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
Diabetes, depression, Weight loss
new onset pancreatic cancer
urethral meatas extending to the corna
hypospades
Bloody Diarrhea
Yersinia Campylobacter Hemorrhagic e.coli Enameba histolytica (parasite) Shigella Salmonella
diarrhea and vomitting in kids not immunized less than 2
rotavirus
giardia and entameba histolytica vs. ETEC
ETC comes on more suddenly where as Giardia and histolytica comes on more slowly Because fungi
lymphatic network dysgenesis
turner syndrome
severe hypospades
karyotype analysis
primary amenorrhea dx
do TSH–>ultrasound
MRCP
biliary and pancreatic stones or structural abnormalities or pancreatitis
proximal muscle weakness and increased abdominal girth
muscle wasting due to cushing, cortisol myopathy because catabolic effects of steroids
cosyntropin
synthetic ACTH
thyroid hormone increases during what state
preg
ALT >150 and pancreatitis what do you do
do cholecystectomy
prostatitis what will you UA be
normal
tx calcium ox stones
thiazides
Thyroid nodule workup
- check TSH. If normal do U/S
- if >1 cm with weird features do FNA or > 2 cm with no weird features do FNA
adrenal crisis in people with cushing
hypotension, so give hydrocortisone or any steroid
DKA and potassium
Basically diuresis so net loss of potassium but appears normal because goes to extracellular compartments
best tx for PTSD
CBT
pheo electrolyte
get hyperglycemia, hypernatremia and potassium is normal
primary hyperaldo tx
elepronine or spironalactone
control diabetes with what med
basal bolus (a shot of insulin)
Vitamin D deficiency (calcium and phosphorous)
Both low
pap thyroid tx
surgery
malaria vs. juvenile arthritis
can both have spiking fevers but only the latter also has a rash
type I vs. IV RTA
Type I can’t excrete H+
II cant reabsorb bicarb so have high urinary pH
IV-impaired aldo
vs. NAGMA, hyperkalemia
what can cause adrenal crisis
surgery, injury, infection
most common cause of PAI
autoimmune adrenalitis
central vs. primary adrenal insufficiency
only in primary do u see hyperpigmentation. Central always think brain
fatigue
hypoglycemia
what to do about kidney stones
increase fluid
decrease salt
normal dietary calcium intake
no relief of testicle when elevates
testicular torsion
what does kidney do when respiratory alkalosis and what happens to the urine pH
excretes bicarb elevating the urine pH
what biliary thing is increased during pregnancy
gallstones
euthyroid sick syndrome
can’t convert to T4–>T3
Carotid endarterectomy when to do
All patients with carotid artery stenosis should receive medical therapy with anti-platelets agents and statins
Carotid endarterectomy in patients with high grade 80-99
Asx with lower grade 80
bph treatment
frst line alpha blockers(terazosin), second line 5 alpha reductase (finasteride)
strict glycemic control (6-6.5) reduces risk of___
mortality
glycemic control below 7
decreases the risk of complications like retionopathy
patients with macroprolactinoma (> 1cm or symptomatic prolactinoma), what do you do?
treat with dopaminergic agonists (cabergoline, bromocriptine) which can lower the prolactin levels
panc pseudocyst, what do you do?
drain
MM can lead to what kind of AKI
ATN
testosterone and DHEAS
if only testosterone is elevated then think coming from ovaries and if both testosterone and DHEAS then can more of an adrenal source
carcinoid tumor and vitamin deficiency
tryptophan–>serotonin. therefore not enough tryptophan for niacin B3
urine osmolality in SIADH vs. neph
> 100 vs. <100
VIPoma
decreased chloride and potassium
refeeding syndrome increase in what?
Insulin leading to cellular uptake of potassium, phos and mag leading to deficienies.
Renal vein thrombosis complication of what and what do you see
membranous nephropathy
metabolic problems, what kind of stones
uric acid
uric acid stones what do you treat w
potassium citrate
hyponatremia give
NS
central AI dont develop
skin hyperpigmentation and hyperkalemia
third most common cause of pancreatitis
meds like diuretics
greatest risk of prostate cancer
age
primary vs. secondary epo
primary decreased epo like in case of PV
vs
secondary has high epo and is due to either tumor or hypoxia
varices what do you give
beta blockers
retain bicarb what happens to chloride
decreases it.
prolactinoma when prolactin reaches
> 200
PTU and MMI SE
agranulocytosis
varicocele that doesn’t not go away in recumbant position
RCC
RTA
failure to excrete H+ or absorb bicarb leading to NAGMA.
Give bicarb replacement. Get failure to thrive
parafollicular thyroid cancer measure
calcitonin because they are calcitonin secreting
uncomplicated cystitis what do next
can jump straight to treatment
after stabilization of burns what is next step
urinary catheterization
paroxetine (SSRI) can help w what male issue
premature ejaculation
LM normal but effacement of foot processes on EM
MCD
thickened bm with spikes
patho for membranous nephropathy
mesangial hypercellularity
membranoproliferative
opioids can cause
secondary hypogonadism such as low testosterone
gallstone pancreatitis dx
U/S
pyelo important sign
fever and can progress to TOA
progesterone can help stimulate
appetite
longitudinal splitting of membrane
alport
meningococcemia problem
WF syndrome=adrenal hemorrhage
sulfonylurea RF
weight gain
DPP4 affect weight at all?
No
tacrolimus and cyclosporin
nephrotoxic in that can make someone prerenal
whipple disease
infection with grap pos bacillus tropheryma whipplei
chronic malabsorptive diarrhea, weight loss, migratory arthritis, lymphadenopathy
salicylate=
aspirin
succinylcholine electrolyte disturbance
because upregulates post synaptic acetylcholine can cause life threatening hyperkalemia
neuromasucular blocking agent
vecuronium and rocuronium
persistent activation of complement pathway
membranoproliferative
acetazolamide
increasing HCO3- renal excretion so get NAGMA
Shiga toxin E coli do you tx?
No, because abx can lead to HUS
recurrent cystitis after sex
post-coital abx
when give ace to someone with diabetes
only if HTN or albumin/creatine ratio is >30. Nml is <30
+leukocyte esterase with no dysuria but frequency
still UTI
portal hypertension leads to splanchnic vasodilation
to decrease SVR
nml renal function, hypocal, hyperphosphate
hypoparathyroid
low thyroglobulin if what state
taking exogenous
chloride needed to excrete HCO3 so without Chloride you get
metabolic alkalosis
diarrhea
NAGMA
other mac/pap rash on hands and feet
staph
urge incontinence
first line bladder training and second line is anti-muscarinic=oxybutin
hypothyroidism leads to what elevation
prolactin that supresses FSH, LH and estrogen so annovulation
fenofibrate
high triglycerides
rhabdo get what kind of of casts on microscopy
pigmented casts
paraneoplastic with small cell
also cushing
calcified pancreas
pancreatitis
secondary hyperparathyroidism
low calcium, high phosphate due to CKD
cholinergic agonists
beth
SBP
high temperature, abdominal pain/tenderness
AMS
hypotension, hypothermia
HE causes
infection
electrolytes
bleeding
adrenal med disease
pheo
urine pH >8 think what bug
proteus miri
increasing power size
decreases confid
hydronephrosis radiating and non-radiating
non radating
eosinophilia
HL
water deprivation test
neph DI will remain dilute , vs. primary polydipsia will correct
PE
dyspnea, tachycardia, tachypnea, edema can also see pleural effusion low grade fever and troponin levels
struvite stones
recurrent UTIs with urease producing organism (proteus/klebsiella)
uric acid stones
myeloproliferative
conjugated bilirubin vs. uncon
con water soluble (dubin johnson) and is excreted in the urine (no urobin) vs. unconjugated is insoluble and forms excess metabolism to create urobolinogen
trimethoprim SE
hyperkalemia due to blockade of sodium channels . and can artificiall increase creatinine
PRIM POTASSIUM
flat facies, pulm hypoplasia, limb deformitis
potters sequence
AST ALT for cirrhosis
<500
triemterene SE
high potassium
SIADH tx
water dep
exocrine pancreas if damaged
because high bicarb from exocrine glands, if damaged, lead to acidosis
thyroid in preg
estrogen increases total TBG and bhg increases T4 by stimulating TSH receptors
d xylose test
if cant absorb the d xylose then urinary secretion will be low vs. enzyme def will be high
prothrombin complex concentrate
give to reverse warfarin
