Renal Flashcards
CKD
- imaging
- US: bilateral small kidneys = CKD
CKD
- RF
- HTN
- AA
- DM
- NSAID use
Hypercalcemia of malignancy
- treatment
- aggressive hydration
- IV bisphosphonates to inhibit ca release from bone
Nephrotic syndrome
- features
NAPHROTIC
- Na decrease
- Albumin decrease
- Proteinuria >3.5 / day
- Hyperlipidemia
- Renal vein thrombosis
- Orbital edema
- Thromboembolism
- Infection (loss of Ig in urine)
- Coagulability (loss antithrombin III in urine)
Nephrotic syndrome
- UA
- fatty casts (pathognomonic), “maltese cross”
- lipiduria (sudsy or foamy urine)
- > 3 g protein per day
Nephrotic syndomre
- tx
- increase daily protein intake
- ACE/ARB
- salt restriction
- thiazide/loop diuretic for edema
Hydronephrosis
- overview
distention of renal calyces and pelvis due to obstruction of distal urine flow
Hydronephrosis
- Causes
- urolithiasis
- BPH
- bladder outlet obstruction
- prostate carcinoma
- bladder prolapse
- neoplasms
Hydronephrosis
- dx
renal US initial test
- IV pyelography
- CT scan
hypokalemia on EKG
- flattened T wave
- prominent U wave (after t wave)
Sodium correction in hyperglycemia
- add 1.6 mEq/L for every 100 mg/dL glucose >100
OR
measured sodium + 1.6 (serum glucose - 100)
common cause of hypomagnesemia
malnutrition
Glomerulonephritis
- s/sx
Top three: 1- hematuria 2- proteinuria 3- RBC casts ** - HTN - edema - CHF 2/2 volume overload
MC type kidney cancer
renal cell carcinoma
Renal cell carcinoma
- cells originates from
epithelial cells of PCT
Renal cell carcinoma
- RF
- cigs
- obesity
- prolonged anti-inflammatory use
- HTN
Renal cell carcinoma
- clinical
- flank pain
- flank mass
- hematuria
Renal cell carcinoma
- dx
- XR: solid, irregular or lobulated border mass that distort renal contour
Renal cell carcinoma
- mgmt
- radical/partial nephrectomy
Initial treatment for severe hyperkalemia
- calcium
Hyperkalemia
- MCC
decreased excretion
Hyperkalemia
- RF
- renal impairment
- DM
- K-sparking diuretics, NSAIDs, ACE
Hyperkalemia
- causes
- RF
- increased intake
- shift from intracellular to extracellular
Hyperkalemia
- clinical
- mostly asx
- ## sx related to cardiac and msk function, mc fatigue and weakness
Hyperkalemia
- treatment
- Calcium**
- insulin with dextrose, albuterol, bicarb
- furosemide or dialysis
Acute interstitial nephritis
- MCC
- meds (NSAIS, PCN, PPI)
- infection
Acute interstitial nephritis
- overview
causes AKI dt immune-mediated tubulointerstitial injury
Acute interstitial nephritis
- dx
- eosinophiluria in pt with AKI (indicates allergic reaction)
Polycystic Kidney Disease
- overview
- autosomal dominant
- 50% ESRD by age 60
Polycystic Kidney Disease
- dx
- 30-59 with 2+ cysts on US or CT bilaterally highly likely
- genetic testing to confirm
Polycystic Kidney Disease
- clinical
- abdominal / flank pain
- hx hematuria
- renal infection
- nephrolithiasis
- HTN
Polycystic Kidney Disease
- other risks
- cerebral aneurysm
- MV prolapse
- Aortic aneurysm
- Aortic valve abnl
- colonic diveticula
Polycystic Kidney Disease
- mgmt
- no cure
- aggressive HTN mgmt with ACE/ARB
- low-protein diet
- pain control, infection control
- dialysis or transplant
Renal artery stenosis
- dx
- intimal: CTA or renal angiography
- gadolinium-enhanced MRA if decreased renal fn
Renal artery stenosis
- mgmt
- ACE/ARB
- revascularization
Anion gap calculation
Na - (Cl + bicarb)
nl: 3-11
Anion gap metabolic acidosis
MUDPILES
- methanol
- uremia
- DKA
- paraldehyde
- Iron, Isoniazid
- Lactic acidosis
- Ethylene glycol
- Salicylates
What other electrolyte disorder is associated with hypokalemia
hypomagnesemia
Hyponatremia
- pt with neuro sx = what treatment
- hypertonic saline (3%) 100 ml bolus over 10 min
Acute tubular necrosis (ATN)
- leads to what
1 cause of AKI
Acute tubular necrosis (ATN)
- caused by what
decreased blood flow to kidney, usu 2/2 drop in blood pressure = renal tubule ischemia = necrosis
Acute tubular necrosis (ATN)
- Urine microcopy
- muddy brown cellular casts
- fine gradual casts
- renal tubular epithelial cells
Acute tubular necrosis (ATN)
- labs
- BUN/Cr < 20
- FeNa >2%
- both indicate renal injury
Acute tubular necrosis (ATN)
- MC meds that cause
- NSAIDs
- ACE / ARB
