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CB Internal Medicine > Renal > Flashcards

Renal Flashcards

1
Q

Renal tubular acidosis associated with:

abnormal H+ secretion and nephrolithiasis

A

Type 1 (distal) RTA

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2
Q

Renal tubular acidosis associated with:

abnormal HCO3- reabsorption and rickets

A

Type II (proximal) RTA

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3
Q

Renal tubular acidosis associated with:

low aldosterone state

A

Type IV (distal) RTA

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4
Q

What is the treatment of hypernatremia?

A

NS if unstable vital signs

D5W or 1/2 NS to replace free-water loss

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5
Q

What is the differential diagnosis of hypotonic, hypervolemic hyponatremia?

A

1) Cirrhosis
2) CHF
3) Nephrotic syndrome
4) Acute kidney injury (AKI)
5) Chronic kidney disease (CKD)

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6
Q

Chvostek and Trousseau signs present in what electrolyte imbalance?

A

Hypercalcemia

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7
Q

What is the 2 most common causes of hypercalcemia?

A

1) Malignancy

2) Hyperparathyroidism

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8
Q

What electrolyte imbalance presents with T-wave flattening and U waves on ECG?

A

Hypokalemia

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9
Q

What electrolyte imbalance presents with peaked T waves and widened QRS on ECG?

A

Hyperkalemia

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10
Q

What is the treatment of hyperkalemia?

A

C BIG K

Calcium glutinate; bicarb; insulin; glucose; kayexalate

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11
Q

What is the first-line treatment for moderate hypercalemia?

A

IV hydration

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12
Q

Type of AKI in a patient with FeNA < 1%

A

Pre renal

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13
Q

A 49 year old man presents with acute-onset flank pain and hematuria. What is the diagnosis?

A

Nephrolithiasis

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14
Q

What is the most common type of nephrolithiasis?

A

Calcium oxalate

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15
Q

What is the test of choice for nephrolithiasis?

A

Non contrast CT

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16
Q

Ultrasonography shows bilateral enlarged kidneys with cysts. What is the associated brain anomaly?

A

Cerebral berry aneurysms

autosomal dominant polycystic kidney disease, PCKD

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17
Q

What condition presents with:

hematuria, hypertension, oliguria

A

Nephritic syndrome

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18
Q

What condition presents with:

proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema

A

Nephrotic syndrome

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19
Q

What is the most common form of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

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20
Q

What kind of nephritic syndrome presents 3 days after URI (*normal C3)?

A

IgA nephropathy (Beger disease)

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21
Q

What condition presents with:

palpable purpura, arthralgias, abdominal pain

A

Henoch-Schonlein purpura

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22
Q

What condition presents with:

glomerulonephritis with deafness

A

Alport syndrome

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23
Q

What condition presents with:

glomerulonephritis with hemoptysis

A

Granulomatosis with polyangiitis and Goodpasture syndrome

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24
Q

What condition presents with:

red cell casts in urine sediment

A

Glomerulonephritis/ nephritic syndrome

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25
Q

What condition presents with:

eosinophils in urine sediment

A

Allergic interstitial nephritis

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26
Q

What condition presents with:

waxy casts in urine sediment and Maltese crosses (seen with lipiduria)

A

Nephrotic syndrome

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27
Q

What condition presents with:

muddy brown casts

A

Acute tubular necrosis

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28
Q

What condition presents with:

drowsiness, asterixis, nausea, and a pericardial friction rub

A

Uremic syndrome seen in patients with renal failure

29
Q

Salicylate ingestion occurs in what type of acid-base disorder?

A

Anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation

30
Q

What acid-base disturbance is commonly seen in pregnant women?

A

Respiratory alkalosis

31
Q

What complication can occur if you correct hyponatremia too rapidly?

A

Central pontine myelinolysis

32
Q

What labs will you order for HTN workup?

A

Urinalysis (protein)
Electrolytes (check K+)
Cr

Fasting blood glucose/ HBA1C
Lipid profile
12-lead ECG (looking for end organ involvement)

33
Q

Pt with high blood pressure and low potassium

A

Hyperaldosteronism

34
Q

Renovascular HTN should be suspected in patients presenting with what?

(Renal artery stenosis)

A
  1. Sudden onset worsening of HTN and age <30 or >55
  2. Abdominal bruit
  3. HTN resistant to 3 or more drugs
  4. Rise in Cr of 30% or more with use of ACE or ARB
  5. Other atherosclerotic vascular disease (pt smoke, dyslipidemia)
  6. Recurrent pulmonary edema associated with HTN surges
35
Q

What do you order if you suspect DM with HTN?

A

urinary protein excretion

36
Q

What do you order if you suspect renovascular HTN?

A

renal ultrasound, catopril renal scan, MRA/ CTA

37
Q

What do you order if you suspect endocrine causes?

A 
plasma aldosterone (will be high)
plasma renin (will be low)
or
24hr urine aldosterone if plasma tests not available
38
Q

What do you order if you suspect pheochromocytoma?

A

24h urine for metanephrines and creatinine
then
CT abdomen

39
Q

What exogenous factors induce HTN?

A 
NSAIDs
Steroids 
OCPs
Decongestants 
Calcineurin inhib
MAOIs, SSRIs, SNRIs 
Cocaine
Salt
Liquorice root
Alcohol
40
Q

What test can you use to confirm primary aldosteronism?

A

Saline loading test

41
Q

How do you treat hyper aldosteronism?

A

Surgery
Spironolactone (aldosterone blocker)
Triamterene

42
Q

Pigmented granular casts

A

Acute tubular necrosis

43
Q

How can you differentiate Prerenal AKI from ATN AKI?

A

FeNa > 1% (ex, 5%) is ATN

FeNa < 1% is prerenal (holding onto sodium)

44
Q

What is the urea:creatinine ratio in pre renal azotemia?

A

2:1

45
Q

Most common cause of nephrotic syndrome in kids

A

Minimal change

46
Q

Hallmark of nephrotic syndrome

A

24 urine protein > 3.5g

47
Q

How do you screen for diabetic nephropathy?

A

Urine albumin to creatinine ratio

ACR > 2.8mg/mmol (female), ACR > 2.0mg/mmol (male) consistent with microalbuminuria

48
Q

Is minimal change disease nephritic or nephrotic syndrome?

A

NEPHROTIC

damage to glomuerli - give steroids

49
Q

Features of nephrotic syndrome (“HELP”)

A

Hypoalbuminemia
Edema
Lipid abnormalities
Proteinuria

50
Q

Features of nephritic syndrome (“PHAROH”)

A 
Proteinuria
Hematuria
Azotemia
RBC casts
Oliguria 
HTN
51
Q

Work up of hematuria

A

PURE hematuria (vs blood + protein) think urology causes

UTI
stone
bladder tumor
RCC (>60yrs) etc

Need CBC, urinalysis, ultrasound, cystoscopy, maybe imaging for stones (CT)

52
Q

What is the most common type of primary glomerular disease worldwide?

A

IgA nephropathy (Bergers Disease)

  • post URTI
  • it’s actually a nephritic syndrome
  • compliment level will be normal
53
Q

Difference between IgA nephroparthy and Post-infectious GN?

A 
IgA = normal C3
Post-Ifxn = low C3
54
Q

Hallmark of rapidly progressive glomerulonephritis

A

Fibrous crescents on renal histopathology

also in Goodpastures

55
Q

Rapidly progressive glomerular nephritis type 1 with hemoptysis and dyspnea

A

Goodpastures Syndrome

56
Q

Purport on buttock and legs, abode pain, arthralgia, fever

IgA and C3 staining of mesangium

A

HSP

Henoch-Schonlein Purpura

57
Q

c-ANCA is associated with what clinical picture

A

granulomatosis with polyangiitis

Wegeners

58
Q

p-ANCA is associated with what clinical picture

A

microscopic polyangiitis

59
Q

patient presents with purpura, fever, Raynaud’s phenomenon, arthalgias and Hep C

A

cryoblobulinemia

60
Q

How will HIV-associated renal disease present?

A

FOCAL SEGMENTAL GLOMERULONEPHRITIS

61
Q

child who received an antibiotic, now presenting with flank pain, WBC casts in urine and eosinophils in urine

A

ACUTE tubulointerstitial nephritis

62
Q

patient in ICU who is being treated for sepsis, is hypotensive, with abrupt decline in renal function despite lots of fluids
with high FE Na+ and pigmented granular casts

A

Acute Tubular Necrosis

63
Q

what can you give patients with chronic renal disease who require radiographic contrast? (to prevent ATN)

A

N-acetylcysteine fay before and day of procedure

IV NaHCO3

64
Q

what is the definition of chronic renal failure

A

GFR < 60 for >3 months

65
Q

what are the most common causes of chronic renal disease?

A

1) DM
2) HTN
3) glomerular nephritis

66
Q

what do you have to worry about in adults with polycystic kidney disease?

A

cerebral aneurysms (causing subarachnoid hemorrhage)

67
Q

what is the best way to reverse uremic signs and symptoms in chronic kidney disease?

A

renal transplant

68
Q

where is a renal transplant placed anatomically?

A

iliac fossa (renal artery of kidney goes to recipient external iliac artery)

69
Q

significant benefits in quality of life can occur if dialysis is started before what CrCl?

A

CrCl < 15 mL/min

CB Internal Medicine (12 decks)

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