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Medicine Clerkship > Renal > Flashcards

Renal Flashcards

1
Q

Causes of prerenal AKI

A

Pump: HF, MI
Leaky Vessels: Cirrhosis, nephrosis, gastrosis
Low volume: diarrhea, dehydration, diuresis, hemorrhage
Tubing issue: RAS, FMD

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2
Q

Causes of postrenal AKI

A

Obstruction leading to hydronephrosis
Ureter:Stones, cancer
Bladder: Stones, cancer, neurogenic bladder
Urethra: Stones cancer, neurogenic, BPH, foley clog

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3
Q

Causes of renal AKI

A 
Glomerular issue
Tubular issue (ATN)
Intertitial issue (AIN)
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4
Q

Glomerulonephritis

A

RBC casts on UA – rule out nephrotic syndrome

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5
Q

Nephrotic syndrome

A

> 3.5mg protein, edema, increased cholesterol

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6
Q

Acute interstitial nephritis

A

Caused by drugs (beta lactams) or infection. WBC casts, eosinophils, rash, fever.

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7
Q

Acute tubular necrosis

A

Caused by ischemia, drugs/toxins (iv contrast, myoglobin, aminoglycosides). Brown muddy casts

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8
Q

Phases of intrarenal pathology

A

Prodrome with increased creatinine,
oliguric phase with decreased urine,
polyuric phase with increased urine.

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9
Q

How to calculate FeNa?

A

Clearance of Na/GFR

=Urine Na/Plasma Na * Plasma Cr/Urine Cr

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10
Q

Lab findings suggestive of prerenal pathology?

A

BUN:Cr >20

FeNa

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11
Q

Normal GFR

A

> 90

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12
Q

Stage II CKD and how to treat

A

GFR between 60 and 90

Aggressively treat comorbidities = BP

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13
Q

Stage III CKD and how to treat

A

30-59

Aggressively treat comorbidities

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14
Q

Stage IV CKD and how to treat

A

GFR 15-29. Put on transplant list, create AV fistula if symptomatic

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15
Q

Stage V CKD and how to treat

A

GFR

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16
Q

Indications for acute dialysis

A 
Acidosis
Electrolyte abnormalities (hyper K)
Ingestion of toxins
Overload
Uremia
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17
Q

How to decrease risk of contrast induced nephropathy?

A

IV NS, or use deiodinated contrast.

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18
Q

First step in working up hyponatremia?

A

Calculate vs measured serum osms

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19
Q

How to calculate S Osm?

A

2Na +Glu/18+Bun/2.8

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20
Q

Normal S osm?

A

270-280

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21
Q

How to correct Na if hypertonic hyponatremia?

A

For each 100 BG above 100, add 1.6 to Na.

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22
Q

Causes of euvolemic hyponatremia

A 
RATS
RTA IV
Addisons
TSH
SIADH
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23
Q

Action of PTH

A

PTH maintains level of Ca in blood
Increased PTH activates osteoclasts to increse serum ca,
in kidney, PTH will resorb ca, excrete phos, and convert Vit D to active form to absorb more ca and phos.

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24
Q

Correction of ca for albumin

A

99% of calcium is albumin bound. Normal albumin is 4, if albumin reads 3, then need to add 0.8 to Ca.

25
Q

Signs of hypocalcemia

A

Tetany, chvostek sign (tap facial nerve), trousseau’s sign (bp cuff for 3 mins causes tetany), perioral tingling

26
Q

How to work up hypocalcemia

A

Check albumin. If it corrects because albumin is low, then check ionized calcium level. If that’s low, replete with IV calcium

27
Q

Signs of hypercalcemia?

A

Stones, moans, bones, psychiatric overtones.

28
Q

How to work up hypercalcemia?

A

Recheck calcium levels, if normal do nothing.
If high, then give IVF, then calcitonin.
Long term hyperca, give bisphosphonates.

Don’t give loop diuretics because this has fallen out of favor.

29
Q

Primary, secondary, tertiary hyperparathyroidism

A

Primary is autonomous PTH adenoma
Secondary is due to early renal failure
Tertiary hyperPTH is due to multple autonomous adenomas.

30
Q

How does patient with hyperPTH present? Lab values?

A

Bone pain, pathologic fractures, brown tumors. Increased PTH, increased CA, decreased phos. Don’t need vitamin D

31
Q

How to determine 1 from 2 and 3 hyper PTH?

A

Sestomibi scan.

32
Q

How to treat hyperparathyroidism

A

Resect and cinacalcet to prevent tertiary hyperparathyroidism

33
Q

Hypercalcemia of malignancy

A

Cancer can cause hyperca from mets or from PTHrp.

Treat with bisphosphonates.

34
Q

Hypervitaminosis D

A

From granulomas. Increases Ca, decreases PTH, increases phos

35
Q

Hyper Ca of immobilization

A

Causes Ca and phos to rise, and pth to decrease

36
Q

Familial Hypercalcemic Hypocalciuria

A

Asymptomatic increase of calcium with decreased urinary calcium

37
Q

HypoPTH

A

Usually iatrogenic. Decreased PTH, Decreased Ca. Tx with IV Ca

38
Q

PseudohypoPTH

A

Due to insensitivity to PTH.

Causes increased PTH, but decreased Ca.

39
Q

Vitamin D deficiency.

A

Decreased Ca and phos, increased PTH, osteopenia.
Dx with 1,25oh D level
Tx with ca and vitamin d or high dose vitamin D

Also treat with bisphosphonates if severely osteopenic.

40
Q

CKD induced hypocalcemia

A

Decreased Vitamin D conversion causes decreased Ca and Phos, so increased PTH. (2 hyperparathyroidism)

41
Q

Causes of hyperkalemia

A

Iatrogenic, trauma, hypoaldosteronemia (acei, arb, spironolactone), ESRD, diet

42
Q

How to work up hyperkalemia

A

Recheck, then get an EKG, if any changes (peaked T waves, long qrs, give ca gluc, will eventually cause torsades.

If no ekg changes, not emergent so give kayexalate or lasix.

43
Q

Treatment options for hyperkalemia

A

Insulin w/D50, bicarb or albuterol, decreases EC K but no change inTBK
Kayexalate
Diuretics
Dialysis

44
Q

Hypokalemia

A

From GI losses or renal losses (hyperaldosteronism, diuretics, barters syndrome, gittleman’s)
Ekg shows flat T waves and U waves.

Just replete K. PO is better than IV.

If peripheral

45
Q

How to work up kidney stone?

A

Do a UA first, no blood, no stone.

Then do spiral CT scan or ultrasound if pregnany

46
Q

How to treat kidney stone

A

Fluid, pain meds, tamsulosin

47
Q

How to treat kidney stone between 5 mm and 3 cm

A

Lithotripsy

48
Q

How to treat kidney stone >3cm

A

Surgery, then later, strain urine and type, followed by 24 h urine catch.

49
Q

Types of stones

A

Ca oxalate (envelope), radioopaque
Struvite (coffin), radioopaque, proteus
Cysteine (hexagon), radiolucent
Uric acid (rhomboid), radiolucent, gout or increased turnover.

50
Q

Simple renal cyst (pt, dx tx)

A

Patient: asymptomatic, small no loculations.

No need for diagnostic tests or treatment

51
Q

Complex renal cyst

A

Patient has a flank mass that can cause infection and hematuria. Evaluate with CT, u/s if pregnant. Then biopsy, tx: resection

52
Q

RCC

A

Flank mass, increased EPO, hematuria. CT scan or us if prenant. DO NOT BIOPSY.

Tx: nephrectomy, ex vivo pathology.

Spreads hematogenously.

53
Q

ARPKD

A

Infants. Complete renal failure, aneuric. Dx with ux. Radially oriented cysts.

54
Q

ADPKD

A

Flank mass, infections, bleeds. CT scan. Biopsy. Supportive then transplant.

55
Q

Minimal change disease

A

Associated with hodgkins, children

56
Q

FSGS

A

Associated with blacks, aids, heroin use.

57
Q

Membranous

A

In whites, hep b and c, solid tumors

58
Q

MPGN

A

Hep B and C, C3 nephritic factor.

Medicine Clerkship (12 decks)

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