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Renal Flashcards

1
Q

Specific treatments for anion-gap causes of RTA- MUDPILES?

A

Methanol: Fomepizole; Uremia: Dialysis; DKA: Insulin, fluids; Paraldehyde; Phenformin; Iron, INH: Gl lavage, charcoal (INH); Lactic acidosis; Ethylene glycol: Fomepizole; Salicylates: Alkalinize urine

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2
Q

Nongap metabolic acidosis, hypophosphatemia, glycosuria, aminoaciduria, normal blood glucose, pH<5.5; w/ rickets, osteomalacia.

A

RTA2 - Proximal (Fanconi’s) rx Thiazides, volume depletion to increase reabsorption.

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3
Q

Nongap metabolic acidosis, hypokalemia, ca phosphate kidney stones, urine pH>5.5

A

RTA1 - Distal (H+ secretion defect); rx replace bicarbonate; can be genetic, autoimmune (sjogrens), medication tox

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4
Q

Nongap metabolic acidosis, hyperkalemic, hyperchloremia, pH<5.5 (can be a/w obstructive uropathy, CAH)

A

RTA4 - Hyperkalemia impairs ammoniagenesis, buffering capacity, H+ excretion; rx Furosemide, mineralocorticoid, glucocorticoid

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5
Q

RTA 2 etiology?

A

Defect in proximal tubule HCO3− reabsorption: Hereditary (Fanconi’s or cystinosis), drugs (carbonic anhydrase inhibitors), multiple myeloma, amyloidosis, heavy metal poisoning, vitamin D deficiency

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6
Q

RTA 4 etiology?

A

1 aldosterone deficiency, hyporeninemic hypoaldosteronism (kidney disease, ACEis, NSAIDs), drugs (amiloride, spironolactone, heparin), pseudo­hypoaldosteronism.

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7
Q

RTA 1 etiology?

A

Defect α intercalated cell H+ secretion:Hereditary, cirrhosis, autoimmune disorders (Sjogren’s syndrome, SLE), hypercalciuria, sickle cell disease, drugs (lithium, amphotericin)

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8
Q

Indications for acute Dialysis; AEIOU

A

Acidosis; Electrolyte abnormalities (hyperkalemia sx or >6.5) Ingestions (salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol); Overload (fluid); Uremic symptoms (pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus)

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9
Q

Diabetic pt w/ chest pain, significant azotemia, friction rub, ST elevations, absent pulsus paradoxus, pruritis, elevated BUN, dx, rx?

A

Uremic pericarditis w/o tamponade; emergent dialysis

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10
Q

Diabetic w/ H2O depletion, hyperglycemia, post rx w/ insulin p/w flattened T waves, flaccid paralysis, hypercapnia, rhabdomyolysis

A

Hypokalemia via insulin, aldosterone increase form dehydration (Na in/K out)

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11
Q

Hypokalemia resistant to correction, explained via another electrolyte abnormality?

A

Hypomagnesium

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12
Q

Hypernatremia causes­ The 6 D’s

A

Diuresis; Dehydration; Diabetes insipidus; Docs (iatrogenic); Diarrhea; Disease (eg, kidney, sickle cell)

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13
Q

Hyperkalemia rx? C BIG K

A

Calcium, Bicarb, Insulin, Glucose, Kayexalate

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14
Q

Hypercalcemia causes? CHIMPANZEES

A

Ca supplements; Hyper-thyroid/parathyroidism; Iatrogenic (thiazides)/lmmobility; Milk-alkali sx; Paget’s; Adrenal insufficiency/Acromegaly; Neoplasm; Zollinger-EIIison sx (MEN 1); Excess vit A, D; Sarcoidosis

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15
Q

Hypocalcemia w/ Hypoalbuminemia correction?

A

Each 1 g/dL reduction in albumin, total Ca is lowered by 0.8 mg/dL, but not ionized Ca and thus will not cause clinical hypocalcemia.

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16
Q

Hereditary defect of renal PCT and intestinal amino acid transporter for Cysteine, Ornithine, Lysine, and Arginine (COLA); dx, rx?

A

Cystinuria: Precipitation of hexagonal cystine stones. dx- Urinary cyanide-nitroprusside; Rx: urinary alkalinization (potassium citrate, acetazolamide), chelating agents, hydration.

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17
Q

Nephritic dz sx? PHAROH

A

Proteinuria, Hematuria, Azotemia, RBC casts, Oliguia, HTN

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18
Q

Water retention, Euvolemic hyponatremia, urinary Na excretion Una>20, Urine osm> 300 serum <270, cerebral edema, seizures

A

SIADH, decreased aldosterone -> hyponatremia, Rx fluid restriction, IV hypertonic saline, conivaptan, tolvaptan, demeclocycline.

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19
Q

Pt w/ renal artery stenosis p/w decreased urine output, BUN:Cr>20, FENa<1%, new med, iatragenic?

A

ACEi induced prerenal failure (decreasing GFR by dilating afferent arteriole, hypoperfusion of the kidney)

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20
Q

FENa calculated?

A

(urine sodium × plasma creatinine)/(plasma sodium × urine creatinine) × 100

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21
Q

Indications for Emergent Dialysis

A

refractory K>6.5, pH<7.1, Uremia, refractory fluid overload, BUN>100, dialyzable toxic o/d

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22
Q

FENa%? Prerenal Azotemia vs. Tubular Necrosis

A

FENa<1% (normal kidney fnc) Prerenal Azotemia vs. FENa>2% Tubular Necrosis

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23
Q

Prerenal Azotemia (kidney hypoperfusion) signs

A

FENa<1%, BUN:Cr>20, UNa<20, Uosm> 500

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24
Q

BUN:Cr>20, FENa<1%, UNa<20, UOSM>500, U specgravity>1.02

A

Pre-Renal AKI/Azotemia

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25
Q

BUN:Cr<20, FENa>1%, UNa>20, UOSM<300, U specgravity<1.02

A

ATN, Intrinsic Renal

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26
Q

Prerenal AKI p/w thirst, orthostatic hypotension, tachycardia, skin turgor, dry mucous membranes, etiology?

A

Hypovolemia, cardiogenic shock, sepsis, anaphylaxis, drugs (ACEis, NSAIDs), renal artery stenosis, hypoalbuminemia (cirrhosis, nephrotic syndrome), abdominal compartment syndrome, hepatorenal syndrome

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27
Q

Postrenal AKI p/w prostatic disease, low urine output, suprapubic pain, distended bladder, flank pain, etilogy?

A

Obstruction via prostatic disease, pelvic tumors, intratubular crystalluria (indinavir/acyclovir), retroperitoneal fibrosis, bilateral nephrolithiasis.

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28
Q

Intrinsic AKI p/w ischemia or nephrotoxic ATN, allergic interstitial nephritis, glomerulonephritis, thromboembolism, atheroembolic, rhabdomyolysis. Etiology?

A

Drug (aminoglycosides, NSAIDs), infection, contrast, toxins (myoglobin, myeloma protein).

29
Q

Recent Pneumonia treated, now p/w rash, fever, eosinophilia, WBCs and WBC casts on urinalysis, BUN:Cr

A

Acute interstitial nephritis (AIN) via antibiotics: Penicillins, cephalosporins, and sulfonamides

30
Q

Bipolar p/w Hypernatremia, dehydration, thirst, decreased Uosm 200, Plasma Osm 300; dx, rx?

A

Lithium induced nephrogenic diabetes insipidus (DI); Rx salt restriction and fluids, 1st Thiazide diuretic (decreases filtrate at DT and urine vol), NSAIDs (decrease filtration at glomerulus), amiloride (decrease Li at CT)

31
Q

Pt w/ new HTN med p/w exquisitely painful ankle joint, aspiration shows needle crystals w/ negatively birefringence, dx/rx?

A

Acute Gout via Hydrochlorothiazide- increases plasma urate levels by blocking the secretion of urate at the distal tubule.

32
Q

Hematuria in 25yoM 5 days post URI, most common cause? Workup?

A

IgA Nephropathy (w/ GN or nephrotic sx); normal complement, IgA deposits at mesangial membrane

33
Q

Hematuria in 8yo 10(-21) days post URI, most common cause? Workup?

A

Postinfectious (strep)-Glomerulonephritis; decreased complement C3, decreased anti-streptolysin O, anti-DNAse B; Subepithelial humps of C3

34
Q

Pt p/w palpable purpura, arthalgia, increased Cr, elevated ALT/AST, low complement, increased Rheumatoid factor, hematuria, proteinuria; dx, rx?

A

Cryoglobulinemia w/ Vasculitis and MPGN (Mesangial Porliferative GlomeruloNephritis); monoclonal IgM anti IgG (HepC); rx Plasmapherisis, Glucocorticoids, Cyclophosphamide

35
Q

Pt p/w edema, proteinuria, enlarged liver/kidneys, hx RA, HTN, workup? Rx?

A

AA Amyloidosis w/ apple-green birefringence on congo-red bx

36
Q

SE of Furosemide (loops)?

A

Ototoxicity

37
Q

Renal failure sequence of pathology in DM?

A

Glomerular hyperfilteration (HTN), basement membrane thickenin, mesangial expansion, nodular sclerosis

38
Q

Serum Osmolarity Formula?

A

S Osm = 2xNa + BUN/2.8 + Glu/18

39
Q

Increased BUN/Cr ratio?

A

Prerenal azotemia, GI bleed (urea absorption in gut), steroid administration

40
Q

Handelson Hasselbach equation? For PaCO2 and bicarb?

A

PH= Pk + Log([Conjugate base]/[Acid]) = 6.1 + Log[HCO3/(0.03xPaCO2)]

41
Q

Metabolic acidosis compensation? (winter’s)

A

arterial PCO2 = 1.5 x (serum HCO3) + 8 (+/- 2)

42
Q

Metabolic alkalosis compensation?

A

arterial PCO2 = 0.9 x (serum HCO3) + 16 (+/- 2)

43
Q

Respiratory acidosis compensation?

A

increase HCO3 by 1 mEq/L for 10mmHg rise in PCO2

44
Q

Respiratory alkalosis compensation?

A

decrease HCO3 by 2 mEq/L for 10mmHg drop in PCO2

45
Q

Calcium correction for albumin?

A

Corrected Ca = (measured Ca) - 0.8 x (4 - albumin)

46
Q

AG Met Acidosis?

A

MUDPILES: Methanol, Uremia (ESRD), Diabetic ketoacidosi, Propylene glycol, INH/Iron, Lactic acidosis, Ethylene Glycol, Salicylates

47
Q

Normal AG (8-12) Met Acidosis?

A

HARD ASS: Hyperalimentation, Addisons, RTA, Diarrhea, Acetazolomide, Sprinolactone, Saline infusion

48
Q

Metabolic acidosis w/ AG and osmolar gap, envelope shaped crystals in urine; dx?

A

Ethylene glycol intoxication w/ calcium oxalate crystals; (also methanol, ethanol w/o crystals)

49
Q

Mixed respiratory alkalosis w/ AG metabolic acidosis?

A

ASA toxicity

50
Q

Arthalgia, rash, renal failure, eosinophiluria, wbc casts; dx?

A

Drug induced interstitial nephritis; sulfonamides, nsaids, cephalosporins, allopurinol, rifampin, penicillins, phenytoin, diuretics, captopril

51
Q

HTN, hypokalemia, elevated Renin and aldosterone w/ A:R ratio

A

Fibromuscular dysplasia, female <50 resistant HTN, Cr rises w/ ACEi, dx via CT angio or duplex, may p/w Cerebrovascular sx

52
Q

HTN, hypokalemia (muscle weakness), slight hypernatremia, elevated aldosterone w/ A:R ratio >20; dx?

A

Adrenal hyperplasia (Spirinolactone) or adenoma (resection), primary hyperaldosteronism (Conn sx), renal vein sampling diffeniates between the two

53
Q

HTN, hypercalcemia, low phosphate, recurrent kidney stones, neuropsychiatric presentation (confusion, psychosis, depression); dx?

A

Primary hyperparathyroidism

54
Q

HTN, fatigue, dry skin, cold intolerence, weight gain, constipation, bradycardia; dx?

A

Hypothyroidism

55
Q

HTN, obesity, facial plethora, proximal muscle weakness, ecchymosis, amonorrhea/erectile dysfunction; dx?

A

Cushing’s syndrome, HTN w/ adrenal incidentaloma

56
Q

HTN severe > 180/120 after age 55, possible recurrent flash pulmonary edema, unexplained rise in Cr, abdominal bruit; dx?

A

Renovascular disease

57
Q

HTN, elevated Cr, abn UA w/ proteinuria, RBC casts; dx?

A

Renal parenchymal dz

58
Q

HTN paroxysmal w/ tachycardia, palpitations, headaches, diaphoresis, adrenal incidentaloma; dx?

A

Pheochromocytoma

59
Q

Dietary recommendations for renal calculi?

A

Increase calcium intake and fluids, decreased sodium, protein and oxalate intake

60
Q

Nephrotic sx a/w Hep B, NSAIDs, SLE, Adenocarcinoma (breast, lung..), renal vein thrombosis?

A

Membranous Nephropathy

61
Q

Nephrotic sx a/w blacks/hispanics, obesity, HIV, Heroin use?

A

FSGS Focal Segmental Glomerular Sclerosis

62
Q

Nephrotic sx a/w Hep B, Hep C, lipodystrophy?

A

Membranoproliferative glomerulonephritis

63
Q

Nephrotic sx a/w lymphoma, NSAIDs?

A

Minimal change disease

64
Q

Nephrolithiasis w coffin shaped crystals; dx?

A

Struvite stones via urease producing bacteria

65
Q

muddy brown granular casts

66
Q

WBC casts

A

Pyelonephritis or interstitial nephritis

67
Q

RBC casts

A

Glomerulonephritis

68
Q

Fatty casts

A

Nephrotic sx

69
Q

Waxy or broad casts

A

Renal failure

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