renal Flashcards
1
Q
Classic Presentation for [Renal Cell Carcinoma] (4)
A
RCC looks like HAWF!
[Hematuria PAINLESS (most common)] / [Abd palpable Mass] / [Wt loss] / [Flank Pain]
Scrotal varicoceles are in 10% of pts
L RCC in image
2
Q
Normal range for PCO2
A
33 - 44 (40 = standard)
3
Q
List the indications for HemoDialysis - 5
A
AEIOU
Acidosis (HCO3 <10, pH<7.1)
Electrolytes (⇪K>6.5 / Mg / P) or (⬇︎ Ca+)
Intoxication (Alcohols/ASA/Lithium/Anticonvulsants)
Overloaded BADLY with Fluid
Uremia (⇪ NH3-BUN)
4
Q
etx for Sundowning
________________
Tx?
A
[Alzheimers vs. EtOH withdrawal vs. Delirium] –> Circadian Rhythm dysfunction –> [⬆︎confusion & agitation at Sundown]
________________
Tx = Melatonin
5
Q
It takes Lungs minutes to compensate for acidosis/alkalosis
How long does it take Kidneys to compensate for respiratory acid-base
A
2 days
6
Q
What are the 2 main electrolyte SE of Furosemide?
________________
how do they affect the heart?
A
- hypOkalemia which can –>VTach!
- hypOmagnesemia which can –>VTach!
High doses of Loop diuretics also cause reversible or permanent hearing loss and/or tinnitus
7
Q
ADPKD - [Autosomal Dominant Polycystic Kidney Dz]
Describe the Disease - 7
A
ADPKD
Aneurysm (Berry)
Doomed [HTN and MVP]
[PrOteinuria AND Hematuria]
Kidney Failure (Early vs. Late onset) - Hepatomegaly occurs if cystic involvement
Differentation problem = Etx
Image: Renal Ultrasound which = Dx
8
Q
BUN Normal range
A
7- 18
9
Q
How does Ethylene Glycol affect Kidneys?
A
EG is converted into oxalate by liver –> binds to Ca+ = retangular envelope shaped Ca+Oxalate crystals –> Tubular damage
10
Q
Fomepizole
MOA
________________
indication
A
Inhibits [Hepatic Alcohol Dehydrogenase] from converting Ethylene Glycol ➜ oxalate
________________
[Ethylene Glycol] poisoning
11
Q
Name 4 classes of drugs to cause Fever
A
- Anticonvulsants (via Hypersensitivity syndrome)
- Abx
- Anticholinergics
- Sympathomimetic
12
Q
Hepatorenal syndrome Etx
A
Portal HTN from liver failure –> MASSIVE Splenic ARTERIAL Vasodilation –> ⬇︎BP –> PreRenal AKI that’s NOT RESPONSIVE TO IVF
Type 1 = Rapid / Type 2 = slow
13
Q
General beta blockers (propranolol) are used to treat what complication of cirrhosis?
A
⬇︎ GastroEsophageal variceal bleeding
14
Q
List Causes of Anion Gap Metabolic Acidosis-9
A
15
Q
List Causes of NORMAL-Anion Gap Metabolic Acidosis (NAHA)-7
A
16
Q
Urine Osmolarity values in
Pre renal failure
________________
Intrinsic renal failure
A
>350
________________
=300
________________
17
Q
Urine Specific Gravity values in
Pre renal failure
________________
Intrinsic renal failure
A
> 1.020
________________
= 1.010
________________
18
Q
FeNa values in
Pre renal failure
________________
Intrinsic renal failure
A
<1
________________
>2
________________
19
Q
BUN/Cr Ratio values in
Pre
Intrinsic
Post Renal Failure
A
>20
________________
10-20
________________
10-20
20
Q
UNa values in
Pre renal failure
Intrinsic renal failure
A
<20
________________
>30
________________
21
Q
In a pt w/hematuria, what also in the urine would indicate Glomerular etx specifically?
A
Protein (On Urine Dipstick)
22
Q
How is Uremia associated w/GI px?
A
Uremia can –> Glanzmann Thromboasthenia (dysfunction of Platelet 2b3a Fibrinogen binding R) –> Bleeding! GI px and ASA avoidance is necessary to prevent GI bleeds
Dx = ⬆︎Bleeding Time // Tx = DDaVP (⬆︎release of vWF)
23
Q
List Risk Factors for Contrast induced nephropathy
________________
What are the 2 most important?
A
Ctx: SCr > 1.5 or GFR <60
24
Q
How do you address Contrast induced neprhopathy At-Risk pts, who needs contrast imaging?-4
A
- avoid high-concentraton radiocontrast
- DC NSAIDs
- [NS IVF] prior to imaging
- NAC (N-AcetylCysteine) prior to imaging
25
MAJOR signs/symptoms of Uremia -6
1. AMS (FATIGUE)
2. Pericardial Rub
3. Pruritus
4. Nausea
5. Hiccups
6. Asterixis
26
How should you evaluate Sodium Imbalance?
\< (**t**) **N V** \>
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**t**onacity (only with hypOnatremia)]
**N**a+
**V**olume status
27
What causes
[HYPERnatremia HYPERvolemia] -6
\< R R \>
## Footnote
1. [NaHCO3 iatrogenic]
2. [TPN iatrogenic]
3. [exogenous CTS]
4. Cushings Syndrome
5. Saltwater Drowning
6. Primary HYPERaldosternism
28
What are the **NONrenal** causes of
[HYPERnatremia hypOvolemia] -2
\< NONrenal R o \>
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
diarrhea
diaphoresis
29
What are the **RENAL** causes of
[HYPERnatremia hypOvolemia] -2
\< RENAL R o \>
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Diuresis (pharm vs osmotic)
Renal Failure
30
What causes
[HYPERnatremia eUvolemia] -2
\< R u \>
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Diabetes Insipidus
Tachypnea
31
Normal GFR range
90 - 120 mL/min **but most labs report \> 60**
32
Normal Creatinine Clearance for Men vs Women
Men = 97-137
Women = 88-128
33
Describe the 2 types of Hepatorenal syndrome
Type 1: **Rapid & Fatal** Renal failure triggered by Spontaneous bacterial peritonitis = poor pgn
Type 2:**slow** renal decline see in refractory ascities
34
Hepatorenal Syndrome tx -4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*type 1=FAST/RAPID | type 2=slow*
*⬆︎volume to kidneys*
## Footnote
1st: Stop Diuretics (Spironolactone, Fusermoide)
2nd: Albumin IV
3rd: Alternative: Add Octreotide to vasoconstrict splanchnics
4th: Liver transplant
35
What are the 2 most common causes of Chronic Kidney Disease
DM and HTN
36
Why is a Lipid Panel ordered in CKD pts?
Prevent Cardio dz by controlling lipids **since CV dz is most common cause of Death in CKD pts**
## Footnote
*Because of this, also order EKG*
37
What is the significance of Proteinuria in CKD -3
1. Protein filtration **worsens** Kidney dz
2. Proteinuria = early heart dz in CKD pts
3. Proteinuria = Glomerulus damage
38
Why is it important to prevent Hyperphosphatemia in CKD pts
Elevated Phosphate 2/2 CKD --\> ⬆︎ PTH release (*2° HyperParathyroid*) --\> [Renal Osteodystrophy] and Mortality
39
List causes of pseudOhypOnatremia -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*serum* *OSm 280-295*
\< (p) o \>
⬆︎Protein
⬆︎TAG
40
List **RENAL** causes of [hypOtonic true hypOnatremia]
in a *hypOvolemia* patient -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[*serum* *OSm \<280] and [UNa\>20]*
\< RENAL ooo \>
## Footnote
1. Diuretics excessively
2. low aldosterone
3. [acute tubular necrosis]
41
List **NONrenal** causes of [hypOtonic true hypOnatremia]
in a *hypOvolemia* patient -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[*serum* *OSm \<280] and [UNa\<10]*
\< NONrenal ooo \>
## Footnote
1. GI loss (diarrhea/vomiting)
2. Diaphoresis
3. 3rd spacing
42
List causes of [hypOtonic true hypOnatremia]
in a *Euvolemia* patient -6
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*serum* *OSm \<280*
\< o o u \>
## Footnote
1. SIADH
2. [psychogenic polydipsia]
3. postOp
4. hypOthyroid
5. Beer potomania
6. [Tea & Toast syndrome]
43
List causes of [hypOtonic true hypOnatremia]
in a *HYPERvolemia* patient -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*serum* *OSm \<280*
\< o o R \>
## Footnote
1. CHF
2. nephrOtic syndrome
3. Liver disease
44
List causes of Hypertonic hypOnatremia -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*serum* *OSm \>295*
\< (R) o \>
1. ⬆︎ Glucose
2. ⬆︎ Glycerol
3. Mannitol
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Too much OSMOTICALLY ACTIVE substances in extracellular fluid*
45
Wilms tumor etx
proliferation of metanephric blastema --\>
## Footnote
HAWF (Hematuria painless/HTN, Abd mass, Wt loss, Fever, Flank Pain)
46
What are the renal complications of sickle cell TRAIT - 5
1. **Painless Hematuria 2/2 papillary necrosis**
2. Inability to concentrate urine (due to vasa recta damage)
3. Distal Renal Tubular Acidosis
4. UTI
5. Renal Medullary CA
## Footnote
*Sickle cell trait is a benign condition with Hgb AS that can cause fleeting papillary necrosis*
47
What is the earliest renal abnormality in pts diagnosed with DM?
Glomerular Hyperfiltration
## Footnote
* this is also the major pathophys mechanism for gluemrular injury in DM. Hint the reason ACE inhibitors help*
* Glomerular Hyperfiltration--\>Basement membrane thickening --\>mesangial expansion --\> Kimmelsteil Wilson nodular sclerosis*
***⬆︎ urine microalbumin:creatinine is the earliest sign of NEPHROPATHY***
48
What are the 5 different types of renal stones
1. [Ca+ (oxalate or phosphate) stones]
2. [Uric acid radiolucent stone]
3. [Xanthine radiolucent stone]
4. [AMPS (**A**mmonium **M**g **P**hosphate **S**truvite) stone]
5. [Cystine hexagonal stones] *- inherited*
49
Tx for Uric acid radiolucent stone - 3
1. Alkalinize urine with [PO K+ Citrate] or NaHCO3 to \> 6.5pH
2. low purine diet
3. +/- Allopurinol
You may see uric acid radiolucent stones in tumor lysis syndrome
50
Tx for Ca+ renal stone - 4
1. Hydration ≥2L / day
2. HCTZ
3. Na+ dietary ⬇︎
4. Vit C dietary⬇︎
## Footnote
\*\*Normal Ca+ dietary intake \*\*
51
cp of Alports X-linked Syndrome - 3
*Can't **See**, Can't **Pee**, Can't **Hear** a buzzing bee*
1. ocular defects
2. [isolated hematuriia and prOteinuria]
3. [sensorineural hearing loss]
*EM = SPLITTING of Glomerular basement membrane with thinning*
52
Electron microscopy findings for Alports X-linked Syndrome
*Can't **Pee**, Can't **See**, Can't **Hear** a buzzing bee*
SPLITTING of Glomerular basement membrane with thinning
53
What type of renal effects does IV Acyclovir have?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
Collecting Duct Crystalline nephropathy **with renal tubular obstruction**
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
AGGRESSIVE IVF before and after tx
54
Needle shaped crystals on UA indicate what dx?
Uric Acid radiolucent stone
55
Normal Post Void Residual for Women
\< 150 cc
56
Normal Post Void Residual for Men
\< 50 cc
57
List the differentiating factors for a renal cyst to be classified as Simple? - 6
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What is mngmt for Simple Renal cyst?
58
Normal range for Ca+ is 8.4-10.4
What is the mngmt for Asymptomatic Hypercalcemia 10.4 - 14
**NOTHING**. Just avoid worsening factors like dehydration
## Footnote
**ALWAYS BE PREPARED TO GIVE IVF FOR HYPERCALCEMIA**
59
Normal range for Ca+ is 8.4-10.4
What is the mngmt for Symptomatic OR Hypercalcemia \>14 - 3
1. IVF +/- calcitonin
2. Bisphosphonates for long term
3. Avoid loop diuretics UNLESS HF is present
*Remember that Lung SQC can secrete PTH-related protein and cause Hypercalcemia*
**ALWAYS BE PREPARED TO GIVE IVF FOR HYPERCALCEMIA**
60
What are lab values that diagnose SIADH - 5
1. hypOnatremia
2. Serum Osmo \<275
3. Urine Osmo \>100
4. Urine Na+ \>40
5. low serum Uric acid
61
Causes of SIADH - 4
1. Intracranial process
2. SSRIs
3. NSAIDs
4. Lung disease (especially SOLC)
62
If renal obstruction is present, what does elevated Creatinine tell you about its laterality?
Must be **BILATERAL** - uL obstruction (i.e. from stone) does not bump creatinine since other Kidney will compensate
63
Major causes of Rhabdomyolysis - 4
1. Immobilization prolonged (direct damage)
2. Cocaine (direct damage)
3. Physical restraints
4. Dehydration
## Footnote
Muscle breakdown --\> ⬆︎CPK, ⬆︎K, ⬆︎myoglobin(which causes renal damage when filtered)
64
Why is it dangerous to give Nitroprusside to a renal failure pt?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for this?
Nitroprusside's byproduct, thiocyanate, is renal excreted, especially if infusion is \> 24 hours
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx = Sodium Thiosulfate
65
cp for Acute Urinary Retention-2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What are the risk factors for AUR?-6
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dx?
suprapubic tenderness and agitation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. Male
2. \>80 yo
3. BPH
4. Cognitive impairment
5. Surgery
6. Meds (opioids, anticholinergics)
Dx = Bladder US ≥300cc
66
Pt has [Dense Intramembranous C3b deposits] in their glomerulus
Diagnosis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
etx?
[**MembranoProliferative GN type 2** (dense deposit disease)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
caused by IgG Ab constantly activating the alternative complement pathway
67
What are the 2 major examples of Immune complex-mediated Glomeronephritis
1. SLE
2. PSGN-PiG
68
Pt has Anti-Glomerular Basement Membrane (GBM) IgG
Diagnosis?
**G**ood**P**asture syndrome
## Footnote
**G**lomerulonephritis and **P**ulmonary hemoptysis
69
pt has Hepatitis C
What renal pathology should you be concerned for?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cp?-4
Cryoglobulinemia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. Palpable Purpura
2. ⬇︎complement
3. hematuria
4. proteinuria
HepC is also associated with Porphyria Cutanea Tarda
70
Dx criteria for Nephrotic syndrome -3
\>3g protein/24 hr + hypOalbumin + edema
71
Minimal change disease is more common in kids
When is it associated with adults? - 2
1. NSAID use
2. Hodgkin Lymphoma
72
Name the 2 most common Nephrotic syndromes in adults
FSGS \> Membranous nephropathy(subEpithelial spikes)
73
What are complement levels for IgA Nephropathy?
NML
74
Major side effects of Loop Diuretics - 4
1. ⬇︎K+ which --\>
2. metabolic alkalosis
3. Prerenal AKI
4. Tinnitus and hearing loss at high doses
75
Tx options for uncomplicated cystitis - 3
PO abx **WITHOUT waiting for cx**
1. Bactrim x 3
2. Nitrofurantoin x 5
3. Fosfomycin x 1
76
Tx for complicated cystitis
## Footnote
*complicated: DM, CKD, Immunocompro, obstruction, failed initial therapy, hospital acquired, indwelling item*
**Urine CX FIRST --\> tailored abx** (or Levofloxacin PO or CefTriaxone IM while waiting for cx)
77
Which two renal pathologies is analgesic nephrophathy associated with?
1. [ATiN (Acute Tubulointerstitial nephritis)]
2. Papillary necrosis
78
Causes of Papillary Necrosis - 5
**NSAID**
1. **N**SAIDs
2. **S**ickle Cell
3. **A**nalgesic abuse
4. **I**nfection from PYELO
5. **D**M
79
Why is Succinylcholine contraindicated in conditions like burns or skeletal muscle trauma?
Succinylcholine already causes HYPERKalemia
These conditions --\> ⬆︎PostSynpatic ACh R --\> More Succinylcholiine activity --\> FATAL HYPERKalemia
80
In a pt with pyelonephritis, cx are taken before empiric abx
When is urological imaging indicated?-4
1. persistent sx after 3 days
2. hx of nephrolithiasis/obstruction
3. complicated pyelo
4. gross hematuria
81
Urine cytology is mostly helpful in diagnosing \_\_\_\_\_
Bladder CA
82
How is chronic constipation related to UTIs?
Chronic constipation can --\> rectal distension --\> compresses bladder --\> incomoplete voiding and urinary stasis --\> **RECURRENT UTIs**
83
What is a cystocele?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cp?-3
bladder prolapse into the ANT vaginal wall --\>
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. dyspareunia
2. urinary sx
3. vaginal pressure
84
Interstitial Cystitis is also known as ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Etx?
Painful Bladder Syndrome
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[idiopathic chronic bladder pain **relieved with voiding**]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*can also include dyspareunia and urinary sx. do NOT confuse with a cystocele*
85
What condition should you suspect in a PreRenal AKI that does NOT respond to IVF
HepatoRenal Syndrome
86
Renal Vein Thrombosis is most commonly associated with which nephrOtic syndrome?
Membranous nephropathy
Membranous nephropathy is also the most a/w general carcinoma
87
Why do you see abnormal hemostasis in pts with chronic renal failure? ; Tx-3
CRF --\> **UREMIA** --\> Qualitative PLATELET DYSFUNCTION --\> ⬆︎Bleeding Time
Tx = DESMOPRESSIN \> Cryoprecipitate or Conjugated Estrogens
88
Why should you not give Platelet transfusion to a pt with uremic-induced abnormal hemostasis
THOSE platets will ALSO become dysfunctional and inactivated. Tx of choice = DESMOPRESSIN
89
What is the most common cause of death in Dialysis pts?
Cardiovascular disease
## Footnote
*This is also the most common COD in Renal Transplant pts*
90
Which demographic of pts are at the highest risk of Contrast induced neprhopathy? ; Px if these HAVE to be given Contrast?-2
DM pts with elevated baseline creatinine ;
1. IVF (NS or isotonic HCO3) +
2. Acetylcysteine
*This resolves in 1 week*
91
In a pt who has hypovolemic hypernatremia, which fluids should be given for resuscitation?
**NORMAL** saline first and then --\> hypOtonic saline once pt is euvolemic
92
How fast can serum sodium be corrected
0.5 mEq/dL/hr AND NO MORE THAN 12 mEq/dL/hr
93
DM pts are also at risk for NORMAL anion gap metabolic acidosis
What condition is this from?
Type 4 RTA
## Footnote
*definitely suspect this if pt has persistent hyperkalemia*
94
What type of electrolyte abnormalities are seen in chronic alcoholics? - 3
⬇︎MPK
1. ⬇︎Mg (which can --\> ⬆︎renal K+ excretion actually)
2. ⬇︎K+ (in part from the ⬇︎Mg)
3. ⬇︎Phosphorous
95
Renal stones of which size require surgical intervention?
≥5mm
## Footnote
*determined by NC upper abd helical CT*
96
Dx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
etx?
[Cystine hexagonal renal stones]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[inherited amino acid transport impairment] --\> **COAL** dibasic amino acids (**C**ysteine/**O**rnithine/**A**rginine/**L**ysine) accumulation
*will have positive urine cyanide nitroprusside test*
97
What are the risk factors for Focal Segmental Glomerular Sclerosis nephrotic syndrome - 7
**HASH BPH**
1. **HIV**
2. **A**frican american
3. **S**ickle cell
4. **H**eroin
5. **B**ody builder
6. **P**arvoB19
7. **H**ispanic
98
What infections are most commonly associated with Membranoproliferative Glomerulonephritis Type 1 - 2
Hepatitis B and Hepatitis C
99
tx for Minimal Change Disease
CTS
100
What are the effects of Angiotensin II - 3
1. vasoconstrcition
2. ⬆︎Aldosterone
3. ⬆︎Na+ reabsorption DIRECTLY
101
Renal transplant dysfunction in the early post operative period has many etiologies
Name them - 5
1. Ureteral obstruction
2. Vascular obstruction
3. acute rejection (treat with IV CTS)
4. cyclosporine toxicity
5. ATN
102
What type of acid base abnormality is seen in seizure patients?
[Metabolic Acidosis -Anion Gap] 2/2
Postictal **Lactic Acidosis** after a GTC
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
this is transient and resolves within 90 min
103
When is it ok to use hypertonic 3% saline?
**symptomatic** hypOnatremia ONLY
## Footnote
*HA, NV, seizures, weakness*
104
What are the side effects of the Thiazide family - 4
Hyper**GLUC**
1. **G**lucose
2. **L**ipids
3. **U**ric acid
4. **C**alcium
105
Pt has a serum K+ of 5.7
When is it appropriate to start acute therapy (CaGluconate, Insulin with Glucose) for HyperKalemia? - 3
1. EKG changes
2. K+ ≥7
3. rapidly rising K+ from tissue breakdown
## Footnote
*ONLY give K+ lowering therapy if these are present, otherwise just fix underlying cause*
106
Normal range for Serum Osmolality
275-295
107
List the EKG changes seen in Hyperkalemia - 3
108
In which immune mediated vasculitis disorder are pts at risk for intussuception?
Bergers IgA Nephropathy Henoch Scholein Purpura
109
Which glomerular disease (nephrotic or nephritic) is most commonly associated with carcinoma?
Membranous Nephropathy
## Footnote
**BUT NOTE: MINIMAL CHANGE DISEASE IN ADULTS IS MOST ASSOCIATED WITH HODGKIN LYMPHOMA AND NSAIDS**
110
Explain Winter's Formula
COMPENSATED arterial pCO2 *should* be within +/- 2 of [1.5 x HCO3 + 8]
If not, there is a mixed picture
111
Active Hepatitis B is a huge risk factor for which glomerular disease?
Membranous Nephropathy
112
Hyalinosis of both the afferent and efferent renal arterioles indicates which disease?
Diabetic nephropathy
This process happens in **mostly the efferent** which is why DM pts first develop Glomerular Hyperfiltration
