Renal Flashcards
Chronic NSAID use increases risk for?
tubulointerstitial nephritis and papillary necrosis
Fluid management for hypovolemic hypernatremia w/ syx
NS until euvolemic
Then add 5% dextrose
Tx for urge incontinence
1st line - pelvic floor exercises
Non responders - add po oxybutynin
Why is it difficult to correct hypokalemia in some alcoholics?
If they also have hypomagnesemia - removes inhibition of renal K+ excretion
Why does nephritic syndrome cause pulmonary edema?
Decreased GFR -> retention of Na+ and water by the kidneys
Get crazy high HTN
Gross hematuria with blood and protein in the sediment, no specific syx, comes from?
Glomerular damage
What is amiloride?
K+ sparing diuretic
Consider switching in pts with hyperkalemia
why do diuretics cause AKI?
Reduced CO -> prerenal ARI
DM pt has nocturia and 3+ protein in dipstic. Wy?
Diabetic micrangiopathy
Moderate proteinuria and CKD with elevated Cr
Dietary recommendation to prevent calcium oxalate renal stones
- Increased fluid intake
- Decreased sodium intake
- Normal dietary calcium intake
- Thiazide diuretics
- Low protein diet
While on nitroprusside drip pt develops HA, confusion, arrhythmia, flushing, respiratory depression. why?
Cyanide toxicity
Risk is increased when pt has CKD
How do you tx nephrogenic DI d/t Lithium?
Salt restriction
d/c lithium
Girl has anorexic patterns but presents with orthostatic hypotension, hyponatremia, hypokalemia. But, her urinary Na and K are elevated. Why?
Diuretic abuse
When would you do urgent dialysis?
AEIOU
Acidosis (pH<7.1)
Electrolyte abn - EKG changes or K+> 6.5
Ingestion - methanol, salicylate, lithium
Overload - volume overload refractory to diuretics
Uremia - if syx (encephalopathy, pericarditis, bleeding)
Best initial tx for renal a. stenosis
ACEI or ARB
Consider stenting or revascularization if resistant to medical mangment
Initial management of hypercalcemia
IVF hydration and calcitonin
Bisphosphonates if it remains high despite adequate fluid resuscitation
Hypertension
Palpable b/l abdominal masses
Microhematuria
AD Polycystic kidney dz
Strong association with berry aneurysm
Correcting hyponatremia too quickly puts pt at risk for?
osmotic demyelination
Correcting hypernatremia too quickly puts pt at risk for?
Cerebral edema
Bladder pain that is relieved by voiding UTI syx (frequency, urgency) w/ benign UA and dyspareunia also common
Interstitial cystitis
Tx - PT, behavior modification
Nephrolithiasis with hexagonal crystals, + urinary cyanide nitroprusside test. Dx?
Cystinuria
Abnormality in amino acid transport
inherited
AG acidodic pt has rectangular envelope shaped crystals. Suspect?
Ethylene glycol poisoning
Also causes renal failure
Renal bx - intimal thickening and luminal narrowing of renal arterioles w/ evidence of sclerosis. Dx?
HTN
Renal bx - increased extracellular matrix, basement membrane thickening, mesangial expansion, and fibrosis
Diabetic nephropathy
Seizure pt gets a UA:
Large amount of blood, but only scant RBCs on microscopy. Suspect?
Rhabdomyolysis
causes myoglobinuria, electrolyte abn (high K+)
T2dm pt has syx similar to BPH (weak stream, dribbling) but NL sized prostate. Decreased LE sensation, absent achiles reflex
Neurogenic bladder dysfunction d/t DM nephropathy
Causes urinary retention and bladder distention
Tx for severe hyponatremia (<120)
3% saline
HIV, nephrotic urine
Focal and segmental glomerulosclerosis
“HIV related nephropathy”
Young male
asyx hypercalcemia
NL to elevated PTH
low urine calcium
Familial hypocalciuric hypercalcemia
HPTH would have elevated Ca2+, other causes of hypercalcemia would have low PTH
