittent episodes of high volume. This is likely..
urinary outflow obstruction
What is the classic form of kidney damage in HIV?
focal and segmental glomerulosclerosis
What are the most common causes of nephrotic syndrome?
membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease
What are the risk factors for FSGS?
African American, obesity, heroin use
A patient presents with nephrotic syndrome and improves before suddenly having abdominal pain, fever and hematuria. What happened and what was the likely etiology of her underlying kidney disease?
renal vein thrombosis, a common complication of membranous glomerulonephritis
A patient presents with symptoms of worsening urinary urgency, hesitancy, and nocturia as well as an elevated Cr. What should be done next?
abdominal ultrasound to evaluate for hydronephrosis
What antibiotics are commonly associated with acute renal failure ?
aminoglycosides (amikacin, tobramycin, gentamicin)
What is type I RTA? Type II? Type IV?
Type 1 - inability to excrete H+. nephrocalcinosis common
Type 2 - inability to reabsorb HC03
Type 4 - hypoaldosteronism - decreased Na absorbtion, decreased K+/H+ excretion. hyperkalemia and acidic urine
What is the most common cause of death in dialysis patients?
cardiovascular disease
What is the pathophysiology of membranoproliferative glomerulonephritis?
antibodies against C3 convertase leading to persistent activation of alternate complement pathway
How can one distinguish between metabolic alkalosis that is saline responsive vs. saline unresponsive?
saline resistant - excess mineralocorticoid leading to increased extracellular volume, high urine chloride
saline responsive - low urine chloride due to hypovolemia and hypochloremia
What are the characteristic findings on renal biopsy of diabetic nephropathy?
nodular glomerulosclerosis
What are the best measures that can be taken to improve diabetic nephropathy?
intensive BP control
A patient presents with periorbital swelling, hematuria, and oliguria after a course of illness. C3 levels are low. UA shows RBC casts and proteinuria. This is..
post streptococcal glomerulonephritis
A patient presents with hemoptysis, difficulty breathing, ankle edema and dark urine - it is diagnosed as goodpasteur’s. What is the best management?
emergency plasmaphoresis
A patient presents with recurrent kidney stones. What are the best recommendations?
increased fluid intake, sodium restriction, thiazide diuretic
What is the cause of cough as a side effect in ACEI patients?
increased in kinins
A patient comes in with low serum sodium and K+ but high urine electrolytes. Suspect..
diuretic abuse
A female patient aged 30 presents with transient vision loss, family history of stroke and resistant hypertension. What should you do next?
CT of abdomen - this is fibromuscular dysplasia
How does pH affect serum Ca levels?
increase in pH promotes Ca binding to albumin, decreasing serium Ca
What electrolyte disorders can result from loop diuretics?
hypokalemia and metabolic alkalosis
A patient presents with bilateral palpable abdominal masses, hypertension and microhematuria. This is..
autosomal dominant polycystic kidney disease
A patient presents with a 2 day history of fever and left sided scrotal pain with a leukocytosis and no urethral discharge. this is most likely caused by?
e. coli - if STD, likely would be urethral discharge
A patient presents with infertility, decreased testis size, elevated hemoglobin and he’s been working out. Serum testosterone levels are normal
exogenous steroid use - leves are normal because exogenous stuff supresses the natural stuff but it’s still picked up
A patient with diabetic nephropathy presents with lots of bleeding following getting blood drawn. this is due to? (and how do you treat?)
platelet dysfunction from uremic coagulopathy - tx with DDAVP
A patient with hx of IV drug use presents with urine all over the floor, confused and a CK of 15000. He is at greatest risk for..
acute renal failure
How large can kidney stones be to pass?
less than 5mm
A patient comes in with fevers, chills, dysuria and is given cipro. A few days later she’s still febrile and her symptoms haven’t improved. What is the next step?
renal ultrasound
What can be done to minimize contrast nephropaty?
non ionic agents, hydration
What would you expect for a patient with pyelonephritis on dipstick?
positive for nitrites nad esterase
A patient presents with skin rash, joint pains, fatigue, pos Hep C, palpable purpura, proteinuria and hematuria - this is..
mixed cryoglobinemia
How can you distinguish HSP from acute Hep C infection?
similarly can present with palpable purpura on buttocks, abdominal pain, proteinura - usually in children
complement levels normal in HSP, low in HepC;
What are the long term effects of analgesic abuse?
premature aging, urinary tract cancer, atherosclerotic vascular disease
A woman presents with 3 day history of burning urination, incereased frequency and labs show pos leuk esterase and nitrates. She has superpubic tenderness with no discharge. Tx?
nitrofunatoin for 5 days (uncomplicated cystitis)
What is a “complicated” cystitis and how do you manage it differently than uncomplicated cystitis?
diabetes, CKD, pregnancy, immunocompromised, UTI, hospital acquired infection - tx with flouroquinolones
A young patient presents with refractory hypertension and an abdominal bruit. Best course of tx?
percutaneous angioplasty with stent
What are common complications of nephrotic syndrome?
hypercoagability, transferrin loss leading to microcytic anemia, vit D deficiency, susceptibility to infection
What are the stages of diabetic nephropathy?
glomerular hyperfiltration – > GBM thickening – > mesangial expansion – > sclerosis
A man presents wtih a cough, takens some benadryl and then has difficutly voiding. why?
anticholinergic effects - detruser inactivity
