Renal Flashcards
Whats on ddx when patient has Hypokalemia, Alkalosis, Normal BP
Low Urine Chloride
1. Bulimic (surreptious) vomiting
High Urine Chloride
- Diuretic abuse
- Bartters syndrome (reab defect in TAL NaK2Cl)
- Gittelmans syndrome (reab defect of NaCl in DCT)
Hyponatremia with Serum osmolality >300
Glucose, Mannitol, Contrast Agents
Hyponatremia with low serum Osm and Urine osm >100
SIADH
hypothyroid
glucorticoid def
drugs
Hyponatremia with low serum Osm and Urine osm <100
Primary polydipsia, Beer drinker potomania
Hyponatremia in schizophrenic patient
Psych hx –> Primary polydipsia
T/F: Hypercoagulation is commonly seen in nephrotic syndrome
True, especially renal vein thrombosis
->loss of Antithrombin III, changes to protein C and S, liver make more fibrinogen,
Earliest sign of diabetic nephropathy?
Glomerular hyperfiltration
Ultimately leads to GBM thickening, mesangial expansion, and the characteristic nodular sclerosis
Nephrotic syndrome in blacks/mexicans
FSGS
Nephrotic syndrome in heroin users, HIV, sickle cell, obesity
FSGS
Nephrotic syndrome in whites
Membraneous
How to remember nephrotic syndrome in whites vs blacks/mexicans
Blacks/Mexicans are segregated: FSGS
Whites are always members: Membraneous
T/F: Amitryptiline has anticholinergic side effects, including urinary retention
True. This TCA drug, used for pain/neuropathy, can cause atropine like sxs: dry mouth, urinary retention, etc.
Intramembraneous deposits that stain for C3 + proteinuria
Membraneoproliferative glomerulopathy
- -> caused by persistent activation of alternate pathway
- ->IgG Ab = C3 nephritic factor
Renal vascular lesions seen in hypertension
Arterio sclerotic of afferent and efferent arterioles and glomerular capillary
Characteristics of diabetic nephropathy
increased extracellular matrix, BM thickening, mesangial expansion, fibrosis
T/F: Diabetic nephropathy is characterized by nodular (or sometimes diffuse) glomerulosclerosis and GBM thickening
True, with Kimmelstiel-Wielstein lesion
Envelope-shaped rectangular crystals on UA
Calcium stones
- -> acidic low pH = calcium oxalate
- ->basic high pH = calcium phosphate
–Tx = hydration, thiazides, citrate
Causes of calcium oxalate stones (acidic low pH)
Ethylene glycol (antifreeze)
vitamin C abuse
malabsorption (Crohns)
Oliguria, hypertension, increased Creatinine/BUN a few days after renal transplant
Renal transplant dysfunction: causes = ureteral obstruction (look for dilated calcyces), cyclosporine toxicity (high levels), vascular obstruction, ATN, acute rejection
–>Acute rejection Tx with IV STEROIDS
How do you prevent contrast-induced nephropathy?
Pre-tx with IV hydration is the big one. can also pretx with sodium bicarb. can give acetylcysteine on top of one of those.
Signs of aspirin toxicity
Gastric ulcer, tinnitus. Causes hyperventilation and mixed respiratory alkalosis and anion gap metabolic alkalosis
T/F: Thiazides decrease uric acid
False. Toxicity can cause hyperuricemia
Tx for uric acid stones
Alkalinization of the urine (POTASSIUM CITRATE), low-purine diet, hydration. Or Allopurinol.
Hematuria, unilateral flank pain, palpable renal mass in a smoker
Renal cell carcinoma