Renal Flashcards
Renal artery stenosis in a young woman from fibromuscular dysplasia is treated how? HY
Treat fibromuscular dysplasia with a STENT, not surgery. use surgery if stent fails (Angioplasty with stent)
What is a sign of uremia in labs?
uremia sign is high BUN and look for asterixis
BUN correlates to what indication for dialysis
BUN elevation can show uremia which is an indication for dialysis
What are signs of uremia (high BUN )
Asterixis with encephalopathy and pericarditis/bleeding
What are uremia signs of dialysis
Dialyze with uremia (high BUN) and pericarditis, bleeding or ecephalopathy
When is an acidosis indication for dialysis
Dialysis when pH
When is dialysis used for eletrolyctes
Refractory K+ >6.5 or EKG changes and ventricular arrythmia
When is dialysis used for volume overload
Dialysis is used for volume overload refractory to diuretics
How is hypernatremia treated?
The MCC of hypernatremia is volume status. First assess volume status and if volume is low then give NS if symptomatic and D5W 1/2NS if asymptomatic
What happens if you replace and lower hypernatremia to fast?
Lower hypernatremia too fast you get cerebral EDEMA
Labs of dehydration?
Increased Cr and BUN, increased HCT from hemoconcetration and dry mucuous membranes, common in elderly
When is hypertonic saline used
use hypertonic saline when severe hyponatremia exists with s/s present (3%) is hypertonic and use until Na is back to 120 and s/s are gone
What happens if hyponatremia is corrected to quick?
Central pontine myelinolysis results when hyponatremia is corrected to quickly
How is mild SIADH treated
Mild SIADH causes hyponatremia, without syx they can just get fluid restriction
how is moderate wiht syx SIADH treated
syx hyponatremia with SIADH = 3% hypertonic saline until Na >120 and syx are gone
First step in hyper K diagnosis
first step in hyper K diagnosis i EKG which determines treatment
what two things determine treatment in hyper K
Hyperk Tx is determiend by K > 7 or changes on EKG
Preferred tx for no EKG changes and K
IV furosemide, or hemodialysis. First line is IV loop diuretics.
EKG hyperK signs?
Long PR and QRS and peaked T
what do peaked T tell you
peaked T tell you there is hyper K
When do you see long PR QRS, peaked T and low P?
Peaked T and long PR and QRS with low P is hyperK
When do you see sine wave
Sine wave is hyper K
How does albuterol affect K
Albuterol nebulizer causes K+ to move into the cells it is B2 agonism
what electrolyte does TMPSMX affect
TMP SMX affects K+
Peaked T =
hyperkalemia
Why is Cl low in vomiting
KCl and HCl loss causing hypovolemia and hypochloridia; alkalotic due to H+ loss and aldosteorne release and reabosrption of HCO3-
Classic sign on labs of diarrhea
Acidosis with hypokalemia
why is there acidosis in diarrhea
metabolic acidosis occurs in diarrhea as HCO3 is wasted in stool with potassium
What is the cutoff for oliguira
less than 250mL in 12 hours
First step in oliguira?
First step in oliguira is actually bed side bladder either followed by cath if retention or figuring out underlying cause
Oliguria workup postop
Bladder scan is first step; inconclusive = cath, retention = cath. No retention = run labs and find cause.
What are common AE of trypitylines? (TCAs_
TCAs are anticholinergs = dry mouth, urinary retention, delirium, pinpoint pupils, orthostatic hypoTN
In ADPKD why is the right kidney easier to palpate?
it lies lower due to the liver, you may not always feel both kidneys, but suspect in historyof b/l kidney masses and HTN and h/o kidney cysts
Someone gets AKI due to furosemide IV in cor pulmonale and has kidney failure, why AKi and why a metabolic anion gap acidosis?
Furosemide used for CHF exac/ cor pulmonale IV can cause hypovolemia and lead to AKI, the resultant increase in uremia is a foreign body that leads to anion gap metabolic acidosis
In persons with renal failure, why do you see metabolic acidosis?
uremia and/or lactic acidosis or bicarbonate loss from incompetent responding kidneys
what pH precipitates uric acid stones
uric acid stones are precipitated by low pH
uric acid stones are precipitated by low pH, how can they be treated?
Potassium citrate is alkaline and urine excreted, if you alkalanize the urine, you raise urinary pH and prevent crystallization of low pH compounds in the urine
Does lupus drop complement?
yes, lupus cause IC3 complex deposition and low complement
how can lupus kidney failure be distinguished from other causes in the absence of systemic syx by just basic labs?
Lupus causes low WBC/anemia/low plt as well as proteinuira and RBC casts and low complement
what kidney dysfuncitons (2) is SLE assoc with?
Diffuse proliferative GN (wire LOOPus-ing) and membranous nephropathy (black people (AA) in membranes (spike and dome) playing sports
What does drug induced interstitial nephritis show
eosinophilia with WBC
what are signs of acute interstitial nephritis?
Develops 7-10d after ingestion fo the toxin/medicine and causes rash, eosinophilia, pyuria
what are causes of secondary amyloidosis
secondary amyloidosis is due to deposition of b2 microglobulin (AA = bTWO (2)), lipoprotein and transytheritin and may cause kidney disease and other end-organ failure
when do you see b2 microglobulin
AA (secondary) amyloidosis from systemic inflammation like RA, SLE, IBD and chronic disease of TB
When do you see AL (light chain) primary amyloidosis
MM and Waldenstrom – lambda light chains = primary AL
MCC of AA amyloidosis?
RA
tx of hyeprcalcemia fo malginancy?
IV hydration + bisphosph long term
first step in hyperlcacemia
IV hydration
what is long term treatment in hypercalcemia of granulomatous disease
steroids (1ahydroxylase in M0)
What is a way to tell methanol toxicity?
Do optho exama nd look for disc hyperemia (damages eyes) and metabolic gap acidosis due to foreign body
What type of acid base disorder does salicyclates cause?
They cause a respiratory alkalosis and a metabolic acidosis
What are the causes of anion gap metabolic acidosis?
MUDPILES- methanol, uremia, DKA (NOT diarrhea), phenol, INH/iron, lactic acidosis, ethanol, salicyclates
RAA system causes excretion of what ion and retention of what ion?
RAA excretes K+ and retains HCO3-
What is type 4 RTA due to
It is due to failure of aldostorone response or secretion
why does RTA 4 causes acidosis
loss of bicarb, cannot be absorbed due ot failure of aldosterone
How does uremia affect the platelets
Blood counts are normal (plt, PTT and aPTT) but the PLT fxn, is not (count is ok) = uremia just affects platelet function
why is there metabolic acidosis in ESRD
no HCO3 retention + foreign body uremia and foreign body lactic acdisosi
Cause of anemia in ESRD?
Low EPO
What does EPO cause as AE
high hct resulting in HTN
What must be monitored before EPO admin
Before EPO admin administer iron
what is prerenal AKI
hypoperfusion (low vol, heart failure, IV diuresesis overload)
Postvoid > 50mL means?
urinary retention.
When does injury due to contrast spike Cr levels
within 24 hours there is a spike in Cr for contrast injury that falls in 5-7d and is prevented by IV hydration and isotonic bicarb or acetylcysteine
Which has low C3, IgA nephro or PSGN
PSGN occurs later AND has a drop in C3 versus IgA nephropathy which does NOT have low C3 like Lupus and PSGN do.
What are findings in HTN kidney
intimal thickening with sclerosis and small kdineys and luminal narrowing
what are findings in DM nephropathy
large kidneys wiht mesangial expansion and kimmelstein wils nodular sclerosis along with icnreased ECM
When is U/S needed for nephrolithiasis
use U/S instead of CT for nephrolithiasis when the patient is pregnant
Gold standard for nephrolithiasis
CT, unless pregant = U/S
Who gets MCD and how is ti treated?
MCD is treated withotu biopsy with stseorids and is common in lympoma in kids and MCC of nephroapthy in kids
Focal
what kidney disease does HIV get
HIV patients and heroine users get focal segmental
who gets focal segmental glmoerulo
AA wih HIV/iV drugs andobese
who gets membranous nephropathy
membranous = remember HBV
other than HBV who gets membranous nephropathy
other than HBV membranous happens in SLE and HBV with solid tumors
Prevention of calcium stones
hydrate and HCTZ diuretics
what diruretics prevent calcium stones
HCTZ increase reabsorption of calcium
What is MC stone
oxalate
what is a common cause of oxalate stones
calcium malabsorption (I.E IBD)
What crystals result from ethylene glycol
calcium oxalate
why do struvite stones form
urine alkalinization and precipitation of struvite due to proteus, klebsiella, morganzlel, pseudo, ureasplams
how is uric acid stone treated
alkalinize urine (low pH) with cistrate
diagnosis of polycystic kidney disease?
Just use U/S to look for bilateral cysts
What lab abn is common in RCC?
many have increased EPO and Hct in RCC resulting in polycythemia
How is RCC diagnosed
RCC is diagnosed by going right to CT do not get a U/S
When you have an acid base disorder with COPD patient and a GI bleed + BUN/Cr issue, how can you confirm what the cause is?
you HAVE to check ANION GAP every time you see an acidosis that is metabolic
How is uremic platelet dysfunction treated?
DDAVP to realese VIII and vWF – (plt not working right give them more to grab onto)
What are hyperkalemia EKG findings
Everything stretches due to slowing of conduciton with peaked t waves, long QRS and long PR interval
How does pyschogenic polydipsia present
very dilute urine with very dilute Na. the body’s ability to excrete the Na is overwhelmed and this drops Na and causes maximally dilute urine
When should you suspect cyanide toxicity in a patient
when a patient is treated with nitroprusside and get CNS changes or skin flushing and a metabolic acidosis due to CN- foreign body
Is serum C3 normal in IgA nephro or PSGN?
igA nephro has NORMAL C3
