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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
Hyponatremia: order of parameters to look at (3)
``` Serum osmolality (< or >290) Urine osmolality (< or >100) Urine sodium (< or >25) ```
26
Diabetes insipidus: 2 types? Too little or too much of what hormone? Leads to hyper or hyponatremia?
Central, nephrogenic Too little ADH Hypernatremia
27
Drugs that can stimulate hypothalamic ADH production, causing SIADH (3)
carbamazepine cyclophosphamide SSRIs (eg. fluoxetine)
28
Drugs (or classes) that can cause hyperkalemia (8)
``` Nonselective b-blockers ACEi/ARB/K+ sparing diuretics Digitalis Cyclosporine Heparin NSAIDs Succinylcholine Trimethoprim ```
29
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?
CT abdo without contrast Decrease protein and oxalate consumption; decrease sodium intake; increase fluid intake; increase dietary calcium HCTZ
30
Urine dipstick: 2 parameters measured for UTIs, and what a positive result for each indicates
Nitrites: presence of Enterobacteriaceae, which convert urinary ntrates to nitrites Leukocyte esterase: presence of significant pyuria
31
Name of equation for calculating bicarb from pH and PaCO2
Henderson-Hasselbalch
32
1st step in Tx of metabolic alkalosis from vomiting
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
Initial hematuria usually indicates _____. Terminal hematuria usually indicates ______. Total hematuria usually indicates ______.
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
Renal cell carcinoma: classic triad and 2 other findings (or groups of findings)
``` Triad: flank pain, hematuria, palpable abdominal renal mass Scrotal varicoceles (left-sided) Paraneoplastic syndromes (anemia or erythrocytosis, thrombocytosis, fever, hypercalcemia, cachexia) ```
35
Electrolyte disturbance that can occur during or immediately after surgery requiring multiple blood transfusions
Hypocalcemia (usually results from volume expansion and hypoalbuminemia as well as citrate binding) Sx = hyperactive deep tendon reflexes, muscle cramps, convulsions (rarely)
36
Glomerulopathy most often associated with HIV
Collapsing focal and segmental glomerulosclerosis (aka HIV-related nephropathy) Sx = nephrotic range proteinuria, azotemia, normal-sized kidneys
37
What is given for cardioprotection before Tx for hyperkalemia?
Calcium gluconate (reduces the excitability of cardiomyocytes thus lowering the likelihood of developing cardiac arrhythmias) or calcium chloride
38
What is fastest way to decrease hyperkalemia?
Insulin/glucose (15-30 min, although transient, so further action must be taken) - faster than hemodialysis (set-up!), Kayexalate, furosemide, inhaled b2-agonists
39
Amitriptyline is from what class of drugs; has what property and common side effect?
Tricyclic antidepressant Anticholinergic properties Urinary retention (bladder empties under muscarinic control)
40
Gastric contents are rich in which 3 electrolytes?
H+, Cl-, K+
41
Most common and pathognomonic histologic lesions in diabetic nephropathy? Findings? (2)
Most common: Diffuse glomerulosclerosis; Pathognomonic: Nodular glomerulosclerosis (with Kimmelstiel-Wilson nodules) Proteinuria, progressive decline in GFR
42
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?
Myoglobinuria | Usually caused by rhabdomyolysis, freq leads to acute renal failure (due to tubular injury).
43
Choices to shift potassium intracellularly in hyperkalemia (3)
b2-agonists (eg. albuterol by nebulizer) insulin/glucose sodium bicarb (in certain cases)
44
Patients with hyperkalemia in the setting of CKD (esp those in ACEi) require what strategy to reduce K and why? What are options? (3)
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
The most common cause of abnormal hemostasis in patients with chronic renal failure (uremia) is ______. Tx of choice?
``` 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
Signs of mixed cryoglobulinemia (3 main ones and 4 possible ones). What underlying infection is associated with it?
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
Autosomal dominant polycystic kidney disease - Presenting Sx? (5)
Gross hematuria, recurrent flank pain, kidney cysts, UTI/pyelonephritis, nephrolithiasis
48
Patients age >35 with gross painless hematuria should be evaluated for _________; workup includes ________ (2).
``` Urological neoplasms (bladder tumours are most common malignancy assoc with painless hematuria) Diagnostic imaging (CT urogram) and cystoscopy. ```
49
Major side FX of cyclosporine (6) and tacrolimus (4)
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
Mech and major toxicity of azathioprine (3)
Immunosuppressant; inhibits purine synth Dose-related diarrhea, leukopenia, hepatotoxicity.
51
Mech and major toxicity of mycophenolate (1)
Inh de novo purine synth --> Immunosuppression Bone marrow suppression
52
Stones with hexagonal crystals?
cysteine (cysteinuria is due to defective transport of dibasic amino acids - familial) - stones are hard and radioopaque
53
Test that is usually positive with cysteinuria
urinary cyanide nitroprusside test
54
Stones assoc with UTIs
struvite
55
Etiologies that cause increased K mvt out of cells and therefore hyperK (2)
uncontrolled hyperglycemia | metabolic acidosis
56
Etiologies that cause hyperK due to increased tissue catabolism (2)
trauma | tumour lysis syndrome
57
Indications for acute Tx of hyperK (eg. calcium gluconate + insulin/glucose)
- pts with ECG changes - K>7 without ECG changes - rapidly rising K due to tissue breakdown
58
Nephrotic syndrome is defined as _____. | Most common causes of nephrotic syndrome in adults in the absence of a systemic disease? (2)
``` 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
Morning sickness vs. hyperemesis gravidarum
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
What CO2 levels are seen in late preg? Why?
Hypocapnia; progesterone directly stimulates central resp centre leading to increased resp drive + exaggerated resp effort --> primary resp alkalosis with metab compensation
61
______ is an important complication of nephrotic syndrome. Presentation? This complication is most common with which etiology?
Renal vein thrombosis Sudden onset abdo pain, fever, hematuria Membranous glomerulonephritis
62
Reason for urinary retention in the setting of herniated disk with no saddle anesthesia and normal sphincter tone?
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
Nearly 20% of cocaine overdoses are complicated by _____ leading to ______.
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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