Renal Flashcards
Most sensitive screen for diabetic nephropathy
Urine Microalbumin:Creatinine ratio
Small bilateral kidneys
Chronic HTN
Prevention of contrast induced nephropathy (CIN)
Pre-CT IVF
(+ acetylcysteine)
Post-cardiac cath AKI
Cholesterol emboli vs. CIN (contrast-induced nephropathy)
- CIN resolves within 3-7d
- Cholesterol emboli can be immediate or delayed >30d
Causes of primary adrenal insufficiency
Autoimmune vs. TB
TB is a common cause of
Primary adrenal insufficiency
Na+, K+, and H+ in primary adrenal insufficiency
Hyponatremia, hyperkalemia, and NAGMA (decreased aldosterone)
Painless gross hematuria
Bladder cancer
Red urine negative for RBCs
Myoglobinuria vs. Beet ingestion vs. Rifampin
Lithium polyuria
Nephrogenic DI
(renal ADH resistance)
Tx: Discontinue Lithium + Salt restriction
Common complications of ADPKD
IC berry aneurysms, hepatic cysts
Potassium citrate
Alkalinization of urine
Uric acid stones diet
Low-protein diet
(low-purine diet)
Cause of refractory hypokalemia
Hypomagnesemia
Tamsulosin
α-1 blocker
(tx of ureteral kidney stone)
C3 dense deposits in glomerular BM due to persistent activation of the alternative complement pathway
MPGN
(persistently low C3)
Causes of Papillary Necrosis
NSAID:
NSAIDs, SCD, Analgesic abuse, Infection (pyelo), DM
Acute hypercalcemia Tx
Aggressive NS hydration + Calcitonin
Bisphosphonates in acute hypercalcemia
NEVER choose this. Effect is 2-4d delayed.
Increased bleeding in CKD
Uremic coagulopathy
(platelet dysfunction —> Increased BT)
Cocaine abuse + elevated CPK & K+
Renal failure
(myoglobin-induced ATN in setting of rhabdomyolysis)
Tx:
- Aggressive hydration
- Mannitol
- Urine Alkalinization (potassium citrate)
Kidney biopsy w/ increased extracellular matrix, basement membrane thickening, mesangial expansion, and fibrosis
Diabetes Mellitus
Kidney biopsy w/ intimal thickening, luminal narrowing of renal arterioles, and e/o sclerosis
Hypertension
(arteriosclerosis + capillary tufts)
Most common cause of death in dialysis patients
Cardiovascular disease
(SCD then acute MI)
Needle-shaped crystals on CT
Uric acid stones
- Rhomboid or Rosette on microscopy (uRhomboid acid)
- Acidic pH
- Radiolucent (transparent) on XR
- Tx: Urine Alkalinization + Allopurinol
Tx of Hypercalcemia:
- NS hydration (first step)
- Calcitonin (inhibit bone resorption)
- Bisphosphonates
Euvolemic hyponatremia + HIGH urine Osm + HIGH urine sodium
SIADH
Tx of post-operative urinary retention (PUR)
Urgent bladder scan & catheterization!
Nodular glomerulosclerosis
Pathognomonic change in diabetic nephropathy
(Diabetic GN)
Cervical motion tenderness
PID
Metformin should be discontinued in pts w/ renal failure, liver failure, or sepsis as it can cause ____
Lactic acidosis
IBD predisposes to this type of nephrotic syndrome
Amyloidosis (AA)
RA predisposes to
Amyloidosis (AA)—abnormal proteins
Hyalinosis of afferent and efferent glomerular arterioles on LM
Diabetic nephropathy
Incontinence in uncontrolled diabetes
Diabetic autonomic neuropathy
(DAN)
Congo Red staining and Apple Green birefringence in polarized light
Amyloidosis
(staining of glomerular deposits)
Earliest renal abnormality in diabetic nephropathy
Glomerular hyperfiltration, followed by:
- Glomerular basement thickening
- Mesangial expansion (creating broad casts)
- Nodular glomerulosclerosis (pathognomonic for DM [Kimmelsteil-Wilson nodules])
Associated with HBV
PAN
(Polyarteritis Nodosa: small- to medium-sized vasculitis)
Associated with HCV
Cryoglobulinemia
(HSP-like adult syndrome w/o GI)
Associated with Cryoglobulinemia
HCV
Test all pts with mixed cryoglobulinemia for ____
HCV
HSP-like renal disease in adults w/ HCV
Mixed cryoglobulinemia
GFR when uremic symptoms may occur
GFR <60
Tx for symptomatic uremia
Dialysis!
(encephalopathy, pericarditis, or bleeding)
Indications for urgent dialysis
AEIOU
- Acidosis <7.1 refractory to medical therapy
- Electrolyte abnormalities (severe hyperkalemia, >6.5 refractory to medical therapy)
- Intoxication (ASA, methanol/ethylene glycol, lithium, valproic acid/carbamazepine)
- Overload (e.g. CKD; refractory to diuretics)
- Uremia (Symptomatic [encephalopathy, pericarditis, bleeding; usually will have GFR <60)
Chlorthalidone is a _____
thiazide diuretic
Thiazide diuretic effects →
- Decreased K+ (hypokalemia)
- Decreased Mg2+ (hypomagnesemia)
- Decreased Na+ (hyponatremia)
- Increased Ca2+ reabsorption (hypercalcemia)
- Increased glucose (hyperglycemia)
- Increased uric acid (hyperuricemia; predisposed to gout)
- Increased LDL & TGs
Contrast is required/not required to visualize ureteral stones (abd CT)
Not required
Lower abd pain that radiates to groin
Obstructive ureterolithiasis
(kidney stone)
Winter’s Formula is used to
calculate respiratory compensation for metabolic acidosis
(pCO2 = 1.5(HCO3) + 8 ± 2)
ASA causes mixed respiratory alkalosis & metabolic acidosis by directly stimulating the ____ and decreasing ____ respectively
- medullary respiratory center (tachypnea)
- renal elimination of lactic acid & ketoacids (& increased production)
Low C3, Normal C4
PSGN
Persistently Low C3, Normal C4
MPGN
Low C3 & C4
SLE
Higher Ca2+ concentrations required to suppress PTH release due to AD mutation of Ca2+-sensing receptor (CaSR)
FHH
(Familial Hypocalciuric Hypercalcemia)
Drug that causes red to orange discoloration of body fluids (urine, saliva, sweat, tears)
Rifampin
(also causes AIN)
High-dose TMP-SMX requires serial monitoring of ____
K+ levels
MOA of ADH stimulation from hypovolemia
Stretch receptors in LA
MOA of ADH stimulation from decreased renal perfusion
Angiotensin II
MOA of ADH stimulation from hypotension
Baroreceptor stimulation in carotid arteries
____ stimulates thirst
Angiotensin II
Decreased skin turgor
Hypovolemia
“Red Urine”
Rifampin
Elevated urinary sodium AND potassium
Diuretic use/abuse
Pre-renal causes:
- Decreased EABV (HF, Cirrhosis)
- Displaced intravascular fluid (sepsis, pancreatitis)
- Decreased afferent flow (RAS, NSAIDs)
Small bowel disease malabsorption of fatty acids and bile salts can predispose to ____ kidney stones
calcium oxalate
(Unabsorbed fatty acids chelate with calcium, freeing up oxalic acid for absorption)
Coffin-lid
(stud-shaped) kidney stone
Struvite
Kidney stone caused by infection w/ urease+ bugs
(Proteus mirabilis, Klebsiella, Staph saprophyticus)
Staghorn calculi
(struvite—ammonium magnesium phosphate stone)
caused by bacterial conversion of urea to ammonia
Tx: Abx + Surgery
Tx of calcium oxalate kidney stones
- IVF
- Low sodium diet
- Thiazides (prevent hypercalciuria)
- Citrate (lowers insoluble calcium oxalate formation)
Dumbell-shaped crystals
Calcium oxalate
(alternatively “envelope-shaped”)
Rhomboid or rosette-shaped stones
Uric acid stones
Radiolucent (transparent) on XR and CT
- Uric acid stones (visible on US)
- Cystine stones