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IM > Renal > Flashcards

Renal Flashcards

1
Q

What are the causes of hypovolemic hypotonic hyponatremia?

A

diuretics, adrenal insufficiency, vomiting

diarrhea, sweating, burns

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2
Q

What are causes of euvolemic hypotonic hyponatremia?

A

thiazides, glucocorticoid deficiency, hypothyroid, SIADH

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3
Q

What are the causes of hypervolemic hypotonic hyponatremia?

A

CHF, liver disease, nephrosis

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4
Q

What are some of the signs of uremia?

A

Mental status change, pericardial rub, metallic breath

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5
Q

What is the difference between DK and HHNK?

A

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

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6
Q

What are the treatment protocols for a hyperglycemia crisis?

A

IVF with NS, IV insulin, if pH < 6.9, bicarb, serum K+, check glucose every 60 mins,

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7
Q

Describe the pros/cons of renal dialysis vs. transplantatin

A

transplant: better survival and quality of life, resolution of anemia, bone disease, return of endocrine, sexual functions etc, autonomic retinopathy improves,

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8
Q

Describe the workup for hypocalcemia

A

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

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9
Q

Describe the workup for a patient with hypertension and hypokalemia

A

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)

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10
Q

Describe the presentation of hypokalemia including EKG findings

A

weakness, fatigue, muscle cramps
in severe cases, flaccid paralysis, tetany, rhabdo,
EKG - broad flat T waves, U waves, ST depression, PVCs

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11
Q

Describe the findings of hyperkalemia including EKG findings

A

peaked T waves, widening of QRS, development of sinusoidal pattern

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12
Q

What are potential side effects of diuretics?

A

metabolic alkalosis, hypokalemia

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13
Q

What is the presentation, lab findings, treatment and complications of Hereditary Spherocytosis?

A

hemolytic anemia, jaundice, splenomegaly
lab findings: spherocytes, increased osmotic fragility
treatment: folic acid, blood transfusions, splenectomy
complications: pigment gallstones

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14
Q

What are some of the causes of primary adrenal insufficiency?

A

autoimmune, infectious, hemorrhagic (meningococcemia), cancer

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15
Q

What is the clinical presentation of adrenal insufficiency? (acute and chronic)

A

acute - shock, abdominal tenderness, nausea, vomiting, hyponatremia, hyperkalemia
chronic - fatigue, weakness, GI, weight loss, vitiligo, anemia, eosinophilia

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16
Q

How is adrenal insufficiency diagnosed?

A

ACTH and serum cortisol
primary : low cortisol, high ACTH
secondary : low cortisol, low ACTH

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17
Q

What kind of stones are envelope shaped associated with?

A

Oxalate stones

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18
Q

What kind of stones are coffin shaped crystals associated with?

A

Struvite - proteus infections forming staghorn calculi and repetitive urinary infections

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19
Q

What kind of stones are hexagon shaped crystals associated with?

A

Cysteine - caused by amino acid transport abnormality

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20
Q

What is the typical presentation of a patient with analgesic nephropathy?

A

headaches with painless hematuria (papillary necrosis)- analgesics also induce chronic tubulointerstitial damage (WBC casts)

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21
Q

What is the treatment of choice for uric acid stones?

A

potassium citrate (alkalizes urine)

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22
Q

What are the long term sequelae of hypertension on the kidneys?

A

nephrosclerosis causing fibrosis of the arterioles

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23
Q

Describe the presentation of drug induced interstitial nephritis

A

fever, rash arthralgias

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24
Q

What are some of the risk factors for renovascular hypertension?

A

elevation in serum Cr. after starting ace, recurrent flash pulmonary edema, severe hypertension in patients with atherosclerosis, onset of severe hypertension after age 55

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25
Q

How is resistant hypertension defined?

A

persistent after 3 meds (one of which is a diuretic)

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26
Q

A young African American male presents with painless hematuria. He likely has..

A

sickle cell

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27
Q

What patterns of renal injury have an elevated BUN/Cr ratio?

A

obstructive uropathy, prerenal

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28
Q

What is the treatment for acute kidney transplant rejection?

A

IV steroids

29
Q

Patients with nephrotic syndrome are at increased risk for…

A

atherosclerosis due to alterations in lipid metabolism

30
Q

A patient presents with flank pain, poor urine output with intermittent episodes of high volume. This is likely..

A

urinary outflow obstruction

31
Q

What is the classic form of kidney damage in HIV?

A

focal and segmental glomerulosclerosis

32
Q

What are the most common causes of nephrotic syndrome?

A

membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease

33
Q

What are the risk factors for FSGS?

A

African American, obesity, heroin use

34
Q

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?

A

renal vein thrombosis, a common complication of membranous glomerulonephritis

35
Q

A patient presents with symptoms of worsening urinary urgency, hesitancy, and nocturia as well as an elevated Cr. What should be done next?

A

abdominal ultrasound to evaluate for hydronephrosis

36
Q

What antibiotics are commonly associated with acute renal failure ?

A

aminoglycosides (amikacin, tobramycin, gentamicin)

37
Q

What is type I RTA? Type II? Type IV?

A

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

38
Q

What is the most common cause of death in dialysis patients?

A

cardiovascular disease

39
Q

What is the pathophysiology of membranoproliferative glomerulonephritis?

A

antibodies against C3 convertase leading to persistent activation of alternate complement pathway

40
Q

How can one distinguish between metabolic alkalosis that is saline responsive vs. saline unresponsive?

A

saline resistant - excess mineralocorticoid leading to increased extracellular volume, high urine chloride
saline responsive - low urine chloride due to hypovolemia and hypochloremia

41
Q

What are the characteristic findings on renal biopsy of diabetic nephropathy?

A

nodular glomerulosclerosis

42
Q

What are the best measures that can be taken to improve diabetic nephropathy?

A

intensive BP control

43
Q

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..

A

post streptococcal glomerulonephritis

44
Q

A patient presents with hemoptysis, difficulty breathing, ankle edema and dark urine - it is diagnosed as goodpasteur’s. What is the best management?

A

emergency plasmaphoresis

45
Q

A patient presents with recurrent kidney stones. What are the best recommendations?

A

increased fluid intake, sodium restriction, thiazide diuretic

46
Q

What is the cause of cough as a side effect in ACEI patients?

A

increased in kinins

47
Q

A patient comes in with low serum sodium and K+ but high urine electrolytes. Suspect..

A

diuretic abuse

48
Q

A female patient aged 30 presents with transient vision loss, family history of stroke and resistant hypertension. What should you do next?

A

CT of abdomen - this is fibromuscular dysplasia

49
Q

How does pH affect serum Ca levels?

A

increase in pH promotes Ca binding to albumin, decreasing serium Ca

50
Q

What electrolyte disorders can result from loop diuretics?

A

hypokalemia and metabolic alkalosis

51
Q

A patient presents with bilateral palpable abdominal masses, hypertension and microhematuria. This is..

A

autosomal dominant polycystic kidney disease

52
Q

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?

A

e. coli - if STD, likely would be urethral discharge

53
Q

A patient presents with infertility, decreased testis size, elevated hemoglobin and he’s been working out. Serum testosterone levels are normal

A

exogenous steroid use - leves are normal because exogenous stuff supresses the natural stuff but it’s still picked up

54
Q

A patient with diabetic nephropathy presents with lots of bleeding following getting blood drawn. this is due to? (and how do you treat?)

A

platelet dysfunction from uremic coagulopathy - tx with DDAVP

55
Q

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..

A

acute renal failure

56
Q

How large can kidney stones be to pass?

A

less than 5mm

57
Q

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?

A

renal ultrasound

58
Q

What can be done to minimize contrast nephropaty?

A

non ionic agents, hydration

59
Q

What would you expect for a patient with pyelonephritis on dipstick?

A

positive for nitrites nad esterase

60
Q

A patient presents with skin rash, joint pains, fatigue, pos Hep C, palpable purpura, proteinuria and hematuria - this is..

A

mixed cryoglobinemia

61
Q

How can you distinguish HSP from acute Hep C infection?

A

similarly can present with palpable purpura on buttocks, abdominal pain, proteinura - usually in children
complement levels normal in HSP, low in HepC;

62
Q

What are the long term effects of analgesic abuse?

A

premature aging, urinary tract cancer, atherosclerotic vascular disease

63
Q

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?

A

nitrofunatoin for 5 days (uncomplicated cystitis)

64
Q

What is a “complicated” cystitis and how do you manage it differently than uncomplicated cystitis?

A

diabetes, CKD, pregnancy, immunocompromised, UTI, hospital acquired infection - tx with flouroquinolones

65
Q

A young patient presents with refractory hypertension and an abdominal bruit. Best course of tx?

A

percutaneous angioplasty with stent

66
Q

What are common complications of nephrotic syndrome?

A

hypercoagability, transferrin loss leading to microcytic anemia, vit D deficiency, susceptibility to infection

67
Q

What are the stages of diabetic nephropathy?

A

glomerular hyperfiltration – > GBM thickening – > mesangial expansion – > sclerosis

68
Q

A man presents wtih a cough, takens some benadryl and then has difficutly voiding. why?

A

anticholinergic effects - detruser inactivity

IM (24 decks)

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