- 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

Renal Flashcards by AS W

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!

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What is the proteinuria threshold for glomerular disease?

> 3500 mg/g

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What is the threshold for macroalbuminuria?

> 300 mg/g

FYI this is now termed severely increased albuminuria

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

don’t be tricked!

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how do you diagnose positional (orthostatic) proteinuria?

split daytime standing and nighttime supine urine collections

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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

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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

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what are broad casts associated with

CKD

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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

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

Polydipsia

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

SIADH
Hypothyroid
AI
Cerebral salt wasting

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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

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What is the treatment for central DI?

intranasal desmopressin

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What are the most common causes of hypokalemia?

vomiting and diarrhea and diuretics

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how can you distinguish GI vs renal Mg losses?

24 urine mag excretion

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What are common causes of AGMAs?

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

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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

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A negative urine anion gap suggests what?

NAGMA from extrarenal bicarb loss (diarrhea)

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how do you calculate plasma osms?

2x Na + BUN/2.8 + glucose /18

normal is 10

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elevated ketones and osmolar gap

What is the diagnosis?

isoprophyl alcohol poisoning

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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

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what is the definition of resistant htn?

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

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

thiazides

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

20 weeks

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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

What is the treatment for FSGS

steroids or calcineurin inhibitors

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

membranous glomerulopathy

Hep B and C are associated with what renal disease?

membranous glomerulopathy

What is the treatment for membranous glomerulopathy

33% spontaneously remit in 6-12 months steroids and cyclophosphamide or calcineurin inhibitors treat concurrent hep b

patients with membranous glomerulopathy are at high risk for what?

thrombosis, especially renal vein thrombosis

do adults get minimal change disease?

yes, 10% of cases seen in adults

What is the treatment for minimal change disease

steroids

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

not due to diabetes if no retinopathy need biopsy for definitive diagnosis don't be tricked!

All patients with nephrotic syndrome should be treated how?

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

what is the hallmark of nephritic syndrome?

RBC casts and dysmorphic RBCs

what do dysmorphic RBCs look like under the microscope?

mickey mouse ears

Anti GBM Ab disease can have what features?

Ab against type IV collagen can be associated with rapidly progressive GN in young patients if involves pulmonary capillaries can cause pulmonary hemorrhage

Kidney biopsy with proliferative GN with linear deposition of immunoglobulin What is the diagnosis?

Anti GBM Ab disease

What is the treatment for Anti GBM Ab diasese?

Cyclophosphamide Glucocorticoids daily plasmapheresis

What specific GN diseases are associated with pauci-immune GN

pauci-immune GN: necrotizing GN with few immune deposits and normal complement Ganulomatosis with polyangiits Microscopic polyangiitis Eosinophilic granulomatosis with polyangiitis

What GN diseases have immune complex deposition?

ALL have low complement except IgA nephropathy ``` IgA nephropathy IgA vasculitis (Henoch-Schonlein purpura) Lupus nephritis Infection related GN membranoproliferative GN Cryoglobulinemia ```

What is the treatment for pauci-immune GN?

glucocorticoids | cyclophosphamide or ritux +/- plasmapheresis

Treatment for IgA nephropathy?

usually self limited ACEi or ARB for patients with proteinuria and risk for progression

What are typical lab findings in lupus nephritis?

positive ANA, dsDNA, low C3 adn C4

What is the treatment for: lupus nephritis

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 ```

What illnesses are associated with membranoproliferative GN?

SLE infections - hep C monoclonal gammopathy

What lab findings are seen in membranoproliferative GN?

low complement

how do you diagnose ADPKD

kidney ultrasound genetic testing for equivocal cases

What is the diagnosis and workup? Complete anuria

renal cortical necrosis kidney ultrasound

What is the diagnosis and workup? large kidneys on US

amyloid diabetes HIV nephropathy SPEP, glucose, HIV serologies

What is the diagnosis and workup? kidney failure after a colonoscopy?

phosphate containing bowel prep -> acute calcium phosphate crystal deposition in the kidneys tx: supportive care

What is the diagnosis and workup? recent abdominal surgery, hemorrhage or acute pancreatitis

abdominal comparent syndrome check intravesicular pressure, positive if >20

What is the diagnosis and workup? peripheral blood smear with schistos, thrombocytopenia

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

What is the diagnosis and workup? urine dipstick positive for blood, no erythocytes on UA

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

What is the diagnosis and workup? AKI associated with acute leukemia or lymphoma or its treatment

TLS uric acid, phos, K -- all will be elevated

What is the diagnosis and workup? worsening kidney function iso diuretic-resistant HF

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

worsening kidney function iso cirrhosis and ascites

hepatorenal IV albumin and IV volume repletion, liver transplant

What is the treatment for scleroderma renal crisis

ACEi regardless of the Cr level

Struvite kidney stones are associated with what organisms?

klebsiella and proteus

What is the outpatient treatment for kidney stones

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

What size kidney stones require intervention

>10mm

Does a Ca restricted diet prevent kidney stones?

NO, can increase stone formation and contribute to bone demineralization don't be tricked!

Should patients who are on dialysis be on statins?

no, no benefit

papillary necrosis on renal ultrasound is suggestive of what pathophys

analgesic abuse

Are clinical outcomes different between patients getting PD vs HD?

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

kidney transplant

what are the contraindications to kidney transplant?

systemic malignancy chronic infection severe CVD neuropsych disorder

Should magnesium containing antacids be used in patients with ESRD?

What is the mgmt for priamry membranous glomerulopathy?

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