Renal Flashcards
What does doughy skin on exam indicate?
hypernatremia
Tx for:
hypovolemic hypernatremia
euvolemic hypernatremia
hypervolemic hypernatremia
hypovolemic hypernatremia - Dw5 if unstable, or 0.9NaCl
euvolemic hypernatremia - hypotonic fluids (Dw5 or 0.45Na
hypervolemic hypernatremia - diuretics and Dw5
What can happen if you correct hypernatremia too quickly (faster than 48-72h)
cerebral edema!
What is normal serum osmolality? What are the causes of isotonic hyponatremia?
Normally 280-295. At this osmo, a hyponatremic state can be due to:
Hi lipids, glucose, protein, mannitol
Algorithm for hypotonic (
Assess clinically the ECF volume status:
Low + Una 10 = diuretics, urinary obs, adrenal insuff, RTA, metabolic alk (too much bicarb!)
Normal = psycho poly, SIADH, drugs, hypothyroid, glucocorticoid def
Hi + Una 10 = AKI, CRF
Algorithm for hypertonic (>295) hyponatremia Dx?
Glucose, mannitol, contrast agents
What solution to use to replete hyponatremia? What happens if you do this too quickly?
Usually use NS, only use hypertonic saline if pt is having seizures (Na
Tx for hyperkalemia?
C BIG K (albuterol can also be used to promote cellular reuptake of potassium)
Calcium Bicarb Insulin Glucose Kayexalate
How does hypokalemia sensitize the heart to digoxin?
K binds to the same receptor as digoxin, so if you have less K, dig will bind to cells better (dangerous!) so you have to monitor K levels closely in pts taking dig.
What does hypercalcemia do to the QT interval?
It shortens it
Treatment of hypercalcemia?
IV hydration first
Furosemide to increase Ca excretion (avoid thiazides!)
calcitonin, bisphosphonates
What can cause a falsely low Ca?
Hypoalbuminemia (this is why you always have to check ionized calcium)
Kid with asthma comes in short of breath and his blood pH goes from 7.79 to 7.38, what do you do?
This could mean respiratory muscle fatigue, you have to intubate
Types of RTA: I, II, IV
I: Distal; due to lack of H secretion. Low K, caused by cirrhosis, sjogrens, SLE
II: Proximal; due to lack of bicarb absorption. Low K, caused by fanconi’s anemia, CA inhibitors, Mult Myeloma
IV: Distal; due to aldosterone def/resistance. Hi K, caused by aldosterone def
What do urine labs for ATN look like?
buN/Cr 1%
UNa >20
Uosm
Microscopic Urine labs for AKI: Hyaline casts - RBC casts - WBC, eosinophils - Granular Casts - WBC casts -
Hyaline casts - prerenal volume depletion
RBC casts - intrinsic Glomerulonephritis
WBC, eosinophils - intrinsic allergic interstitial nephritis
Granular Casts - intrinsic ATN
WBC casts - postrenal pyelonephritis
What do urine labs look like for a prerenal azotemia?
FeNa 1.020
Uosm >500
BUN/Cr ratio > 20
Compliment levels in poststrep glomerulnephritis?
Immunoflourecent findings?
low C3
lumpy bumpy immuno
Who gets IgA nephropathy?
What is the dreaded result?
Men, pts who recently had URI or GI infections. Suspect in ppl who JUST got over a URI, not 20 days ago like post strep glom
Can cause ESRD in 20% pts
immuno for goodpasteurs?
linear anti-GBM deposits
What are the criteria for nephrotic syndrome?
proteinuria >3.5 g/day
edema
hypoalbuminemia
hyperlipidemia
imaging of Minimal Change disease?
light microscopy is normal, but EM shows fusion of epithelial foot processes.
Most common nephropathy in kids
Imaging of Membranous Nephropathy?
Spike and dome appearance due to granular deposits of IgG and C3 at basement membrane
Imaging in Membranoproliferative Nephropathy? WHAT DZ is it associated w/?
Tram/track double layered masement membrane w. LOW COMPLEMENT
Associated with HCV, cyroglobulinemia, SLE, and bacterial endocarditis
What are most renal stones made of?
How does RTA I cause renal stones?
calcium oxalate (radiopaque stones, can be seen even on KUB, technically.)
RTA 1 = alkaline urinary pH and hypocitruria –> good place for stones
Which bacteria are associated with staghorn calculi?
proteus (urease secreters make that urine alkaline (much like RTA 1)
Tx of stones: Calcium ox/phos: Struvate: Uric acid: Cystine:
Calcium ox/phos: hydration, Na/protein restriction, thiazides, don’t limit Ca!
Struvate: hydration, surgery
Uric acid: hydration, alkalinize urine (citrate), purine restriction, allopurinol.
*THESE ARE RADIOLUISCENT, MUST GET CT TO SEE
Cystine: hydration, Na restriction, alk the urine, penicillamine
*DUE TO DEFECT IN RENAL TRANSPORT OF COLA AA’S(cysteine, ornithine, lysine, arginine) - Hexagonal crystals, +urinary cyanide nitroprusside test!
Pts with ADPKD have a 50% of ESRD by age 60, but also have an increased risk of….
cerebral berry aneurysms, diverticulosis, MV prolapse
Kid comes in with recurrent UTI’s, his prenatal U/S showed hydronephrosis. Dx?
Vesicouretral reflux. Will cause renal scarring
dx: voiding cysourethrogram as long as they are >2yo
Male infat w/ distended, palpable bladder and low urine output?
Posterior urethral valves
What is a risk factor for cryptorchidism (non descent of teste)
Low birth weight
What do you do for a 12mo old w/ a hydrocele?
Nothing, will likely resolve in 12-18mo
If it does not resolve this is indication of processus vaginalis and can lead to inguinal hernias
For teste pain, what is Prehn’s sign and when is it present?
= less pain w/ scrotal lifting (this is the case in epididymitis.)
It is negative in torsion (pain is bad in any position)
MOA of terazosin
Finasteride
terazosin is an a-blocker, it relaxes SM in the prostate and bladder neck - don’t use if pt is ortho hypotensive!
finasteride is a 5a reductase inhibitor, which blocks production of dihydrotesosterone
Why would DRE not detect BPH?
BPH most commonly occurs in the central prostate, DRE could miss it!
In what context should PSA be used for prostate ca?
screening is ok, controversial ( can be + for other things)
follow up after therapy to evaluate for disease reoccurrence.
DRE annually starting at age 50. Earlier if +family hx
What type of CA is RCC? How does it spread?
It is an adenocarcinoma of the tubular epithelial cells. It spreads via the IVC to the lung and bone.
Left sided varicocele is a sign b/c tumor blockage of the left renal vein! Right side doesnt happen b/c right gonadal vein empties straight into the IVC
Most common type of teste cancer?
Germ cell derived (AFP will be elevated if not a seminoma, and particullarly in yolk sac tumors. If it is later in age (40-50 - it is a seminoma!)
*Check a bHCG as it is elevated in choriocarcinoma and 10% of seminomas!
Risk factors = cryptorchidism, klinefelters
Tx for teste CA?
radical orchiectomy
platinum if a germ cell that is not a seminoma
chemo if seminoma
What is the Dx and tx for rhabdo?
Dx: Urine dipstick will be + and brown/red. Pt may also have muscle pain/injury
Tx: rapid hydration, mannitol, bicarb
Get an EKG to r/o dangerous hyperkalemia!
