Renal Flashcards
What is a common way that Cr leads to an overestimation of GFR?
loss of muscle mass 2/2 age, liver failure or malnutrition
don’t be tricked!
What is the proteinuria threshold for glomerular disease?
> 3500 mg/g
What is the threshold for macroalbuminuria?
> 300 mg/g
FYI this is now termed severely increased albuminuria
Does a urine dipstick detect immunoglobulin light chains associated with multiple myeloma?
no
don’t be tricked!
how do you diagnose positional (orthostatic) proteinuria?
split daytime standing and nighttime supine urine collections
What is the definition of sterile pyuria and what does it suggest as an etiology?
pyuria and a negative urine culture
suggests mycobacterium tuberculosis, interstitaionl cystitis or interstitial nephritis
What do Eos in the urine suggest?
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
what are broad casts associated with
CKD
When should you use MRI to evaluate the kidneys?
- when need to avoid contracts
- to characterize renal masses, cysts and renal vein thrombosis
- to look for renal artery stenosis using MRA with gad
Hyponatremia and euvolemic on exam
- U Na >20
- U Osm 50 - 100
What is the diagnosis?
Polydipsia
Hyponatremia and euvolemic on exam
- U Na >20
- U Osm 350
What is the diagnosis?
SIADH
Hypothyroid
AI
Cerebral salt wasting
Treatment for SIADH?
- 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
What is the treatment for central DI?
intranasal desmopressin
What are the most common causes of hypokalemia?
vomiting and diarrhea and diuretics
how can you distinguish GI vs renal Mg losses?
24 urine mag excretion
What are common causes of AGMAs?
DKA CKD lactic acidosis aspirin toxicity EtOH ketoacidosis methanol and ethanol poisoning
What are common causes of NAGMAs
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
A negative urine anion gap suggests what?
NAGMA from extrarenal bicarb loss (diarrhea)
how do you calculate plasma osms?
2x Na + BUN/2.8 + glucose /18
normal is 10
elevated ketones and osmolar gap
What is the diagnosis?
isoprophyl alcohol poisoning
Patient comes in obtunded, Ca Oxalate crystals in urine, elevated osmolar gap
What is the diagnosis?
Ethylene glycol poisoning
treat with fomepizole and dialysis if severe
what is the definition of resistant htn?
not at bp goal despite 3 bp meds (one must be a diuretic)
Patient with GFR < 30 - what drug class is unlikely to be effective for HTN?
thiazides
What week gestation is the cut off for chronic vs gestational HTN?
20 weeks
What is the definition of preeclampsia?
new onset HTN after 20 weeks of pregnancy with proteinuria
What medications are safe to use during pregnancy to treat HTN?
methyldopa
labetalol
CCBs
ACEi, ARBs and renin inhibitors are absolutely contraindicated
Does treatment of gestational HTN prevent the occurrence of pre-eclampsia or chronic HTN?
NO
don’t be tricked!
What is the protein threshold for nephrotic syndrome?
3500 mg/24h of protein excretion in the urine or
a urine protein to Cr ratio of > 3500 mg/g
What illness is FSGS associated with
HIV