Renal Flashcards
Saline resistant vs. responsive met alkalosis
(urinary chloride values)
> 20 vs. <20
metabolic alkalosis responsive is GI stuff
resistant—primary hyperaldo, cushing or severe hypokalemia
uroperitoneum with normal voiding
unilateral ureteral laceration
excessive diuresis (potassium)
potassium wasting so low potassium
weakness electrolyte
potassium
post obstructive diuresis
increased urine outflow leads to RAAS kicking in and low potassium
Children <2 years with UTI workup
- 1-2 weeks of cephalosporin
- Do renal/bladder ultrasound if have FEVER
*Do voiding cystogram after ultrasound if 1) see
scarring 2) organism is not e.coli 3) with a
child with > than 2 UTIs
urethral hypermobility
stress incontinence
causes of MCD
most often idiopathic
Tx MCD
steroids
Transient proteinuria
Triggers: stress, fever, infection
Dx: urine protein/creatinine ratio and make sure returns to normal
most common nephritis in adults
IgA (usually within 5 days of URI)
crohns and kidney stones
Calcium binds to ox in gut so ox not absorbed. However, in crons when fat mal then calcium binds to fat in GI tract. then lots of oxaloacetate floating around then get kidney stones
10 mm stone
- if <10 mm then do medical management but if uncontrolled and no passage in 4-6 weeks then do lithotripsy.
- if >10 then do lithotripsy
30-40, flank pain, hematuria, palpable abdominal masses, CKD
ADPKD
MD SOAP BRAIN
SLE. Blood all low, renal is nephrotic or nephritic
resistant HTN what to do next?
Imaging of renal
drug that increases lactic acidosis
metformin so dont give to someone with CKD
when hypokalemia what happens to chloride?
also goes down
hexagonal nephrolethiasis
Cystinuria. Defect in renal transport of amino acids COLA cystine, ornithine lysine and arginine
Urinary disorder only affecting boys
PUV that can lead to bladder urinary obstruction bladder distension and hydronephrosis and lung hypoplasia becuase of decrease urine
cerebral aneurysm relationship as well as CKD, liver cysts
ADPKD
papillary necrosis features and sx
NSAID “Nonsteroidals, Sickle cell, Analgesics, Infection Diabetes” and get hematuria
hypokalemia, hypomagnesemia, hypophosphatemia
alcoholism
relationship between mag and potassium and calcium
magnesium blocks potassium secretion so have so high mag high potassium. Low mag low potassium
also low cal because mag stimulates parathyroid.
VHL mnemonic
CPR=Cerebellar and retinal hemangioblastomas
Pheo
Renal cell carcinoma
urinary sodium when prerenal
Decreased because RAAS kicking in
salicylate intoxication
AGMA and respiratory alkalosis so mixed and nml pH
laxitives vs. diuretics
GI vs. urinary
anticholinergics: dry or wet?
dry so no urine
test for renal calculi is
abdominal U/S or non-contrast spiral CT.
Use U/S if pregnant
renal artery stenosis first and second line
1) ACE and ARBS inhibit efferent vasocostriction 2) if resistant then do stenting
alkalosis and ionized calcium
H+and calcium compete with each other to bind to albumin. H usually wins but when alkalosis H dissociates and so calcium can bind so you have LOWER ionized calcium
sodium and calcium
same direction
renal cysts (benign vs. malignant)
benign actually no follow up is needed
diabetes high levels of what in urine?
albumin which is why we check albumin to creatinine ratio
acute renal allograph T cell
1) hyperacute-hours to days-thrombosis
2) acute weeks-months T cell mediated interstitial lymphocytic infiltrate
3) chronic-months to years then get fibrosis
then get graft vs. host where you get a rash
calcinurin toxicity what it does to kidneys
vasoconstricts both the afferent and efferent arterioles and so get High BUN to creatinine ratio because creates a prerenal state
AIN causes
Pee-Diuretics Pain free-NSAIDS Penacillin and cephalosporins, trimethoprin, rifampin rifamPin=red, orange bodily fluids PPIs
aminoglycaside, acyclovir, amphotercin too
Fever maculopap rash and renal failure, white blood cell casts
Transient metabolic acidosis
Seizures and don’t need to treat
crystal induced AKI mneumonic
Protease inhibitors Uric acid (tumor lysis syndrome) Methotrexate Acyclovir Ethylene glycol Sulfonamides
renal tubular obstruction
thiazide SE
hyperglycemia, increased LDL, triglycerides, hyperuricemia so can get gout
hypercalcemia when tx
but then get hyponatremia, hypokalemia, hypomagnesemia
tx hyperkalemia
give calcium gluconate to stabilize the heart
stages of change
precontemplation, contemplation, prep, action, maintenance, identification where behavior is automatic
post partum thyroiditis vs. painless thyroiditis
HYPOTHYROID…
similar to hashimoto in that it moves from hypo to hyper and have TPO antibodies.
Post partum is within a year of pregnancy but painless is after a year of childbirth.
tx with propranolol
Low RAIU uptake because thyroid is destroyed and only preformed thyroid is released.
urine or plasma metanephrines
pheo
pheo tx
preop give alpha blockade to vasoconstrict prior to beta blockade and then surgery.
thyroid storm causes
thyroid or non-thyroid surgery, trauma, infection
epiphyseal widening
Rickets. Low vitamin D leads to low calcium leads to high PTH, low serum phosphate and high AlkP
MEN 1
MEN 2
MEN 3
1-Pituitary, Parathyroid like Primary Hyperparathyroidism, Pancreatic (like ZE syndrome) (3Ps, 0) so can have hypercalcemia and recurrent peptic ulcers because of ZE
2A- Parathyroid, Pheo, Medullary thyroid (2Ps and 1 M)
2B–Mucosal, Marfinoid habitus, medullary thyroid carcinoma, pheo (2Ms, 1Ps)
hypercalcemia, renal insufficiency (AKI), metabolic alkalosis
milk alkali. see symptomatic calcium much more here than w thiazides
hypercalcemia
bones, stones, groans, psychiatric overtones, moans
graves disease
passage of TSH Ab so give methimazole and beta blockers
metabolic syndrome
3-5. cause is insulin resistance waist circumfence fasting glucose HTN triglycerides HDL
metaclopramide
can help with gastroperesis but lots of extrapyramidal SE
HHS treatment
type 2 diabetes, older age, very high glucose. Basically give aggressive hydration and normal saline and IV insulin.
Potassium replacement if potassium is less than 5.3. Hydration is key…
malignancy and hypercal
PTHrP:
squamous cell
renal and bladder
breast and ovarian
Bone:
Breast and bone
1,25 dihydorxi can be lymphoma
PB KTL
Prostate-blastic
breast-both
Kidney, Thyroid, Lungs-lytic
primary hyperaldo (acid distubrance)
PAC/PRA ratio is >20:1
metabolic alkalosis. No hypernatremia because of aldo escape where when enough perfusion kidneys start excreting sodium
myalgia, proximal muscle weakness, hich CK
hypothyroid myopathy
glucorticoids vs. mineralcorticoids
hydrocortisone, prednisone vs. fludricortisone
post prandial hyperglycemia tx
basal and then post prandial insulin
epleronone
aldosterone antagonists
hyperkalemia
PAI
surrepticious intake of thyroid hormone
get low TSH and elevated thyroid hormone
exudative vs. transudative pleural effusions
pleural protein/serum protein >0.5,
Pleural LDH/serum LDH > 0.6.
in transudative
Fe2 to Fe3
methemoglobenemia
Fe3 has stronger connection to what substance
cyaninde which is why you induce methoglobinemia to tx Cyanide poisoning using nitirites to treat cyanide posioning
tx methemoglobinemia
methylene blue and vitamin C
painless coiled scrotal mass that does not transilluminate and decompresses when supine
idiopathic vericocele
renal vein compressed between…
SMA and IVC
if varicocele is on the right rather than left
Scrotal mass compression of IVC due to say wilms tumor
also doesn’t decompress when supine and called a secondary vericocele because likely due to cancer
thiazide diuretics SE
gout
acute prostatitis treatment
Bactrium or Floriquinolone (6 weeks) bug is e. coli also get cultures
most common nephrotic symptom in teens and adults
membranous
If think that hyperthyroid and increased RAIU
graves, TNG or adenoma
if hyperthyroid and decreased uptake
thyroiditis, iodine exposure, exogenous thyroid hormone
acromegaly heart findings
concentric ventricular hypertrophy
how to treat hyperkalemia
. Think Potassium PIG Insulin and Glucose drives potassium inside the cell
chronic use of glucorcoidicoids get
secondary AI
primary AI
high ACTH and low cortisol and aldosterone