Renal Flashcards
Milk-alkali Syndrome can lead to?
Acute Renal Failure
When should you measure PTH levels in Milk Alkali Syndrome?
In milk-alkali syndrome, vigorous treatment of hypERcalcemia with saline diuresis and loop diuretics may lead to hypOcalcemia. With the hypocalcemia, PTH will rise and may reach levels above reference range. Therefore:
PTH levels should be determined BEFORE or AT THE INITIATION of tx.
Gitelman Syn (Bartter Syn if
AR disorder of Na-Cl cotransporter at distal tubule in early adulthood
HyPOKalemia and AlkaLOsis
Hypercalciuria
Inc. Renin, Aldosterone, and HCO3
Weakness, fatigue, spasm
CHF can lead to ischemia which can then lead to what in the kidneys?
What would you see on microscopic urine analysis?
Acute Tubular Necrosis
Muddy brown granular casts
Pts. with ATN will typically have a FeUrea of what?
> 50%
Cystinosis inheritance?
Auto Rec
Cystinosis:
S&S
How does it cause problems?
Defective transport of cystine out of lysosomes that manifests as:
polyuria, polydipsia, dehydration,
non-anion gap met acidosis, rickets, FTT
ADPKD keywords
Hypertension Hematuria (episodic) Stroke fam hx Hepatic cysts on CT, One parent has renal cysts too Chromosome 16 Berry aneurysms
30 y.o.
What is the leading cause of death in ADPKD?
cardiovascular disease
What is the 1st line tx for VUR?
Daily Amoxicillin, TMP-SMX, or Nitrofurantoin
Medullary Cystic Disease
inc. uric acid –> gout in the young teen
eventual renal failure
What has been shown to prevent Contrast-Induced Nephropathy?
Aggressive hydration
Tx. Fibromuscular Dysplasia
Angioplasty + Renal A. Stent placement
What diabetic drug can’t you give to someone with renal failure/impairment? Why?
Metformin –> Lactic Acidosis
Car crash pt. –> brown urine is likely?
Appropriate dx. to confirm?
Rhabdomyolysis
elevated Creatinine Kinase
Bladder pressure is used to dx. what?
Abdominal compartment syndrome
Suprapubic abd pain + fever + dysuria + pneumaturia + urine per rectum would be indicative of?
Colovesical fistula
What is the most common cause of colovesical fistula?
Acute diverticulitis
Primary Hyperaldosteronism
adenoma of glomerulosa of adrenal gland
Bartter Syndrome
Presents prior to 2 y.o.
Low Mg2+
High Urine Ca2+
What is Winter’s Formula?
When is it used?
Expected pCO2 = [1.5 * HCO3-] + 8 +/- 2
During metabolic acidosis
Tx. asymptomatic renal cyst
Nothing
Triad of Renal Cell Carcinoma
Increased risk with?
To where does it usually metastasize?
Hematuria
Flank pain
Possible flank mass
Inc. risk with obesity and smoking
To lungs
Drug given in Microalbuminuria
Lisinopril
Most CKD pts. on dialysis die from?
cardiovascular disease
Liddle Syndrome
AD mutation of ENaC channel in distal tubule HTN HypOkalemia and alkaLOsis HyPERnatremia Low Aldosterone
What common medication should you remember can cause bladder distension via its anticholinergic side effects?
Benadryl
Post-Strep Glomerulonephritis
S&S
Dx?
What is a common consequence of PSGN?
Type 3 H.S. rxn
periorbital edema, coca-cola urine, HTN
UA
CBC, complement levels (remember IgG, IgM, and C3 deposit on basement membrane), strep Ag assays, antiDnase B Abs
“Lumpy bumpy” on immunofluorescence
HTN
Gentamicin is associated with what condition?
Renal Tubular Acidosis Type I –> Hypokalemia –> Flat T waves
NephrOtic Syndrome keywords
e.g.
prOteinuria 3.5 g/d and edema
frothy urine + fatty casts
decreased albumin
increased lipids
e.g. Focal Segmental Glomerulosclerosis (FSGS) Minimal change dz Membranous nephropathy Amyloidosis Diabetic glomerulonephropathy
Nephritic Syndrome keywords
e.g.
Inflammation Azotemia Hematuria Oliguria hypertension granular casts
e.g. Post-strep glomerulonephritis (PSGN) Rapidly progressive glomerulonephritis IgA Nephropathy (Berger Disease) Alport Syndrome Membranoproliferative Glomerulonephritis
ARPKD keywords
Chromosome 6
ARPKD in a full sibling
Ethylene glycol poisoning
calcium oxalate crystals (“envelope”)
Rapidly Progressive (Crescentic) Glomerulonephritis keywords
e.g.
Tx
crescent moon
hematuria, hemoptysis
poor prognosis
e.g.
Goodpasture (pANCA+)
Granulomatosis w/ polyangiitis (aka Wegener - cANCA+)
Tx: Plasmapheresis
Diffuse Proliferative Glomerulonephritis keywords
SLE’s most common cause of death
“wire looping” of capillaries
IgA Nephropathy keywords
mesangial proliferation
immune complex deposits
assoc. w/ Henoch Schonlein Purpura
RBC casts
Alport syndrome keywords
type IV collagen mutation
X-Recessive
“Basket weave”
Membranoproliferative Glomerulonephritis (MPGN) keywords
Type I - Tram track Immune complex deposition, Hep B/ HepC
Type II - intramembranous immune complex “dense” deposits
Focal Segmental Glomerulosclerosis keywords
Foot processes effacement
African Americans, Hispanics
HIV, Heroin, Interferon
Minimal Change Disease keywords
children
normal glomeruli
Tx. Steroids
Membranous Nephropathy keywords
GBM thickening
Spike and Dome
Caucasian adults
Diabetic Glomerulonephropathy keywords
Kimmelsteil Wilson (eosinophilic nodular glomerulosclerosis) GBM thickening
1st Line Tx. for non-pregnant woman with pyelonephritis requiring hospitalization?
Ciprofloxacin
1st line Tx. for Acute cystitis?
TMP-SMX
Staghorn calculi keywords
CVA tenderness (S&S nephrolithiasis)
Alkaline urine pH, urease-producing Proteus
Coffin-lid Mg-Ammonium-Phosphate crystals
Radioopaque (seen on xray)
What value for BUN:Cr would indicate pre-renal cause for Acute Kidney Injury?
BUN:Cr >20
