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
