Renal Flashcards
how do you treat hyponatremia from SIADH that is Na > 120;
> 120: free water restriction and salt tabs
lymphocyte infiltration and intimal swelling after a renal transplant suggests what condition and how should it be treated
acute rejection; give high-dose IV steroids
describe the Potter sequence
urinary tract abnormality –> oliguria –> oligohydramnios –> pulmonary hypoplasia, flat facies, limb deformities
what are the findings on light microscopy vs. electron microscopy for minimal change disease
normal renal architecture on light
podocyte effacement on electron
what are the causes of hypoosmolar, hypovolemic hyponatremia with UNa
nonrenal salt loss (dehydration, vomiting, diarrhea)
painless hematuria is likely ______; what test should you order to confirm?
bladder cancer; order cystoscopy to confirm diagnosis
causes of hypoosmolar, euvolemic hyponatremia with:
-Uosm 300
300: SIADH
causes of hypoosmolar, hypervolemic, hyponatremia
CHF, hepatic failure, nephrotic syndrome
if a patient has urinary obstruction (i.e. BPH) and develops severe back pain what additional urinary sx can occur
inability to urinate (pain prevents valsalva needed to bypass obstruction)
describe the algorithm for working up acute oliguria
bedside bladderscan –> if urine retention then cath, and do urine biochemistry, if no urinary retention then do biochemistries –> determine prerenal vs. renal causes
what are the findings on light microscopy vs. electron microscopy for minimal change disease
normal renal architecture on light
podocyte effacement on electron
what causes kidney stones in Crohn’s
damaged and dysfunctional intestinal mucosa –> fat malabsorption –> fat preferentially binds calcium –> calcium no longer free to bind oxalate –> free unbound oxalate gets absorbed into bloodstream leading to increased urinary oxalate
what is the 1st line and 2nd line treatment for isolated enuresis
1st= desmopressin 2nd= TCA's
what are the mechanisms of the three types of renal tubular acidosis
RTA is non-anion gap metabolic acidosis due to:
type 1= defect in H+ secretion
type 2= defect in HCO3 reabsorption
type 4= aldosterone deficiency or resistance
in what predisposing conditions would you see IgA nephropathy
Henoch Schonlein purpura, after GI or respiratory infection
what kind of kidney disease can acyclovir cause
crystal-induced AKI due to acyclovir-crystal deposits in renal tubules leading to obstruction (less commonly causes ATN or AIN)
how does bactrim cause hyperkalemia
ENaC antagonism (similar to amiloride) which blocks Na reabsoption after the DCT where the macula densa uses high Na to promote aldosterone (therefore aldosterone is not increased and potassium excretion is lower) (note: also causes artificial Cr increase due to impaired secretion of creatinine)
how does chronic constipation (think this if you see anal fissures) cause recurrent cystitis in children
chronic constipation compresses the bladder leading to urinary stasis
what is the treatment for minimal change disease
steroids
what do the following casts signify:
-muddy brown casts, RBC casts, WBC casts, fatty casts, broad and waxy casts
muddy brown casts= ATN, RBC casts= glomerulonephritis, WBC casts=AIN or pyelonephritis, fatty casts=nephrotic syndrome, broad and waxy casts=chronic renal failure
dietary recommendations for patients with history of nephrolithiasis
decrease protein, decrease oxalate, decrease sodium, increase water, increase calcium
what two classes of drugs are used to treat BPH
alpha 1 blockers (tamsulosin, doxazosin), alpha 5 reductase inhibitors (finasteride)
what drugs cause acute interstitial nephritis
penicillins, cephalosporins, rifampin, bactrim, NSAIDs, diuretics, captopril
how does bactrim cause hyperkalemia
ENaC antagonism (similar to amiloride) which blocks Na reabsoption after the DCT where the macula densa uses high Na to promote aldosterone (therefore aldosterone is not increased and potassium excretion is lower) (note: also causes artificial Cr increase due to impaired secretion of creatinine)
what is the best way to test for diabetic nephropathy
spot or timed urine microalbumin/creatinine ratio
what is the treatment for minimal change disease
steroids
most common cause of AL (amyloid light chain) amyloidosis is ___________; most common cause of AA amyloidosis is __________
AL= multiple myeloma, (next is Waldenstrom) AA= rheumatoid arthritis
how do you treat hypernatremia that is:
- euvolemic
- asymptomatic hypovolemic
- symptomatic hypovolemic
- euvolemic: oral free water supplementation
- asymptomatic hypovolemic: 5% dextrose
- symptomatic hypovolemic: 0.9% NS until euvolemic followed by 5% dextrose
what two classes of drugs are used to treat BPH
alpha 1 blockers (tamsulosin, doxazosin), alpha 5 reductase inhibitors (finasteride)
what drugs cause acute interstitial nephritis
penicillins, cephalosporins, rifampin, bactrim, NSAIDs, diuretics, captopril
what is the acute management of severe hypercalcemia
saline hydration and calcitonin
what is the best way to test for diabetic nephropathy
spot or timed urine microalbumin/creatinine ratio
glomerulonephropathy in a patient with rheumatoid arthritis or IBD is most likely due to
amyloidosis
most common cause of AL (amyloid light chain) amyloidosis is ___________; most common cause of AA amyloidosis is __________
AL= multiple myeloma, (next is Waldenstrom) AA= rheumatoid arthritis
how do you treat hypernatremia that is:
- euvolemic
- asymptomatic hypovolemic
- symptomatic hypovolemic
- euvolemic: oral free water supplementation
- asymptomatic hypovolemic: 5% dextrose
- symptomatic hypovolemic: 0.9% NS until euvolemic followed by 5% dextrose
what’s the difference between treatment for contrast-induced nephropathy and contrast allergies
prednisone can help contrast allergies; prednisone MAY NOT be used for CIN, which is seen in patients with elevated creatinine or diabetes and a non-contrast alternative must be used
most common cause of renal failure in multiple myeloma
renal tubular damage due to light chains
what precautions decrease incidence of contrast-induced nephropathy
IV hydration and acetylcysteine
