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Renal Flashcards

1
Q

What is a common way that Cr leads to an overestimation of GFR?

A

loss of muscle mass 2/2 age, liver failure or malnutrition

don’t be tricked!

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2
Q

What is the proteinuria threshold for glomerular disease?

A

> 3500 mg/g

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3
Q

What is the threshold for macroalbuminuria?

A

> 300 mg/g

FYI this is now termed severely increased albuminuria

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4
Q

Does a urine dipstick detect immunoglobulin light chains associated with multiple myeloma?

A

no

don’t be tricked!

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5
Q

how do you diagnose positional (orthostatic) proteinuria?

A

split daytime standing and nighttime supine urine collections

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6
Q

What is the definition of sterile pyuria and what does it suggest as an etiology?

A

pyuria and a negative urine culture

suggests mycobacterium tuberculosis, interstitaionl cystitis or interstitial nephritis

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7
Q

What do Eos in the urine suggest?

A 
AIN
post-infectious GN
atheroembolic disease of the kideny
septic emboli
small vessel vasculitis

don’t be tricked! absence of Eos doesn’t rule out any of these diagnoses

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8
Q

what are broad casts associated with

A

CKD

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9
Q

When should you use MRI to evaluate the kidneys?

A
  • when need to avoid contracts
  • to characterize renal masses, cysts and renal vein thrombosis
  • to look for renal artery stenosis using MRA with gad
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10
Q

Hyponatremia and euvolemic on exam
- U Na >20
- U Osm 50 - 100
What is the diagnosis?

A

Polydipsia

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11
Q

Hyponatremia and euvolemic on exam
- U Na >20
- U Osm 350
What is the diagnosis?

A

SIADH
Hypothyroid
AI
Cerebral salt wasting

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12
Q

Treatment for SIADH?

A
  • H20 restriction
  • Loop diuretic + oral salt supplementation
  • can also use demeclocycline for outpatients
  • vaptans can be used if failed above, but they are pricey and have not demonstrated improved outcompes
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13
Q

What is the treatment for central DI?

A

intranasal desmopressin

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14
Q

What are the most common causes of hypokalemia?

A

vomiting and diarrhea and diuretics

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15
Q

how can you distinguish GI vs renal Mg losses?

A

24 urine mag excretion

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16
Q

What are common causes of AGMAs?

A 
DKA
CKD
lactic acidosis
aspirin toxicity
EtOH ketoacidosis
methanol and ethanol poisoning
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17
Q

What are common causes of NAGMAs

A

diarrhea -> GI bicarb loss
kidney bicarb losses -> ileal bladder, proximal RTA
distal RTA or type IV RTA -> reduced kidney H excretion
fanconi syndorme
carbonic anhydrase use

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18
Q

A negative urine anion gap suggests what?

A

NAGMA from extrarenal bicarb loss (diarrhea)

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19
Q

how do you calculate plasma osms?

A

2x Na + BUN/2.8 + glucose /18

normal is 10

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20
Q

elevated ketones and osmolar gap

What is the diagnosis?

A

isoprophyl alcohol poisoning

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21
Q

Patient comes in obtunded, Ca Oxalate crystals in urine, elevated osmolar gap

What is the diagnosis?

A

Ethylene glycol poisoning

treat with fomepizole and dialysis if severe

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22
Q

what is the definition of resistant htn?

A

not at bp goal despite 3 bp meds (one must be a diuretic)

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23
Q

Patient with GFR < 30 - what drug class is unlikely to be effective for HTN?

A

thiazides

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24
Q

What week gestation is the cut off for chronic vs gestational HTN?

A

20 weeks

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25
Q

What is the definition of preeclampsia?

A

new onset HTN after 20 weeks of pregnancy with proteinuria

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26
Q

What medications are safe to use during pregnancy to treat HTN?

A

methyldopa
labetalol
CCBs

ACEi, ARBs and renin inhibitors are absolutely contraindicated

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27
Q

Does treatment of gestational HTN prevent the occurrence of pre-eclampsia or chronic HTN?

A

NO

don’t be tricked!

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28
Q

What is the protein threshold for nephrotic syndrome?

A

3500 mg/24h of protein excretion in the urine or

a urine protein to Cr ratio of > 3500 mg/g

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29
Q

What illness is FSGS associated with

A

HIV

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30
Q

What is the treatment for FSGS

A

steroids or calcineurin inhibitors

31
Q

a positive antibody against phospholipase a2 receptor is diagnostic of what cause of nephrotic syndrome?

A

membranous glomerulopathy

32
Q

Hep B and C are associated with what renal disease?

A

membranous glomerulopathy

33
Q

What is the treatment for membranous glomerulopathy

A

33% spontaneously remit in 6-12 months

steroids and cyclophosphamide or calcineurin inhibitors

treat concurrent hep b

34
Q

patients with membranous glomerulopathy are at high risk for what?

A

thrombosis, especially renal vein thrombosis

35
Q

do adults get minimal change disease?

A

yes, 10% of cases seen in adults

36
Q

What is the treatment for minimal change disease

A

steroids

37
Q

patient has diabetes and has nephrotic range proteinuria but not diabetic retinopathy - what’s the diagnosis?

A

not due to diabetes if no retinopathy

need biopsy for definitive diagnosis

don’t be tricked!

38
Q

All patients with nephrotic syndrome should be treated how?

A
  • statins if elevated lipids
  • anticoagulation for thrombotic complications (lose antithrombins in urine)
  • low salt diet and loop diuretics for edema
39
Q

what is the hallmark of nephritic syndrome?

A

RBC casts and dysmorphic RBCs

40
Q

what do dysmorphic RBCs look like under the microscope?

A

mickey mouse ears

41
Q

Anti GBM Ab disease can have what features?

A

Ab against type IV collagen

can be associated with rapidly progressive GN in young patients

if involves pulmonary capillaries can cause pulmonary hemorrhage

42
Q

Kidney biopsy with proliferative GN with linear deposition of immunoglobulin

What is the diagnosis?

A

Anti GBM Ab disease

43
Q

What is the treatment for Anti GBM Ab diasese?

A

Cyclophosphamide
Glucocorticoids

daily plasmapheresis

44
Q

What specific GN diseases are associated with pauci-immune GN

A

pauci-immune GN: necrotizing GN with few immune deposits and normal complement

Ganulomatosis with polyangiits

Microscopic polyangiitis

Eosinophilic granulomatosis with polyangiitis

45
Q

What GN diseases have immune complex deposition?

A

ALL have low complement except IgA nephropathy

IgA nephropathy
IgA vasculitis (Henoch-Schonlein purpura)
Lupus nephritis
Infection related GN
membranoproliferative GN
Cryoglobulinemia
46
Q

What is the treatment for pauci-immune GN?

A

glucocorticoids

cyclophosphamide or ritux +/- plasmapheresis

47
Q

Treatment for IgA nephropathy?

A

usually self limited

ACEi or ARB for patients with proteinuria and risk for progression

48
Q

What are typical lab findings in lupus nephritis?

A

positive ANA, dsDNA, low C3 adn C4

49
Q

What is the treatment for: lupus nephritis

A

depends on kidney biopsy findings:

class I and II - no specific therapy
Class III  and IV - high dose steroids and IV cyclophosphamide or mycophenolate mofetil
50
Q

What illnesses are associated with membranoproliferative GN?

A

SLE
infections - hep C
monoclonal gammopathy

51
Q

What lab findings are seen in membranoproliferative GN?

A

low complement

52
Q

how do you diagnose ADPKD

A

kidney ultrasound

genetic testing for equivocal cases

53
Q

What is the diagnosis and workup?

Complete anuria

A

renal cortical necrosis

kidney ultrasound

54
Q

What is the diagnosis and workup?

large kidneys on US

A

amyloid
diabetes
HIV nephropathy

SPEP, glucose, HIV serologies

55
Q

What is the diagnosis and workup?

kidney failure after a colonoscopy?

A

phosphate containing bowel prep -> acute calcium phosphate crystal deposition in the kidneys

tx: supportive care

56
Q

What is the diagnosis and workup?

recent abdominal surgery, hemorrhage or acute pancreatitis

A

abdominal comparent syndrome

check intravesicular pressure, positive if >20

57
Q

What is the diagnosis and workup?

peripheral blood smear with schistos, thrombocytopenia

A

Thrombotic microangiopathy - HUS/TTP, DIC, scleroderma renal crisis

58
Q

What is the diagnosis and workup?

urine dipstick positive for blood, no erythocytes on UA

A

hemolysis, rhabdo

serum CK, serum haptoglobin, retic count, peripheral blood smear

59
Q

What is the diagnosis and workup?

AKI associated with acute leukemia or lymphoma or its treatment

A

TLS

uric acid, phos, K – all will be elevated

60
Q

What is the diagnosis and workup?

worsening kidney function iso diuretic-resistant HF

A

cardiorenal

diuretics, ACE/ARB, vasodilators and inotropes for improved cardiac function

61
Q

worsening kidney function iso cirrhosis and ascites

A

hepatorenal

IV albumin and IV volume repletion, liver transplant

62
Q

What is the treatment for scleroderma renal crisis

A

ACEi regardless of the Cr level

63
Q

Struvite kidney stones are associated with what organisms?

A

klebsiella and proteus

64
Q

What is the outpatient treatment for kidney stones

A

2l fluids daily
if calcium stones: thiazide, allopurinol or citrate
struvite stones: perc nephrostolithotomy and long term ppx antibiotics

65
Q

What size kidney stones require intervention

A

> 10mm

66
Q

Does a Ca restricted diet prevent kidney stones?

A

NO, can increase stone formation and contribute to bone demineralization

don’t be tricked!

67
Q

Should patients who are on dialysis be on statins?

A

no, no benefit

68
Q

papillary necrosis on renal ultrasound is suggestive of what pathophys

A

analgesic abuse

69
Q

Are clinical outcomes different between patients getting PD vs HD?

A

no

70
Q

what is better for long term survival and cost: kidney transplant or long term HD?

A

kidney transplant

71
Q

what are the contraindications to kidney transplant?

A

systemic malignancy
chronic infection
severe CVD
neuropsych disorder

72
Q

Should magnesium containing antacids be used in patients with ESRD?

A

no

73
Q

What is the mgmt for priamry membranous glomerulopathy?

A

observe for 6- 12 months on conservative tx to allow time for possible spontaneous remission before initiating immunosuppresion

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