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Renal Flashcards

1
Q

Why can pts with COPD or asthma exacerbations develop hypokalemia?

A

Increase Beta-adrenergic activiey

Causes K+ to go intracellular

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2
Q

AKI syx (rising Cr) d/t BPH, needs a?

A

Renal U/s

Asses for hydronephrosis

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3
Q

How do you prevent future stones in a pt that just passed a uric acid stone?

A

Alkalinize the urine w/ po potassium citrate

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4
Q

s/p tonic clonic seizure, pt has a AG metabolic acidosis. Why?

A

Postictal Lactic acidosis

recheck labs in 2 hours for resolution

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5
Q

management of simple renal cysts?

A

Reassure, no further work up

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6
Q

Which medications can cause urinary retnention?

A

Anticholinergics (ie amitryptiline)
Prevent detrusor m. contraction
Tx - d/c med and cath

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7
Q

Do you screen for bladder cancer?

A

Nope. Never. Only test if syx appear

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8
Q

Tx for acute kidney rejection?

A

IV steroids

Presents as oliguria, HTN, increased Cr/BUN

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9
Q

Metabolic alkalosis + low urine Cl

A

Vomiting
Prior diuretic use
Responds to saline

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10
Q

Metabolic alkalosis
High urine Cl
Hypovolemia/euvolemia

A

Responds to saline - current diuretic use

No response to saline - Bartter and Gitelman syndromes

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11
Q

Metabolic alkalosis
High urine Cl
Hypervolemia

A 
Excess mineralcorticoid activity
Primary hyperaldosteronism
Cushing dz
Ectopic ACTH
Saline unresponsive
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12
Q

AKI after giving acyclovir?

A

Renal tubular obstruction d/t crystals
acyclovir has low urine solubility and crystalizes out
IVF can help prevent crystal formation

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13
Q

Acid base change in aspirin OD

A

Mixed respiratory alkalosis and AG metabolic acidosis

AG + NL pH

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14
Q

Why do anion gap acidosis’s happen?

A

Uncoupling of oxidative phosphorylation in the mitochondria -> anaerobic metabolism w/ low bicarb

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15
Q

Winter’s formular

A

PaCO2 = [1.5 * HCO3] + 8 =/-2

If PCO2 is lower than expected -> coexisting primary respiratory alkalosis

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16
Q

Earliest renal abn in T2DM

A

Gloverular hyperfiltration, mechanism of glomerular injury in T2DM
The first change that can be quantified = thickening of the GBM

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17
Q

Adult with dark urine after URI

A

IgA nephropathy
Most common GN in adults
usually w/in 5 days of infection vs PSGN 10-21 days

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18
Q

Psych hx
New onset hyponatremia
Urine osmolality < 100

A

Primary polydipsia

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19
Q

Nephrotic syndrome in Hodgkin lymphoma

A

Minimal change dz

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20
Q

Nephrotic syx in cancer pt (esp solid tumors)

A

Membranous nephropathy

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21
Q

which medications can cause interstitial nephritis?

A 
Penicillins
Bactrim
Cephalosporins
NSAIDs
presents w/ fever, maculopapular rash, renal failure.
UA - WBC casts, oc eso
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22
Q

Which medication is helpful in passing a kidney stone?

A

Tamsulosin
alpha-1 receptor blockers act on the distal ureter, lowers muscle tone, reduce reflex ureteral spasm s/t stone impaction.Reduces need for analgesics

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23
Q

Most common COD in HD pts?

A

CVD
50% of all deaths
Also most common COD in renal transplant patients

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24
Q

Most sensitive screen for DM neuropathy

A

Spot microalbumin/Cr ratio
24 hour urine collection
Pathology hallmark - nodular glomerulosclerosis but difuse glomerulosclerosis is more common

25
acid base finding in DKA
AG metabolic acidosis Low pH low bicarp low PaCO2 to compensate (kussmaul breathing)
26
What metabolic effects do thiazide diuretics have?
Hyperglycemia, increased LDL, triglycerides, hyperuricemia | Impairs insulin release from the pancrease and glucose utilization in the peripheral tissues
27
Most common type of kidney stone
calcium oxalate Can have normal Sr Ca2+ Envelope shaped Fat malabsorption predisposes.
28
Tx for platelet dysfunction in renal failure?
DDAVP PT dysfxn d/t high BUN DDAVP increases release of Factor VIII:vWb factor multimers from the endothelium PT transfusions don't work before the PT's become almost instantly inactive Cryo does work
29
Why are Crohn's dz pts at increased risk for kidney stones?
Increased oxalate absorption is seen in all intestinal dz's that cause fat malabsorption
30
Small cell lung cancer has which endocrine abn?
SIADH Also SSRI's, NSAIDs Hyponatremia, SrOsmo <275, Urine Osmo >100 in a euvolemic pt If severe (Na<120, AMS) give hypertonic saline (3%) Correct <8meq/24hr to avoid osmotic demyelination
31
RA + nephrotic syndrome
``` Think amyloid Path - amyloid deposits that stain apple-green on Congo red stain under polarized light. Thin fibrils on EM RA = AA amyloid MM = AL amyloid ```
32
Best way to dx a ureteral calculi?
U/S or NONcontrast CT
33
When do you culture a pt with UTI syx?
If they fail initial abx therapy Complicated cystitis (DCM, CKD, pregnancy, Immunocompromised, urinary tract obstruction, hospital acquired infection, inf d/t procedure, indwelling foreign body) Complicated folks need fluoroquinolones
34
UA finding in hypovolemia
Muddy brown granular casts (ATN)
35
``` Palpable purpura GN arthralgia Hepatosplenomegaly Peripheral neuropathy Low Sr complement ```
Cryoglobulinemia RF - HCV Dx - circulating cryoglobulins
36
Pt with nephrotic syndrome improves with diet modification. Suddenly develops R sided abd pain, fever, gross hematuria
Renal V. thrombosis Associated with membranous glomerulopathy Increased coagulopathy d/t loss of antithrombin III loss in the urine can be acute or gradual
37
which two lab values provide the best picture of acid base status?
pH PaCO2 You can use Henderson-Hassebalch to calculate bicarb
38
Unilateral varicoceles that fail to empty when lying down is scary for?
Obstructive mass like a Renal cell carcinoma (obstructs venous flow) Dx with CT
39
Renal failure caused by NSAIDs
Tubulointerstitial nephritis | Papillary necrosis
40
Nephrotic syndrome increases the risk for which two complications?
``` Atherosclerosis (d/t hyperlipidemia) Arteriovenous thrombosis (d/t loss of antithrombin II) ```
41
How do antihistamines cause urinary retention?
Detrusor m. hypocontractility
42
Pt has urinary retention after surgery. What do you do next?
Renal U/S
43
African american Nephrotic syndrome RF's: obesity, IVDU, HIV
Focal segmental glomerulosclerosis
44
Nephrotic syndrome | RF's adenocarcinoma, NSAIDS, HBV, SLE
Membranous nephropathy
45
Nephrotic syndrome | RF's HBV, HCV, lipodystrophy
Membranoproliferative glomerulonephritis
46
Neprhotic syndrome | Recent URI
IgA nephropathy
47
Hyperkalemia | Spiked T waves on EKG needs?
Calcium gluconate | After you can consider insulin or cation exchange, HD to reduce serum K+
48
Kidney stone syx Urine: WBNC, RBC needle shaped crystals Now what?
CT of the abdomen | needle crystals = uric acid stones are radiolucent, require CT, U/S or IV pyelography
49
Periorbital edema 10-20 days after abx for strep
Post strep glomerulonephritis Hematuria, HTN, RBC casts, proteinuria low serum C3
50
What is the best hope for survival in a pt with renal failure
Transplant from living relative > living non relative > cadaver > HD
51
Cocaine user, High CK at risk of developing?
Acute renal tubular necrosis d/t myoglobinuria d/t rhabdo
52
Liver cirrhosis pt develops worsening kidney fxn despite lactulose and volume resuscitation. He is dx'd with hepatornal syndrome. What is the pashophys?
Splanchnic a. dilation, decreased vascular resistance, local renal vasoconstriction w/ decreased perfusion
53
Pt on diuretics develops hypokalemia. Which med?
Loop diuretics | hypokalemia, metabolic alkalosis, prerenal kidney injury
54
Tx for hyperkalemia?
1. Stabalize cardiac membrane w/ calcium 2. Shift potassium intracellularly 3. Decrease total body potassium content Insulin + glucose is fastest was to decrease serum K+
55
Common cause of chronic primary adrenal insufficiency (Addison's) in the 3rd world?
TB
56
Hormone changes in primary adrenal insufficiency
Low Cortisol Low adrenal sex hormones Low aldosterone - kidney loses sodium and retains K+ H+ -> develop non AG hyperkalemic hyponatremic metabolic acidosis
57
poorly controlled DM Non AG metabolic acidosis hyperkalemia mild-mod renal insufficiency
Type 4 tubular acidosis
58
abx that causes hyperkalemia d/t block of epithelial sodium channel in the collecting tubule Inhibits renal Cr secretion w/o decrease in GFR
Trimethoprim
59
Photosensitive rash, thrombocytopenia Nephritic syndrome low C3 and C4
SLE | Can also be nephrotic

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