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Mistakes > Renal > Flashcards

Renal Flashcards

1
Q

Clues for ADPKD

A

Hypertension
Palpable bilateral abdominal masses
Microhematuria

Common complication - Intracranial berry aneurysm (5 - 10% of cases)

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2
Q

Major extra-renal complications of ADPKD

A

Hepatic Cysts (Most common)
Valvular Heart Disease (Most often mitral valve prolapse & aortic regurg)
Colonic Diverticula
Abdominal Wall & Inguinal Hernias

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3
Q

Thickened Basement Membrane

Sub-Epithelial “Spikes”

A

Membranous Glomerulonephritis

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4
Q

Mesangial hypercellularity

A

Membranoproliferative glomerulonephritis

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5
Q

When do we biopsy the kidney in Minimal Change Disease?

A

If the patient is >10 years old

If the disease is resistant to corticosteroids

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6
Q

Severe symptoms if Sodium <120mEq/L

A

Profound Confusion
Seizures
Coma

Increased risk of cerebral edema & brainstem herniation

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7
Q

Maximum rate of safely correcting hyponatremia

A

<=8mEq/L increase over the first 24 hours

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8
Q

Complication of correcting hyponatremia too quickly

A

Osmotic Demyelination Syndrome

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9
Q

Complication of correcting hypernatremia too quickly

A

Cerebral Edema

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10
Q

How do you correct electrolyte imbalances of SIADH?

A

Hypertonic saline

Saline must be more concentrated than urine.

NS has 300 mOsm/kg H2O
1/2NS has 150 mOsm/kg H2O

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11
Q

Desmopresin

A

ADH Analogue

Treats Diabetes Insipidus

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12
Q

Hyponatremia with Hypovolemia

A

Adrenal Insufficiency

Treat with IV Hydrocortisone

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13
Q

Hyponatremia with Euvolemia

A

Think SIADH

Treat with hypertonic saline (gradually)

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14
Q

Sodium Nitroprusside

A 
Potent Vasodilator (Arterial AND Venous)
Used in hypertensive emergencies

Contains 5 cyanide groups
Undergoes rapid conversion to cyanide
Then Thiocyanate
Eliminated by kidneys

In CKD patients, can lead to cyanide toxicity

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15
Q

Typical findings of cyanide toxicity

A 
Headache
Confusion
Arrhythmias
Flushing
Respiratory Depression
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16
Q

Post-Operative Urinary Retention

A

Precipitating Event: Bladder distension during general anesthesia or epidural anesthesia use

Inefficient detrusor activity leads to acute urinary retention

Risk increases with age
Risk increases with high fluid intake during surgery
Risk increases with concomitant use of other medications (Opiates, anticholinergics)

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17
Q

Postop Oliguria Rate

A

<= 0.5mL/kg/hr

In a 70kg patient, that’s 35 mL/hr

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18
Q

Cardiorenal Syndrome

A

CHF Patient

Volume overload but low CO
Poor renal perfusion

Renal perfusion can improve with loop diuretics

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19
Q

Urine Sediment Analysis - Muddy Brown Casts

A

Acute Tubular Necrosis

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20
Q

Urine Sediment Analysis - Eosinophils

A

Acute Interstitial Nephritis

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21
Q

Signs & Symptoms of Hypernatremia

A 
Most common:
Lethargy
AMS
Irritability
Seizures

Also:
Muscle Cramps
Muscle Weaknesses
Decreased DTRs

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22
Q

Causes of Hypovolemic Hypernatremia

A

Renal Losses:
Diuretics
Glycosuria

Extrarenal:
GI Upset
Excessive Sweating

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23
Q

Causes of Hypervolemic Hypernatremia

A 
Exogenous Sodium Intake
Mineralocorticoid Excess (Hyperaldo)
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24
Q

Why not use hypotonic fluids (like 1/2 NS or 5% Dextrose) to lower the sodium in a hyponatremic patient?

A

Hypotonic solutions exit the intravascular space too quickly and cause precipitous drops in sodium (Cerebral Edema)

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25
Q

Hepatorenal Syndrome

A

Severe Cirrhosis leads to Portal HTN

Leads to increased nitric oxide generation in splanchnic circulation

Leads to systemic vasodilation, reducing peripheral vascular resistance & BP

Leads to renal hypoperfusion & activation of RAAS

Leads to increased water & sodium retention, worsening volume overload

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26
Q

Lab findings of Hepatorenal Syndrome

A

Similar to prerenal azotemia

Elevated Cr (>1.5mg/dL)
Very low urine sodium (<10 mEq/L)

Unremarkable sediment

Does not respond to IV fluids or cessation of diuretics. Renal function continues to decline

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27
Q

Membranoproliferative Glomerulonephritis

A

Associated with HCV

28
Q

Acute Renal Vein Thrombosis - Presentation

A

Abdominal Pain

Hematuria

29
Q

Most common drug-induced chronic renal failure

A

Analgesic Nephropathy

Seen in women 50 - 55 yo who use combined analgesics (ASA & Naproxen)

Pappilary necrosis & Chronic tubulointerstitial nephritis most common

Sterile Pyuria

30
Q

At what level of PaCO2 is CO2 Narcosis seen?

A

PaCO2 > 60 mm Hg

31
Q

How do you calculate Anion Gap?

A

Na - (Cl + HCO3)

Normal is 10 - 14

32
Q

Cause of hyponatremia with Serum Osmolarity > 290 mOsm/kg

A

Marked Hyperglycemia

OR

Advanced Renal Failure

33
Q

Cause of hyponatremia with:

Dilute serum (<290 mOsm/kg)
Dilute urine (<100 mOsm/kg)
A

Primary Polydipsia

OR

Malnutrition (Beer Drinker’s Potomania)

34
Q

Cause of hyponatremia with:

Dilute serum (<290 mOsm/kg)
Concentrated urine (>100 mOsm/kg)
Low urine sodium (<25 mEq/L)
A

Volume Depletion
CHF
Cirrhosis

35
Q

Cause of hyponatremia with:

Dilute serum (<290 mOsm/kg)
Concentrated urine (>100 mOsm/kg)
High urine sodium (>25 mEq/L)
A

SIADH
Adrenal Insufficiency
Hypothyroidism

36
Q

Treatment for simple asymptomatic renal cyst

A

Reassurance

37
Q

Treatment for Renal Artery Stenosis

A

Ace Inhibitors first

Revascularize if they fail that

38
Q

Lithium’s effect on ADH

A

Impairs water resorption in collecting duct
Leads to ADH Resistance

Nephrogenic DI

39
Q

Most common site for metastatic spread of a Wilms Tumor

A

Lungs (This is still rare)

40
Q

Most common cancer in the first year of life

A

Neuroblastoma

Anywhere in sympathetic nervous system
Typically involves adrenal glands
Abdominal mass that crosses the midline
Systemic symptoms

41
Q

Abdominal Pain
Lower Extremity Purpura
Arthritis
Hematuria

in a child

A

HSP

An IgA-mediated vasculitis of small vessels
Renal biopsy demonstrates deposition of IgA into mesangium

42
Q

Typical presentation of FSGS

A

Nephrotic Range Proteinuria
Azotemia
Normal-Sized Kidneys

43
Q

Risk factors for Rhabdomyolysis

A

Immobilization

Cocaine Abuse

44
Q

Signs of Lupus

A

Photosensitive skin
Thrombocytopenia
Glomerulonephritis with significantly low C3

45
Q

Immune complexes in mesangium or subendothelial space

A

If Low C3 & C4, it is Lupus, involving an inflammatory reaction.

If normal C3 & C4, it is membranous glomerulonephritis

46
Q

Cause of metabolic alkalosis with low (<20mEq/L) urine chloride

A

Vomiting/Nasogastric Aspiration

OR

Prior diuretic use

SALINE RESPONSIVE

47
Q

Cause of metabolic alkalosis with high (>20mEq/L) urine chloride in a hypervolemic patient

A

Excess mineralocorticoid activity:

Primary hyperaldo
Cushing’s
Ectopic ACTH production

SALINE UNRESPONSIVE

48
Q

Cause of metabolic alkalosis with high (>20mEq/L) urine chloride in a hypovolemic or euvolemic patient

A

Current Diuretic Use (SALINE RESPONSIVE)

OR

Bartter / Gitelman Syndromes (SALINE UNRESPONSIVE)

49
Q

Treatment for pyelonephritis with an MDR organism

A

Aminoglycosides (like Amikacin)

This can cause ARF

50
Q

Muddy Brown Casts on UA

A

Hallmark of ATN (Nonspecific, but very sensitive)

51
Q

Casts seen in Chronic Renal Failure

A

Broad Casts

Waxy Casts

52
Q

RBC Casts

A

Glomerular Disease

Vasculitis

53
Q

WBC Casts

A

Interstitial Nephritis

Pyelonephritis

54
Q

Fatty Casts

A

Nephrotic Syndrome

55
Q

Hyaline Casts

A

Asymptomatic patients

Pre-renal azotemia

56
Q

TB’s effect on the adrenals

A

Chronic primary adrenal insuficiency

Fatigue
Weakness
Borderline hypotension
Electrolyte abnormalities

57
Q

Granulomatous causes of adrenal insufficiency

A 
TB
Histoplasmosis
Coccidioidomycosis
Cryptococcosis
Sarcoidosis
58
Q

Hypoglycermia
Hyperkalemia
Eosinophilia

A

Adrenal Insufficiency

59
Q

Decreased cortisol
Decreased adrenal sex hormone
Decreased aldosterone

A

Addison’s Disease

Without aldosterone:
Sodium is excreted, potassium & H+ are retained
Normal anion gap hyperkalemic hyponatremic metabolic acidosis

60
Q

Normal anion gap
Hyperkalemic
Hyponatremic
Metabolic Acidosis

A

Lack of aldosterone (likely Addison’s)

Maybe RTA? Not hyponatremic, though

61
Q

Anticholinergic effect on bladder

A

Urinary retention

62
Q

Most common inciting factors of Hepatorenal syndrome

A

Spontaneous bacterial peritonitis

GI Bleed

63
Q

Temporizing options for hepatorenal syndrome while awaiting transplant

A

Midrodrine
Octreotide
Norepinephrine

(Splanchnic vasoconstrictors)

64
Q

Seizure patient with metabolic acidosis

A

Postictal lactic acidosis

Transient
Resolves within 90 min
Repeat chemistry in 2 hours

65
Q

Renal Tubular Acidosis

A

Group of disorders:
Non-Anion Gap Metabolic Acidosis
Preserved kidney function

Hyperkalemic RTA (Type 4 RTA) - seen in elderly diabetics

66
Q

Renal Vein Thrombosis from Nephrotic Syndrome

A

Loss of Antithrombin III in urine

Increases risk of Renal Vein Thrombosis

Most commonly seen with Membranous Glomerulopathy

Mistakes (8 decks)

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