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Shelves > Renal > Flashcards

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
Q

acid base finding in DKA

A

AG metabolic acidosis
Low pH
low bicarp
low PaCO2 to compensate (kussmaul breathing)

26
Q

What metabolic effects do thiazide diuretics have?

A

Hyperglycemia, increased LDL, triglycerides, hyperuricemia

Impairs insulin release from the pancrease and glucose utilization in the peripheral tissues

27
Q

Most common type of kidney stone

A

calcium oxalate
Can have normal Sr Ca2+
Envelope shaped
Fat malabsorption predisposes.

28
Q

Tx for platelet dysfunction in renal failure?

A

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
Q

Why are Crohn’s dz pts at increased risk for kidney stones?

A

Increased oxalate absorption is seen in all intestinal dz’s that cause fat malabsorption

30
Q

Small cell lung cancer has which endocrine abn?

A

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
Q

RA + nephrotic syndrome

A 
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
Q

Best way to dx a ureteral calculi?

A

U/S or NONcontrast CT

33
Q

When do you culture a pt with UTI syx?

A

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
Q

UA finding in hypovolemia

A

Muddy brown granular casts (ATN)

35
Q 
Palpable purpura
GN
arthralgia
Hepatosplenomegaly
Peripheral neuropathy
Low Sr complement
A

Cryoglobulinemia
RF - HCV
Dx - circulating cryoglobulins

36
Q

Pt with nephrotic syndrome improves with diet modification. Suddenly develops R sided abd pain, fever, gross hematuria

A

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
Q

which two lab values provide the best picture of acid base status?

A

pH
PaCO2
You can use Henderson-Hassebalch to calculate bicarb

38
Q

Unilateral varicoceles that fail to empty when lying down is scary for?

A

Obstructive mass like a Renal cell carcinoma (obstructs venous flow)
Dx with CT

39
Q

Renal failure caused by NSAIDs

A

Tubulointerstitial nephritis

Papillary necrosis

40
Q

Nephrotic syndrome increases the risk for which two complications?

A 
Atherosclerosis (d/t hyperlipidemia)
Arteriovenous thrombosis (d/t loss of antithrombin II)
41
Q

How do antihistamines cause urinary retention?

A

Detrusor m. hypocontractility

42
Q

Pt has urinary retention after surgery. What do you do next?

A

Renal U/S

43
Q

African american
Nephrotic syndrome
RF’s: obesity, IVDU, HIV

A

Focal segmental glomerulosclerosis

44
Q

Nephrotic syndrome

RF’s adenocarcinoma, NSAIDS, HBV, SLE

A

Membranous nephropathy

45
Q

Nephrotic syndrome

RF’s HBV, HCV, lipodystrophy

A

Membranoproliferative glomerulonephritis

46
Q

Neprhotic syndrome

Recent URI

A

IgA nephropathy

47
Q

Hyperkalemia

Spiked T waves on EKG needs?

A

Calcium gluconate

After you can consider insulin or cation exchange, HD to reduce serum K+

48
Q

Kidney stone syx
Urine: WBNC, RBC needle shaped crystals
Now what?

A

CT of the abdomen

needle crystals = uric acid stones are radiolucent, require CT, U/S or IV pyelography

49
Q

Periorbital edema 10-20 days after abx for strep

A

Post strep glomerulonephritis
Hematuria, HTN, RBC casts, proteinuria
low serum C3

50
Q

What is the best hope for survival in a pt with renal failure

A

Transplant from living relative > living non relative > cadaver > HD

51
Q

Cocaine user, High CK at risk of developing?

A

Acute renal tubular necrosis d/t myoglobinuria d/t rhabdo

52
Q

Liver cirrhosis pt develops worsening kidney fxn despite lactulose and volume resuscitation. He is dx’d with hepatornal syndrome. What is the pashophys?

A

Splanchnic a. dilation, decreased vascular resistance, local renal vasoconstriction w/ decreased perfusion

53
Q

Pt on diuretics develops hypokalemia. Which med?

A

Loop diuretics

hypokalemia, metabolic alkalosis, prerenal kidney injury

54
Q

Tx for hyperkalemia?

A
  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
Q

Common cause of chronic primary adrenal insufficiency (Addison’s) in the 3rd world?

A

TB

56
Q

Hormone changes in primary adrenal insufficiency

A

Low Cortisol
Low adrenal sex hormones
Low aldosterone - kidney loses sodium and retains K+ H+ -> develop non AG hyperkalemic hyponatremic metabolic acidosis

57
Q

poorly controlled DM
Non AG metabolic acidosis
hyperkalemia
mild-mod renal insufficiency

A

Type 4 tubular acidosis

58
Q

abx that causes hyperkalemia d/t block of epithelial sodium channel in the collecting tubule
Inhibits renal Cr secretion w/o decrease in GFR

A

Trimethoprim

59
Q

Photosensitive rash, thrombocytopenia
Nephritic syndrome
low C3 and C4

A

SLE

Can also be nephrotic

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