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A1 > Renal > Flashcards

Renal Flashcards

1
Q

What are the 6 D’s of hypernatremia?

A 
Diuresis
Dehydration
DI
Docs (iatrogenic)
Diarrhea
Disease
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2
Q

What is the treatment for hypernatremia if hypovolemic with hemodynamic instability?

A

NS

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3
Q

What is the equation for free water deficit?

A

total body water x ([serum Na/140] - 1)

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4
Q

What fluids should be used to replace free water deficits with hypernatremia?

A

D5W or PO water

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5
Q

What is the rate of free water replacement with hypernatremia? Over how long?

A

0.5 mEq/hr over 48-72 hours

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6
Q

What is the diagnosis for hypernatremia with:

-Urine osmolality less than 100

A

Central DI

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7
Q

What is the diagnosis for hypernatremia with:

-urine osmolality 100-300

A

Nephrogenic DI

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8
Q

What is the ddx for hypernatremia with:

-High urine osmolality (over 600)

A 
Extrarenal losses (v/d)
Na gain (hypertonic saline)
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9
Q

What is the calculation for serum osmolality?

A

2[Na] + glucose/18 + bun/2.8

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10
Q

What is the general treatment for hypervolemic and euvolemic hyponatremia?

A

Water restriction +- diuretics

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11
Q

How fast should hyponatremia be corrected in a day?

A

No more than 8 mEq/L/day

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12
Q

Correcting hyponatremia too fast can cause what?

A

Central pontine myelinolysis

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13
Q

When is hypertonic saline always indicated for the treatment of hyponatremia?

A

If seizing and below 120

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14
Q

What are the causes of isotonic hyponatremia? (4 substances)

A

Hyperlipidemia
Hyperproteinemia
Glucose
Mannitol

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15
Q

What are the causes of hypertonic hyponatremia? (3 substances)

A

Glucose
Mannitol
Contrast agents

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16
Q

What are causes of hypovolemic hyponatremia when U[Na] is LESS than 10?

A

Loss of water

  • v/d/NG suction
  • Skin losses
  • 3rd spacing
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17
Q

What are causes of hypovolemic hyponatremia when U[Na] is MORE than 10?

A

Inappropriate loss of free water (Na follows water)

  • Diuretics
  • Urinary obstruction
  • Addison’s
  • Bicarbonaturia
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18
Q

What are causes of isovolemic hyponatremia when urine osmolality is over 100? (4)

A

Producing concentrated urine inappropriately

  • SIADH
  • Drugs
  • Hypothyroidism
  • Glucocorticoid deficiency
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19
Q

What are causes of isovolemic hyponatremia when urine osmolality is under 100? (2)

A

Excreting excess free water

  • Psychogenic polydipsia
  • Beer potomania
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20
Q

What are causes of hypervolemic hyponatremia when U[Na] is LESS than 10? (3)

A

too much water, and holding onto too much water

  • CHF
  • Cirrhosis
  • nephrotic syndrome
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21
Q

What are causes of hypervolemic hyponatremia when U[Na] is MORE than 10? (3)

A

Too much volume, not holding onto electrolytes

  • AKI
  • CKD
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22
Q

Which type of RTA causes hyperkalemia?

A

III

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23
Q

Which HTN drug (besides diuretics) can cause hyperkalemia?

A

beta blockers

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24
Q

What are the three major, non-specific s/sx of hyperkalemia?

A
  • Areflexia
  • Weakness
  • Intestinal colic
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25
Q

What are the ECG changes associated with hyperkalemia?

A

Tall, peaked T waves
Wide QRS
PR prolongation

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26
Q

Over what level does hyperkalemia require emergent treatment?

A

6.5 mEq/L

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27
Q

What are the components of the C BIG K mnemonic for the treatment of hyperkalemia?

A
  • Calcium gluconate
  • Bicarb / beta-2 agonists
  • Insulin
  • Glucose
  • Kayexalate
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28
Q

What other mineral deficiency needs to be corrected prior to correcting K?

A

Mg

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29
Q

What are the non-specific s/sx of hypokalemia?

A
  • Muscle weakness
  • Ileus
  • Hyporeflexia
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30
Q

What are the ECG manifestations of hypokalemia?

A
  • T wave flattening
  • U waves
  • ST segment depression
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31
Q

What are the components of the CHIMPANZEES mnemonic for causes of hypercalcemia?

A
  • Ca supplementation
  • hyperPTH or hyperthyroidism
  • Iatrogenic
  • Milk-alkali syndrome
  • Paget’s disease
  • Adrenal insufficiency
  • Neoplasm
  • ZE syndrome
  • excess vit A
  • excess vit D
  • Sarcoid
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32
Q

What is the the effect of loop diuretics on Ca levels?

A

Lose calcium

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33
Q

What are symptoms of hypercalcemia?

A
  • stones
  • Bones
  • Abdominal groans
  • Psychiatric overtones
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34
Q

What are the ECG findings associated with hypercalcemia?

A

Short QT

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35
Q

What is the treatment for hypercalcemia? What is 2/2 granulomatous diseases?

A
  • IV hydration

- Steroids for granulomatous diseases

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36
Q

What are the s/sx of hypocalcemia?

A
  • Abdominal cramps
  • Tetany
  • Perioral and acral paresthesias
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37
Q

Chvostek and Trousseau’s sign are seen with what derangement of calcium (high or low)?

A

HypOcalcemia (O face)

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38
Q

What two tests are the most fruitful for the workup of hypocalcemia?

A

PTH

Ionized Ca

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39
Q

What are the ECG manifestations of hypocalcemia?

A

Prolonged QT

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40
Q

What is the treatment for hypocalcemia, besides “treating the underlying disorder”?

A

Mg and Ca supplements

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41
Q

What are the three major causes of hypomagnesemia?

A
  • Decreased intake (short bowel syndrome, TPN)
  • INcreased loss (diarrhea, alcoholism)
  • DKA
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42
Q

What is the formula for correcting Ca levels for hypoalbuminemia?

A

Corrected = total serum + 0.8*(4-serum albumin)

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43
Q

What are the components of the MUDPILERS mnemonic for the causes of anion gap metabolic acidosis? What is the treatment for each?

A
  • Methanol: fomepizole
  • Uremia: dialysis
  • DKA: insulin/fluids
  • Paraldehyde/phenformin
  • Iron, INH: lavage, charcoal
  • Lactic acidosis: IVF
  • Ethylene glycol: fomepizole
  • Rhabdo: IVFs
  • Salicylates: alkalinize urine (Na bicarb)
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44
Q

Hypomagnesemia will not allow for correction of what metabolic disorders?

A

Hypokalemia

Hypocalcemia

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45
Q

Urine Ca oxalate crystals are nearly pathognomonic for what intoxication?

A

Ethylene glycol

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46
Q

What will a fundoscopic exam show with methanol poisoning?

A

Optic disc hyperemia

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47
Q

What is renal tubular acidosis?

A

Decrease in H+ secretion or HCO3 reabsorption by the kidneys, leading to a non-anion gap metabolic acidosis

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48
Q

What is the definition of AKI?

A

Abrupt decrease in renal function (elevation in Cr), and decreased urine output

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49
Q

What is Winters formula (both mathematically, and conceptually)?

A

PaCO2 = 1.5(HCO3) + 6 +/-2

Used in metabolic acidosis to determine if there is more than one acid/base disorder present

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50
Q

What are the following value with RTA type II:

  • Defect
  • Serum K
  • Urinary pH
  • Etiologies
  • Treatment
  • Complications
A
  • Defect = cannot secrete H+
  • Serum K = low
  • Urinary pH = over 5.3
  • Etiologies = AUtoimmune disorders
  • Treatment = replace HCO3
  • Complications = nephrolithiasis
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51
Q

What are the following value with RTA type I:

  • Defect
  • Serum K
  • Urinary pH
  • Etiologies
  • Treatment
  • Complications
A
  • Defect = Cannot absorb HCO3
  • Serum K = Low
  • Urinary pH = 5.3 initially, but lower once serum is acidic
  • Etiologies = multiple Myeloma, amyloidosis
  • Treatment = Thiazides,
  • Complications = rickets, osteomalacia
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52
Q

What are the following value with RTA type IV:

  • Defect
  • Serum K
  • Urinary pH
  • Etiologies
  • Treatment
A
  • Defect = aldosterone deficiency or resistance
  • Serum K = High
  • Urinary pH = Less than 5.3
  • Etiologies = Hyporeninemic, hypoaldosteronism
  • Treatment = Furosemide, mineralocorticoid replacement
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53
Q

What are the components of the AEIOU for indications for urgent dialysis?

A
  • Acidosis
  • Electrolyte abnormalities
  • Ingestions
  • Overload
  • Uremic symptoms
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54
Q

What is the definition of CKD?

A

More than 3 months of GFR less than 60 mL/min

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55
Q

What is the treatment that has been shown to prevent progression of CKD?

A

ACEIs/ARBs

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56
Q

What is the treatment for abnormal bleeding 2/2 CKD?

A

Desmopressin (DDAVP)

57
Q

What is the treatment for hyperphosphatemia and hypocalcemia in CKD respectively?

A
  • Hyperphosphatemia = sevelamer (phosphate binder)

- Hypocalcemia = calcinet (or Ca)

58
Q

How long does creatinine take to spike following contrast use? Drug use?

A
  • Contrast = 5-10 days

- Drugs = 24 hours

59
Q

A postvoid residual of how much is characteristic of postrenal azotemia?

A

More than 50 mL

60
Q

What is the FeNa with pre, post, and intra renal?

A 
Pre = less than 1%
Intra = Over 2%
Post = 1-2%
61
Q

What is the urine sodium for pre, intra, and post renal?

A 
Pre = Less than 20 mEq/L
Intra = over 40
Post = over 40
62
Q

What is the urine osm for pre, intra, and post?

A 
Pre = Over 500
Intra = less than 350
Post = less than 350
63
Q

What urine sediment findings are characteristic or prerenal, and intrarenal etiologies of AKI?

A 
Pre = Hyaline casts
Intra = eosinophils for interstitial, muddy brown casts for ATN
64
Q

What is the treatment for prerenal, intrarenal, and postrenal AKI?

A 
Pre = fluids AEIOU
Intra = IVF or d/c offending meds
Post = Cath
65
Q

Postinfectious glomerulonephritis presents how soon after infection? What serum findings?

A

2-6 weeks

Low C3

66
Q

What are the C3 levels with IgA nephropathy? How soon after infection?

A

Few days after infection, normal C3

67
Q

What are the classic symptoms of the following disorders:

  • Granulomatosis with polyangiitis (Wegener’s)
  • Microscopic polyangiitis
  • Churg strauss
A
  • Granulomatosis with polyangiitis (Wegener’s) = kidney, lung and sinuses
  • Microscopic polyangiitis = Kidney and lung
  • Churg strauss = kidney and asthma
68
Q

What happens to H+ reabsorption with CAIs?

69
Q

What are the major side effects of CAIs?

A
  • Hyperchloremic metabolic acidosis

- sulfa allergy

70
Q

What are the loop diuretics? (4)

A
  • Furosemide
  • Ethacrynic acid
  • Bumetanide
  • Torsemide
71
Q

Which loop diuretic is NOT a sulfa drug?

A

Ethacrynic acid

72
Q

Which diuretics are ototoxic?

73
Q

Which diuretics cause hyperuricemia?

74
Q

Which diuretics can raise blood glucose levels?

75
Q

Which diuretics can cause a metabolic acidosis? Alkalosis? (2 for each)

A 
Acidosis = K sparing, CAIs
Alkalosis = thiazides and loops
76
Q

What are the three major K sparing diuretics?

A
  • Spironolactone
  • Triamterene
  • Amiloride
77
Q

What is the ddx of nephrotic syndrome with low C3 levels? (3)

A

Postinfectious
Membranoproliferative
Lupus nephritis

78
Q

Palpable purpura + arthralgias + nephritic/nephrotic syndrome, low C3, and + HCV = ?

A

Mixed cryoglobulinemia

79
Q

What causes the hypercoagulable state with nephrotic syndrome?

A

Loss of antithrombin III

80
Q

What is the treatment for poststreptococcal (postinfectious) glomerulonephritis?

A

SUpportive

81
Q

What is the treatment for IgA nephropathy?

A

Glucocorticoids for select pts

ACEIs in pts with proteinuria

82
Q

What is the classic triad of HSP?

A

Palpable purpura
Arthralgias
Abdominal pain

83
Q

What are the s/sx of granulomatosis with polyangiitis (Wegener’s granulomatosis’)?

A
  • granulomatous inflammation of the respiratory tract with hemoptysis
  • nasopharyngeal involvement
  • Necrotizing vasculitis of the kidney
84
Q

What is the antibody that is present with granulomatosis with polyangiitis?

85
Q

What is the treatment for granulomatosis with polyangiitis? (3)

A

HIgh dose corticosteroids
cytotoxic agents
Rituximab

86
Q

What is microscopic polyangiitis? s/sx? Antibody? Treatment?

A
  • Small vessel vasculitis similar to GPA, but NO granulomas
  • Similar to GPA, but NO nasopharyngeal involvement
  • p-ANCA
  • Glucocorticoids
87
Q

What is eosinophilic granulomatosis with polyangiitis (Churg-strauss)? S/sx (4)? Antibodies present? Treatment?

A
  • Small vessel vasculitis
  • Asthma, sinusitis, skin nodules, neuropathy
  • p-ANCA, IgE
  • Glucocorticoids
88
Q

What are the s/sx of Goodpasture syndrome?

A
  • Hemoptysis

- NO URI involvement

89
Q

What is the treatment for Goodpasture?

A
  • Plasma exchange therapy

- Pulsed steroids

90
Q

What are the histologic findings of Goodpasture? CXR?

A
  • Linear anti-GBM deposits
  • Hemosiderin filled macrophages in sputum
  • CXR with infiltrates
91
Q

What level of proteinuria is diagnostic of nephrotic syndrome? What is the best way to detect this?

A

More than 3.5 g/day

Use spot protein-to-creatinine ratio

92
Q

What is the treatment for nephrotic syndrome, in general?

A

Protein and salt restriction
DIuretics
ACEIs

93
Q

What vaccine should be administered to pts with nephrotic syndrome?

94
Q

Review Pathoma nephrotic syndromes

A

And nephritic syndromes

95
Q

Spike and dome appearance on kidney bx = ?

A

Membranous

96
Q

Tram track appearance on kidney bx = ?

A

membranoproliferative

97
Q

Nephritic syndrome in a HIV positive african american man with a h/o sickle cell disease and heroin use =?

98
Q

Which nephrotic syndromes are associated with HBV/HCV, SLE?

A

Type I membranoproliferative glomerulonephropathy

Membranous nephropathy

99
Q

What size of kidney stones can be treated with ESWL?

A

0.5 - 3 mm

100
Q

What is the only radiolucent kidney stone?

101
Q

What sort of urinary pH predisposes to calcium phosphate vs calcium oxalate stones?

A 
Phosphate = high pH
Oxalate = Low pH
102
Q

Why is lowering calcium intake not recommended for the treatment of calcium oxalate stones?

A

Leads to hyperoxaluria, which pulls Ca into urine. Thus want to INCREASE Ca.

103
Q

What is the treatment for uric acid stones?

A

Hydration,

Alkalinize the urine with citrate

104
Q

What are the amino acids that are lost with cystinuria?

A

Cystine
Ornithine
Arginine
Lysine

105
Q

What urinary pH predisposes to uric acid stones? Cystine?

A

Uric acid = lower pH

Cystine - Low pH

106
Q

What are the extrarenal manifestations of ARPKD?

A

Liver fibrosis
Portal HTN
Cysts in pancreas, liver

107
Q

What are the extrarenal manifestations of ADPKD?

A

cerebral aneurysms

Cysts in pancreas, liver

108
Q

What are the s/sx of polycystic kidney disease?

A

Pain and hematuria
HTN
Hepatic cysts

109
Q

What is the treatment for PKD?

A

Prevent complications and decrease the rate of progression to ESRD

110
Q

What are the GFRs for stages 1-5 of ESRD?

A 
1 = over 90 mL/min
2 = 60-90
3 = 30-60
4 = 15-30
5 = less than 15
111
Q

What are the two major painless etiologies of scrotal swelling?

A

Hydrocele

Varicocele

112
Q

What are the two major painful etiologies of scrotal swelling?

A

epididymitis

Testicular torsion

113
Q

What is the Prehn sign? What does it indicate?

A

Decrease pain with elevation of the testicle

Indicative of epididymitis, and not torsion

114
Q

When should a hydrocele resolve by/when is surgery indicated?

115
Q

What are the medications that can cause ED?

A
  • beta blockers
  • SSRIs
  • TCAs
  • Diuretics
116
Q

What are the accompanying signs of neurologic causes of ED?

A
  • No anal tone

- Loss of lower extremity sensation

117
Q

What are the labs that should be obtained with ED?

A
  • Testosterone and gonadotropin

- Prolactin

118
Q

What are the top four causes of cancer death in men, in order?

A
  1. Lung cancer
  2. Prostate
  3. Colorectal
  4. Pancreatic
119
Q

What sort of bone lesions does prostate cancer cause?

A

Osteoblastic

120
Q

What is the treatment for prostate cancer?

A
  • Watchful waiting if old

- Radical prostatectomy or brachytherapy

121
Q

What are the components of the I PEE RBCS for the ddx of hematuria?

A 
Infection
PKD
Exercise
External trauma
Renal glomerular disease
BPH
CA
Stones
122
Q

What are the two major risk factors for bladder cancer?

A
  • smoking

- Aniline dyes

123
Q

How do you diagnose bladder cancer?

A

Cystoscopy with bx

124
Q

What is the diagnosis that should be suspected in a middle smoker with a left-sided varicocele?

125
Q

What is the treatment for bladder carcinoma in situ?

A

Intravesical chemo

126
Q

What is the treatment for superficial bladder cancer?

A

COmplete transurethral resection of intravesical chemo with HCG

127
Q

What is the treatment for invasive bladder cancer with mets?

128
Q

What is the treatment for RCC?

A

Surgical resection

129
Q

beta-hCG in men = what cancer?

A

Choriocarcinoma

130
Q

What genetic abnormality is associated with testicular cancer?

A

Klinefelter

131
Q

What is the most common testicular cancer between 15-30?

132
Q

Which type of testicular cancers respond extremely well to chemo?

133
Q

What is the tumor marker for: seminomas?

A

Placental ALP

134
Q

What is the tumor marker for: Yolk sac tumors

135
Q

What is the tumor marker for: choriocarcinoma

136
Q

What is the tumor marker for: testicular teratomas

A

AFP and/or beta hCG

137
Q

What is the tumor marker for: Leydig cell tumors

A

Testosterone and estrogen

138
Q

What is the tumor marker for: sertoli cell tumors

139
Q

What is the tumor marker for: testicular lymphomas

A1 (32 decks)

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