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[2a] A ⼀ Step 2 OD USLME > renal > Flashcards

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

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2
Q

Normal range for PCO2

A

33 - 44 (40 = standard)

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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)

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4
Q

etx for Sundowning

________________

Tx?

A

[Alzheimers vs. EtOH withdrawal vs. Delirium] –> Circadian Rhythm dysfunction –> [⬆︎confusion & agitation at Sundown]

________________

Tx = Melatonin

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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

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6
Q

What are the 2 main electrolyte SE of Furosemide?

________________

how do they affect the heart?

A
  1. hypOkalemia which can –>VTach!
  2. hypOmagnesemia which can –>VTach!

High doses of Loop diuretics also cause reversible or permanent hearing loss and/or tinnitus

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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

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8
Q

BUN Normal range

A

7- 18

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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

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10
Q

Fomepizole

MOA

________________

indication

A

Inhibits [Hepatic Alcohol Dehydrogenase] from converting Ethylene Glycol ➜ oxalate

________________

[Ethylene Glycol] poisoning

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11
Q

Name 4 classes of drugs to cause Fever

A
  1. Anticonvulsants (via Hypersensitivity syndrome)
  2. Abx
  3. Anticholinergics
  4. Sympathomimetic
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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

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13
Q

General beta blockers (propranolol) are used to treat what complication of cirrhosis?

A

⬇︎ GastroEsophageal variceal bleeding

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14
Q

List Causes of Anion Gap Metabolic Acidosis-9

A
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15
Q

List Causes of NORMAL-Anion Gap Metabolic Acidosis (NAHA)-7

A
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16
Q

Urine Osmolarity values in

Pre renal failure

________________

Intrinsic renal failure

A

>350

________________

=300

________________

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17
Q

Urine Specific Gravity values in

Pre renal failure

________________

Intrinsic renal failure

A

> 1.020

________________

= 1.010

________________

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18
Q

FeNa values in

Pre renal failure

________________

Intrinsic renal failure

A

<1

________________

>2

________________

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19
Q

BUN/Cr Ratio values in

Pre

Intrinsic

Post Renal Failure

A

>20

________________

10-20

________________

10-20

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20
Q

UNa values in

Pre renal failure

Intrinsic renal failure

A

<20

________________

>30

________________

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21
Q

In a pt w/hematuria, what also in the urine would indicate Glomerular etx specifically?

A

Protein (On Urine Dipstick)

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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)

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23
Q

List Risk Factors for Contrast induced nephropathy

________________

What are the 2 most important?

A

Ctx: SCr > 1.5 or GFR <60

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24
Q

How do you address Contrast induced neprhopathy At-Risk pts, who needs contrast imaging?-4

A
  1. avoid high-concentraton radiocontrast
  2. DC NSAIDs
  3. [NS IVF] prior to imaging
  4. NAC (N-AcetylCysteine) prior to imaging
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25
Q

MAJOR signs/symptoms of Uremia -6

A
  1. AMS (FATIGUE)
  2. Pericardial Rub
  3. Pruritus
  4. Nausea
  5. Hiccups
  6. Asterixis
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26
Q

How should you evaluate Sodium Imbalance?

A

< (t) N V >

________________

[tonacity (only with hypOnatremia)]

Na+

Volume status

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27
Q

What causes

[HYPERnatremia HYPERvolemia] -6

A

< R R >

  1. [NaHCO3 iatrogenic]
  2. [TPN iatrogenic]
  3. [exogenous CTS]
  4. Cushings Syndrome
  5. Saltwater Drowning
  6. Primary HYPERaldosternism
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28
Q

What are the NONrenal causes of

[HYPERnatremia hypOvolemia] -2

A

< NONrenal R o >

________________

diarrhea

diaphoresis

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29
Q

What are the RENAL causes of

[HYPERnatremia hypOvolemia] -2

A

< RENAL R o >

________________

Diuresis (pharm vs osmotic)

Renal Failure

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30
Q

What causes

[HYPERnatremia eUvolemia] -2

A

< R u >

________________

Diabetes Insipidus

Tachypnea

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31
Q

Normal GFR range

A

90 - 120 mL/min but most labs report > 60

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32
Q

Normal Creatinine Clearance for Men vs Women

A

Men = 97-137

Women = 88-128

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33
Q

Describe the 2 types of Hepatorenal syndrome

A

Type 1: Rapid & Fatal Renal failure triggered by Spontaneous bacterial peritonitis = poor pgn

Type 2:slow renal decline see in refractory ascities

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34
Q

Hepatorenal Syndrome tx -4

________________

type 1=FAST/RAPID | type 2=slow

A

⬆︎volume to kidneys

1st: Stop Diuretics (Spironolactone, Fusermoide)
2nd: Albumin IV
3rd: Alternative: Add Octreotide to vasoconstrict splanchnics
4th: Liver transplant

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35
Q

What are the 2 most common causes of Chronic Kidney Disease

A

DM and HTN

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36
Q

Why is a Lipid Panel ordered in CKD pts?

A

Prevent Cardio dz by controlling lipids since CV dz is most common cause of Death in CKD pts

Because of this, also order EKG

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37
Q

What is the significance of Proteinuria in CKD -3

A
  1. Protein filtration worsens Kidney dz
  2. Proteinuria = early heart dz in CKD pts
  3. Proteinuria = Glomerulus damage
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38
Q

Why is it important to prevent Hyperphosphatemia in CKD pts

A

Elevated Phosphate 2/2 CKD –> ⬆︎ PTH release (2° HyperParathyroid) –> [Renal Osteodystrophy] and Mortality

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39
Q

List causes of pseudOhypOnatremia -2

________________

serum OSm 280-295

A

< (p) o >

⬆︎Protein

⬆︎TAG

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40
Q

List RENAL causes of [hypOtonic true hypOnatremia]

in a hypOvolemia patient -3

________________

[serum OSm <280] and [UNa>20]

A

< RENAL ooo >

  1. Diuretics excessively
  2. low aldosterone
  3. [acute tubular necrosis]
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41
Q

List NONrenal causes of [hypOtonic true hypOnatremia]

in a hypOvolemia patient -3

________________

[serum OSm <280] and [UNa<10]

A

< NONrenal ooo >

  1. GI loss (diarrhea/vomiting)
  2. Diaphoresis
  3. 3rd spacing
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42
Q

List causes of [hypOtonic true hypOnatremia]

in a Euvolemia patient -6

________________

serum OSm <280

A

< o o u >

  1. SIADH
  2. [psychogenic polydipsia]
  3. postOp
  4. hypOthyroid
  5. Beer potomania
  6. [Tea & Toast syndrome]
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43
Q

List causes of [hypOtonic true hypOnatremia]

in a HYPERvolemia patient -3

________________

serum OSm <280

A

< o o R >

  1. CHF
  2. nephrOtic syndrome
  3. Liver disease
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44
Q

List causes of Hypertonic hypOnatremia -3

________________

serum OSm >295

A

< (R) o >

  1. ⬆︎ Glucose
  2. ⬆︎ Glycerol
  3. Mannitol

________________

Too much OSMOTICALLY ACTIVE substances in extracellular fluid

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45
Q

Wilms tumor etx

A

proliferation of metanephric blastema –>

HAWF (Hematuria painless/HTN, Abd mass, Wt loss, Fever, Flank Pain)

46
Q

What are the renal complications of sickle cell TRAIT - 5

A
  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

Sickle cell trait is a benign condition with Hgb AS that can cause fleeting papillary necrosis

47
Q

What is the earliest renal abnormality in pts diagnosed with DM?

A

Glomerular Hyperfiltration

  • 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
Q

What are the 5 different types of renal stones

A
  1. [Ca+ (oxalate or phosphate) stones]
  2. [Uric acid radiolucent stone]
  3. [Xanthine radiolucent stone]
  4. [AMPS (Ammonium Mg Phosphate Struvite) stone]
  5. [Cystine hexagonal stones] - inherited
49
Q

Tx for Uric acid radiolucent stone - 3

A
  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
Q

Tx for Ca+ renal stone - 4

A
  1. Hydration ≥2L / day
  2. HCTZ
  3. Na+ dietary ⬇︎
  4. Vit C dietary⬇︎

**Normal Ca+ dietary intake **

51
Q

cp of Alports X-linked Syndrome - 3

A

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
Q

Electron microscopy findings for Alports X-linked Syndrome

A

Can’t Pee, Can’t See, Can’t Hear a buzzing bee

SPLITTING of Glomerular basement membrane with thinning

53
Q

What type of renal effects does IV Acyclovir have?

________________

Tx?

A

Collecting Duct Crystalline nephropathy with renal tubular obstruction

________________

AGGRESSIVE IVF before and after tx

54
Q

Needle shaped crystals on UA indicate what dx?

A

Uric Acid radiolucent stone

55
Q

Normal Post Void Residual for Women

A

< 150 cc

56
Q

Normal Post Void Residual for Men

A

< 50 cc

57
Q

List the differentiating factors for a renal cyst to be classified as Simple? - 6

________________

What is mngmt for Simple Renal cyst?

A
58
Q

Normal range for Ca+ is 8.4-10.4

What is the mngmt for Asymptomatic Hypercalcemia 10.4 - 14

A

NOTHING. Just avoid worsening factors like dehydration

ALWAYS BE PREPARED TO GIVE IVF FOR HYPERCALCEMIA

59
Q

Normal range for Ca+ is 8.4-10.4

What is the mngmt for Symptomatic OR Hypercalcemia >14 - 3

A
  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
Q

What are lab values that diagnose SIADH - 5

A
  1. hypOnatremia
  2. Serum Osmo <275
  3. Urine Osmo >100
  4. Urine Na+ >40
  5. low serum Uric acid
61
Q

Causes of SIADH - 4

A
  1. Intracranial process
  2. SSRIs
  3. NSAIDs
  4. Lung disease (especially SOLC)
62
Q

If renal obstruction is present, what does elevated Creatinine tell you about its laterality?

A

Must be BILATERAL - uL obstruction (i.e. from stone) does not bump creatinine since other Kidney will compensate

63
Q

Major causes of Rhabdomyolysis - 4

A
  1. Immobilization prolonged (direct damage)
  2. Cocaine (direct damage)
  3. Physical restraints
  4. Dehydration

Muscle breakdown –> ⬆︎CPK, ⬆︎K, ⬆︎myoglobin(which causes renal damage when filtered)

64
Q

Why is it dangerous to give Nitroprusside to a renal failure pt?

________________

Tx for this?

A

Nitroprusside’s byproduct, thiocyanate, is renal excreted, especially if infusion is > 24 hours

________________

Tx = Sodium Thiosulfate

65
Q

cp for Acute Urinary Retention-2

________________

What are the risk factors for AUR?-6

________________

Dx?

A

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
Q

Pt has [Dense Intramembranous C3b deposits] in their glomerulus

Diagnosis?

________________

etx?

A

[MembranoProliferative GN type 2 (dense deposit disease)]

________________

caused by IgG Ab constantly activating the alternative complement pathway

67
Q

What are the 2 major examples of Immune complex-mediated Glomeronephritis

A
  1. SLE
  2. PSGN-PiG
68
Q

Pt has Anti-Glomerular Basement Membrane (GBM) IgG

Diagnosis?

A

GoodPasture syndrome

Glomerulonephritis and Pulmonary hemoptysis

69
Q

pt has Hepatitis C

What renal pathology should you be concerned for?

________________

cp?-4

A

Cryoglobulinemia

________________

  1. Palpable Purpura
  2. ⬇︎complement
  3. hematuria
  4. proteinuria

HepC is also associated with Porphyria Cutanea Tarda

70
Q

Dx criteria for Nephrotic syndrome -3

A

>3g protein/24 hr + hypOalbumin + edema

71
Q

Minimal change disease is more common in kids

When is it associated with adults? - 2

A
  1. NSAID use
  2. Hodgkin Lymphoma
72
Q

Name the 2 most common Nephrotic syndromes in adults

A

FSGS > Membranous nephropathy(subEpithelial spikes)

73
Q

What are complement levels for IgA Nephropathy?

A

NML

74
Q

Major side effects of Loop Diuretics - 4

A
  1. ⬇︎K+ which –>
  2. metabolic alkalosis
  3. Prerenal AKI
  4. Tinnitus and hearing loss at high doses
75
Q

Tx options for uncomplicated cystitis - 3

A

PO abx WITHOUT waiting for cx

  1. Bactrim x 3
  2. Nitrofurantoin x 5
  3. Fosfomycin x 1
76
Q

Tx for complicated cystitis

complicated: DM, CKD, Immunocompro, obstruction, failed initial therapy, hospital acquired, indwelling item

A

Urine CX FIRST –> tailored abx (or Levofloxacin PO or CefTriaxone IM while waiting for cx)

77
Q

Which two renal pathologies is analgesic nephrophathy associated with?

A
  1. [ATiN (Acute Tubulointerstitial nephritis)]
  2. Papillary necrosis
78
Q

Causes of Papillary Necrosis - 5

A

NSAID

  1. NSAIDs
  2. Sickle Cell
  3. Analgesic abuse
  4. Infection from PYELO
  5. DM
79
Q

Why is Succinylcholine contraindicated in conditions like burns or skeletal muscle trauma?

A

Succinylcholine already causes HYPERKalemia

These conditions –> ⬆︎PostSynpatic ACh R –> More Succinylcholiine activity –> FATAL HYPERKalemia

80
Q

In a pt with pyelonephritis, cx are taken before empiric abx

When is urological imaging indicated?-4

A
  1. persistent sx after 3 days
  2. hx of nephrolithiasis/obstruction
  3. complicated pyelo
  4. gross hematuria
81
Q

Urine cytology is mostly helpful in diagnosing _____

A

Bladder CA

82
Q

How is chronic constipation related to UTIs?

A

Chronic constipation can –> rectal distension –> compresses bladder –> incomoplete voiding and urinary stasis –> RECURRENT UTIs

83
Q

What is a cystocele?

________________

cp?-3

A

bladder prolapse into the ANT vaginal wall –>

________________

  1. dyspareunia
  2. urinary sx
  3. vaginal pressure
84
Q

Interstitial Cystitis is also known as ⬜

________________

Etx?

A

Painful Bladder Syndrome

________________

[idiopathic chronic bladder pain relieved with voiding]

________________

can also include dyspareunia and urinary sx. do NOT confuse with a cystocele

85
Q

What condition should you suspect in a PreRenal AKI that does NOT respond to IVF

A

HepatoRenal Syndrome

86
Q

Renal Vein Thrombosis is most commonly associated with which nephrOtic syndrome?

A

Membranous nephropathy

Membranous nephropathy is also the most a/w general carcinoma

87
Q

Why do you see abnormal hemostasis in pts with chronic renal failure? ; Tx-3

A

CRF –> UREMIA –> Qualitative PLATELET DYSFUNCTION –> ⬆︎Bleeding Time

Tx = DESMOPRESSIN > Cryoprecipitate or Conjugated Estrogens

88
Q

Why should you not give Platelet transfusion to a pt with uremic-induced abnormal hemostasis

A

THOSE platets will ALSO become dysfunctional and inactivated. Tx of choice = DESMOPRESSIN

89
Q

What is the most common cause of death in Dialysis pts?

A

Cardiovascular disease

This is also the most common COD in Renal Transplant pts

90
Q

Which demographic of pts are at the highest risk of Contrast induced neprhopathy? ; Px if these HAVE to be given Contrast?-2

A

DM pts with elevated baseline creatinine ;

  1. IVF (NS or isotonic HCO3) +
  2. Acetylcysteine

This resolves in 1 week

91
Q

In a pt who has hypovolemic hypernatremia, which fluids should be given for resuscitation?

A

NORMAL saline first and then –> hypOtonic saline once pt is euvolemic

92
Q

How fast can serum sodium be corrected

A

0.5 mEq/dL/hr AND NO MORE THAN 12 mEq/dL/hr

93
Q

DM pts are also at risk for NORMAL anion gap metabolic acidosis

What condition is this from?

A

Type 4 RTA

definitely suspect this if pt has persistent hyperkalemia

94
Q

What type of electrolyte abnormalities are seen in chronic alcoholics? - 3

A

⬇︎MPK

  1. ⬇︎Mg (which can –> ⬆︎renal K+ excretion actually)
  2. ⬇︎K+ (in part from the ⬇︎Mg)
  3. ⬇︎Phosphorous
95
Q

Renal stones of which size require surgical intervention?

A

≥5mm

determined by NC upper abd helical CT

96
Q

Dx?

________________

etx?

A

[Cystine hexagonal renal stones]

________________

[inherited amino acid transport impairment] –> COAL dibasic amino acids (Cysteine/Ornithine/Arginine/Lysine) accumulation

will have positive urine cyanide nitroprusside test

97
Q

What are the risk factors for Focal Segmental Glomerular Sclerosis nephrotic syndrome - 7

A

HASH BPH

  1. HIV
  2. African american
  3. Sickle cell
  4. Heroin
  5. Body builder
  6. ParvoB19
  7. Hispanic
98
Q

What infections are most commonly associated with Membranoproliferative Glomerulonephritis Type 1 - 2

A

Hepatitis B and Hepatitis C

99
Q

tx for Minimal Change Disease

A

CTS

100
Q

What are the effects of Angiotensin II - 3

A
  1. vasoconstrcition
  2. ⬆︎Aldosterone
  3. ⬆︎Na+ reabsorption DIRECTLY
101
Q

Renal transplant dysfunction in the early post operative period has many etiologies

Name them - 5

A
  1. Ureteral obstruction
  2. Vascular obstruction
  3. acute rejection (treat with IV CTS)
  4. cyclosporine toxicity
  5. ATN
102
Q

What type of acid base abnormality is seen in seizure patients?

A

[Metabolic Acidosis -Anion Gap] 2/2

Postictal Lactic Acidosis after a GTC

________________

this is transient and resolves within 90 min

103
Q

When is it ok to use hypertonic 3% saline?

A

symptomatic hypOnatremia ONLY

HA, NV, seizures, weakness

104
Q

What are the side effects of the Thiazide family - 4

A

HyperGLUC

  1. Glucose
  2. Lipids
  3. Uric acid
  4. Calcium
105
Q

Pt has a serum K+ of 5.7

When is it appropriate to start acute therapy (CaGluconate, Insulin with Glucose) for HyperKalemia? - 3

A
  1. EKG changes
  2. K+ ≥7
  3. rapidly rising K+ from tissue breakdown

ONLY give K+ lowering therapy if these are present, otherwise just fix underlying cause

106
Q

Normal range for Serum Osmolality

A

275-295

107
Q

List the EKG changes seen in Hyperkalemia - 3

A
108
Q

In which immune mediated vasculitis disorder are pts at risk for intussuception?

A

Bergers IgA Nephropathy Henoch Scholein Purpura

109
Q

Which glomerular disease (nephrotic or nephritic) is most commonly associated with carcinoma?

A

Membranous Nephropathy

BUT NOTE: MINIMAL CHANGE DISEASE IN ADULTS IS MOST ASSOCIATED WITH HODGKIN LYMPHOMA AND NSAIDS

110
Q

Explain Winter’s Formula

A

COMPENSATED arterial pCO2 should be within +/- 2 of [1.5 x HCO3 + 8]

If not, there is a mixed picture

111
Q

Active Hepatitis B is a huge risk factor for which glomerular disease?

A

Membranous Nephropathy

112
Q

Hyalinosis of both the afferent and efferent renal arterioles indicates which disease?

A

Diabetic nephropathy

This process happens in mostly the efferent which is why DM pts first develop Glomerular Hyperfiltration

[2a] A ⼀ Step 2 OD USLME (21 decks)

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