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CC Internal Med > Renal > Flashcards

Renal Flashcards

1
Q

Appropriate compensation in metabolic acidosis

A

Winters formula:

Arterial paCO2 = 1.5*[HCO3-] + 8 mmHg +/-2 mmHg

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2
Q

Appropriate compensation in metabolic alkalosis

A

Increase in arterial PaCO2 by 0.7 mmHg for every 1mM rise in serum HCO3- above 24

OR: PaCO2 = 0.9*[HCO3-] + 16 +/-2 mmHg

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3
Q

Acute respiratory acidosis appropriate compensation

A

Increase in serum HCO3- by 1mM for every 10mmHg rise in arterial PaCO2

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4
Q

Acute respiratory alkalosis appropriate compensation

A

Decrease in serum HCO3- by 2mM for every 10mmHg decrease in arterial PaCO2

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5
Q

Common extrapulmonary sites for TB (5)

A

Liver, spleen, kidney, bone, adrenal

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6
Q

5 granulomatous diseases that can cause adrenal insufficiency

A 
TB
histoplasmosis
coccidiomycosis
cryptococcosis
sarcoidosis
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7
Q

Aldosterone acts on what part of kidney?
What does it do?
What abnormalities are present if aldosterone is deficient?
What abnormalities with hyperaldosteronism?

A

Distal renal tubules
Increase sodium resorption and secrete potassium and hydrogen ions
Deficient: Hyperkalemia, hyponatremia, normal anion gap metabolic acidosis
Hyperaldosteronism: metabolic alkalosis, hypokalemia

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8
Q

Crystals (shape and composition) seen in urine of pt with ethylene glycol poisoning

A

calcium oxalate - envelope-shaped

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9
Q

Loop diuretics function by inhibiting ________ in what part of the kidney?

What do they do to H+ and K+?

A

Na-K-2Cl carrier in the loop of Henle

(1) Increased loss of Na in urine –> increased Na to distal tubule –> elevated H+ and K+ secretion in urine
(2) Volume contraction –> increased aldosterone –> further H+ and K+ secretion into urine

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10
Q

AKI tends to cause what acid-base and electrolyte disturbances?

A

Anion gap metabolic acidosis

Hyperkalemia

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11
Q

Bowel ischemia causes what acid-base disturbance?

A

Anion gap acidosis from increased circulating lactate

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12
Q

Acid-base disturbance caused by atelectasis?

A

Atelectasis is not a common cause of acid-base disturbances.

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13
Q

Hypocalcemia may cause… (3)

A

Hyperactive deep tendon reflexes, muscle cramps, convulsions

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14
Q

Severe hypomagnesemia may mimic hypocalcemia because it causes ____.

A

decreased PTH secretion and decreased peripheral responsiveness to PTH

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15
Q

Hypokalemia SX? (3)

ECG change? (1)

A

Muscle weakness, cramps; may progress to flaccid paralysis if severe. ECG shows U waves (severe).

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16
Q

Hyperkalemia Sx? (3)

A

Muscle weakness, flaccid paralysis; asystole if severe.

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17
Q

Hypermagnesemia may cause… (5)

A

Decreased deep tendon reflexes (mild);

loss of reflexes, muscle paralysis, apnea, cardiac arrest (severe)

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18
Q

What is special about aspirin overdose and acid-base disturbances?

A

ASA diretly stimulates the medullary respiratory centre to cause tachypnea and respiratory alkalosis; it also causes an anion gap metabolic acidosis due to increased production and decreased elim of organic acids (lactic acid, ketoacids). Therefore, mixed acid-base disorder; pH can be normal.

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19
Q

Initial tx for severe hypovolemic hypernatremia?

Mild hypovolemic hypernatremia?

A

Isotonic 0.9% saline
Once volume deficit is restored, switch to 0.45% saline (1/2NS) to better replace the free water deficit
Goal rate of correction: max 1mM/h (faster may result in cerebral edema)

Mild cases: initially use 5% dextrose in 0.45% saline.

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20
Q

Initial Tx for euvolemic or hypervolemic hypernatremia?

A

D5W

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21
Q

DDx hyponatremia with high serum osmolality (>290) (2)

A

Marked hyperglycemia

Advanced renal failure

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22
Q

DDx hyponatremia with serum osmolality <100 (2)

A

Primary polydipsia

Malnutrition (beer drinker’s potomania)

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23
Q

DDx hyponatremia with normal or low serum osmolality (100 and urine sodium <25 (3)

A

Volume depletion
CHF
Cirrhosis

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24
Q

DDx hyponatremia with normal or low serum osmolality (100 and urine sodium >25 (3)

A

SIADH
Adrenal insufficiency
Hypothyroidism

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25
Q

Hyponatremia: order of parameters to look at (3)

A 
Serum osmolality (< or >290)
Urine osmolality (< or >100)
Urine sodium (< or >25)
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26
Q

Diabetes insipidus: 2 types?
Too little or too much of what hormone?
Leads to hyper or hyponatremia?

A

Central, nephrogenic
Too little ADH
Hypernatremia

27
Q

Drugs that can stimulate hypothalamic ADH production, causing SIADH (3)

A

carbamazepine
cyclophosphamide
SSRIs (eg. fluoxetine)

28
Q

Drugs (or classes) that can cause hyperkalemia (8)

A 
Nonselective b-blockers
ACEi/ARB/K+ sparing diuretics
Digitalis
Cyclosporine
Heparin
NSAIDs
Succinylcholine
Trimethoprim
29
Q

Test for detecting radioopaque and radiolucent stones?
Dietary advice to lower likelihood of stone formation? (4)
Patients with hypercalciuria and recurrent stones should be placed on which med?

A

CT abdo without contrast
Decrease protein and oxalate consumption; decrease sodium intake; increase fluid intake; increase dietary calcium
HCTZ

30
Q

Urine dipstick: 2 parameters measured for UTIs, and what a positive result for each indicates

A

Nitrites: presence of Enterobacteriaceae, which convert urinary ntrates to nitrites
Leukocyte esterase: presence of significant pyuria

31
Q

Name of equation for calculating bicarb from pH and PaCO2

A

Henderson-Hasselbalch

32
Q

1st step in Tx of metabolic alkalosis from vomiting

A

IV NS and K
(1. vomiting causes loss of H+ & Cl- and because no acid reaches pancreas, bicarb is not released into duodenum, causing increase in blood bicarb; 2. lower volume causes activation of renin-angiotensin and loss of H+ and K+ (=contraction alkalosis) —> reverse by giving volume and K+)

33
Q

Initial hematuria usually indicates _____.
Terminal hematuria usually indicates ______.
Total hematuria usually indicates ______.

A

Initial (at start of urination only): lesion in urethra (eg. urethritis)
Terminal (at end of urination): prostatic or bladder lesion
Total (throughout urination): disease in ureters or kidneys

34
Q

Renal cell carcinoma: classic triad and 2 other findings (or groups of findings)

A 
Triad: flank pain, hematuria, palpable abdominal renal mass
Scrotal varicoceles (left-sided)
Paraneoplastic syndromes (anemia or erythrocytosis, thrombocytosis, fever, hypercalcemia, cachexia)
35
Q

Electrolyte disturbance that can occur during or immediately after surgery requiring multiple blood transfusions

A

Hypocalcemia (usually results from volume expansion and hypoalbuminemia as well as citrate binding)

Sx = hyperactive deep tendon reflexes, muscle cramps, convulsions (rarely)

36
Q

Glomerulopathy most often associated with HIV

A

Collapsing focal and segmental glomerulosclerosis (aka HIV-related nephropathy)

Sx = nephrotic range proteinuria, azotemia, normal-sized kidneys

37
Q

What is given for cardioprotection before Tx for hyperkalemia?

A

Calcium gluconate (reduces the excitability of cardiomyocytes thus lowering the likelihood of developing cardiac arrhythmias) or calcium chloride

38
Q

What is fastest way to decrease hyperkalemia?

A

Insulin/glucose (15-30 min, although transient, so further action must be taken) - faster than hemodialysis (set-up!), Kayexalate, furosemide, inhaled b2-agonists

39
Q

Amitriptyline is from what class of drugs; has what property and common side effect?

A

Tricyclic antidepressant
Anticholinergic properties
Urinary retention (bladder empties under muscarinic control)

40
Q

Gastric contents are rich in which 3 electrolytes?

A

H+, Cl-, K+

41
Q

Most common and pathognomonic histologic lesions in diabetic nephropathy? Findings? (2)

A

Most common: Diffuse glomerulosclerosis; Pathognomonic: Nodular glomerulosclerosis (with Kimmelstiel-Wilson nodules)
Proteinuria, progressive decline in GFR

42
Q

In cases of large amount of blood on urinalysis with relative absence of RBCs on urine microscopy, suspect ________. What is it usually caused by and what does it frequently lead to?

A

Myoglobinuria

Usually caused by rhabdomyolysis, freq leads to acute renal failure (due to tubular injury).

43
Q

Choices to shift potassium intracellularly in hyperkalemia (3)

A

b2-agonists (eg. albuterol by nebulizer)
insulin/glucose
sodium bicarb (in certain cases)

44
Q

Patients with hyperkalemia in the setting of CKD (esp those in ACEi) require what strategy to reduce K and why? What are options? (3)

A

Interventions to remove potassium from the body (and not shift it intracellularly) because they have an excess of total body potassium
Diuretics (eg. loop) & hydration, cation exchange resins (trade Na for K), hemodialysis

45
Q

The most common cause of abnormal hemostasis in patients with chronic renal failure (uremia) is ______. Tx of choice?

A 
Platelet dysfunction (PT, PTT, and platelet count are normal; BT is prolonged)
Desmopressin - releases VIII/vWF multimers from endothelial storage sites
Platelet transfusion is not indicated since transfused platelets quickly become inactive.
46
Q

Signs of mixed cryoglobulinemia (3 main ones and 4 possible ones).
What underlying infection is associated with it?

A

Palpable purpura, proteinuria, hematuria
Other suggestive manifestations: nonspecific systemic Sx, arthralgias, hepatosplenomegaly, hypocomplementemia

Majority of pts have underlying HepC infection. (Test for circulating cryoglobulins and HCV antibodies)

47
Q

Autosomal dominant polycystic kidney disease - Presenting Sx? (5)

A

Gross hematuria, recurrent flank pain, kidney cysts, UTI/pyelonephritis, nephrolithiasis

48
Q

Patients age >35 with gross painless hematuria should be evaluated for _________; workup includes ________ (2).

A 
Urological neoplasms (bladder tumours are most common malignancy assoc with painless hematuria)
Diagnostic imaging (CT urogram) and cystoscopy.
49
Q

Major side FX of cyclosporine (6) and tacrolimus (4)

A

Both immunosuppressants, same mech (calcineurin inh - inh IL-2 transcription)

Cyclosporine: nephrotoxicity, hyperK, hyperT, gum hypertrophy, hirsutism, tremor.

Tacrolimus: same as above except for hirsutism and gum hypertrophy.

50
Q

Mech and major toxicity of azathioprine (3)

A

Immunosuppressant; inhibits purine synth

Dose-related diarrhea, leukopenia, hepatotoxicity.

51
Q

Mech and major toxicity of mycophenolate (1)

A

Inh de novo purine synth –> Immunosuppression

Bone marrow suppression

52
Q

Stones with hexagonal crystals?

A

cysteine (cysteinuria is due to defective transport of dibasic amino acids - familial) - stones are hard and radioopaque

53
Q

Test that is usually positive with cysteinuria

A

urinary cyanide nitroprusside test

54
Q

Stones assoc with UTIs

A

struvite

55
Q

Etiologies that cause increased K mvt out of cells and therefore hyperK (2)

A

uncontrolled hyperglycemia

metabolic acidosis

56
Q

Etiologies that cause hyperK due to increased tissue catabolism (2)

A

trauma

tumour lysis syndrome

57
Q

Indications for acute Tx of hyperK (eg. calcium gluconate + insulin/glucose)

A
  • pts with ECG changes
  • K>7 without ECG changes
  • rapidly rising K due to tissue breakdown
58
Q

Nephrotic syndrome is defined as _____.

Most common causes of nephrotic syndrome in adults in the absence of a systemic disease? (2)

A 
Heavy proteinuria (>3.5 g/24h) with hypoalbuminemia and edema.
Focal segmental glomerulosclerosis, membranous nephropathy (FSGS is more common in blacks, obese, heroin use, and HIV)
59
Q

Morning sickness vs. hyperemesis gravidarum

A

Both: 1st to late-2nd trimesters
Morning sickness: nausea +/- mild vomiting, no volume depletion
Hyperemesis gravidarum: severe vomiting, leads to weight loss and volume depletion –> generation stage of metab alkalosis + contraction metab alkalosis

60
Q

What CO2 levels are seen in late preg? Why?

A

Hypocapnia; progesterone directly stimulates central resp centre leading to increased resp drive + exaggerated resp effort –> primary resp alkalosis with metab compensation

61
Q

______ is an important complication of nephrotic syndrome. Presentation? This complication is most common with which etiology?

A

Renal vein thrombosis
Sudden onset abdo pain, fever, hematuria
Membranous glomerulonephritis

62
Q

Reason for urinary retention in the setting of herniated disk with no saddle anesthesia and normal sphincter tone?

A

Severe pain - usually in men with BPH, they require Valsalva to initiate and maintain urinary stream, but in this case it’s too painful to initiate sufficient intraabdo pressure.

63
Q

Nearly 20% of cocaine overdoses are complicated by _____ leading to ______.

A

Rhabdomyolysis (marked by elevated serum creatine phosphokinase > 20,000) –> acute renal tubular necrosis due to myoglobinuria.

CC Internal Med (6 decks)

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