Renal

Question 1

Prerenal AKI versus Intrinsic AKI:

urine sodium

Answer 1

Prerenal: low <20
Intrinsic: high >40

Question 2

Prerenal AKI versus Intrinsic AKI:

FENa

Answer 2

Prerenal: FENa <1%
Intrinsic: FENa >1-2%

Question 3

Prerenal AKI versus Intrinsic AKI:

Urine osmolality

Answer 3

Prerenal: high >500
Intrinsic: low <500

Question 4

Prerenal AKI versus Intrinsic AKI:

BUN:Cr ratio

Answer 4

Prerenal: high >20:1
Intrinsic: low

Question 5

Prerenal AKI versus Intrinsic AKI:

specific gravity of urine

Answer 5

Prerenal: low (dilute)
Intrinsic: high (concentrated)

Question 6

5 stages of CKD

Answer 6

1: GFR >90 with evidence of kidney damage
2: GFR 60-89
3. GFR 30-59
4. GFR 15-29
5. GFR <15

Question 7

when do symptoms of uremia show up in CKD

Answer 7

Stage 3-5

Question 8

when do lab values show disease (BUN/Cr) in CKD

Answer 8

Stage 3

Question 9

when do signs of anemia, acidosis, hyperkalemia, hypocalcemia, hyperphosphatemia show up in CKD

Answer 9

Stage 4

Question 10

what is the best predictor of disease progression in CKD

Answer 10

proteinuria

Question 11

what is the best way to test for proteinuria in CKD

Answer 11

Spot albumin:cr ratio

preferred over 24h urine

Question 12

what factors are taken into account in Cockcroft Gault GFR equation

Answer 12

age
weight
creatinine
gender

Question 13

how to instruct a patient on CKD diet??

Answer 13

low protein
adequate calories, Ca, and Vit D
limit H2O, Na, K and Phos

Question 14

what should you suspect if someone with CKD has a skull X-ray showing salt and pepper skull, bony cysts, periosteal erosions?

Answer 14

renal osteodystrophy

Question 15

what is treatment for renal osteodystrophy

Answer 15

Vit D + Ca

Question 16

Pt with PKD: what is the test of choice

Answer 16

US

fluid-filled cysts will be seen

Question 17

name some extrarenal manifestations of PKD

Answer 17

berry aneurysms
hepatic, pancreatic, spleen cysts
MVP
diverticula

Question 18

MC cause of nephrolithiasis

Answer 18

Ca stone

Question 19

imaging of choice for nephrolithiasis

Answer 19

helical spiral ct scan

Question 20

treatment for stone <5mm

Answer 20

fluid, strain urine, pain meds, alpha or ca channel blocker

Question 21

treatment for stone 5-10mm

Answer 21

fluid, pain meds

lithotripsy or ureteroscopy

Question 22

treatment for stone >10mm

Answer 22

FLUIDS

if renal function impaired - ureteral stent or percutaneous nephrostomy

Question 23

what drug can you give for a Ca stone to help

Answer 23

HCTZ

Question 24

what drug can you give for a uric acid stone to help

Answer 24

allopurinol

Question 25

DIABETES INSIPIDUS - urine sodium - urine output - urine sp gravity - serum sodium

Answer 25

``` DI: urine sodium: LOW urine output: high urine sp gravity: low, dilute serum sodium: HIGH ``` causes a hypernatremia (which is why patients feel thirsty)

Question 26

SIADH - urine sodium - urine output - urine sp gravity - serum sodium

Answer 26

SIADH: - urine sodium: high - urine output: low - urine sp gravity: high, concentrated - serum sodium: low

Question 27

describe the mechanism of DI: central and/or nephrogenic

Answer 27

Decreased ADH (central: can't produce, nephrogenic: not sensitive) Leads to kidneys not being able to concentrate urine --> large amounts of dilute urine

Question 28

describe the mechanism of SIADH

Answer 28

increased ADH --> increased water retention --> dilutional hyponatremia AND --> kidneys not being able to dilute urine --> concentrated urine

Question 29

how to differentiate DI: central from nephrogenic

Answer 29

DDAVP test | Give DDAVP. If central - will have effect and urine will concentrate

Question 30

how to dx DI

Answer 30

fluid deprivation test | take fluid away - normal urine will concentrate but in DI it won't

Question 31

how to treat SIADH (mild vs severe)

Answer 31

water restriction is the mainstay | can give hypertonic IV saline with furosemide if severe or brain bleed

Question 32

how to treat DI (nephrogenic vs. central)

Answer 32

Central: DDAVP Nephrogenic: Na + protein restriction, hctz

Question 33

what happens if you replace volume too fast in HYPOnatremia

Answer 33

central pontine myelinolysis

Question 34

what happens if you replace volume too fast in HYPERnatremia

Answer 34

pulmonary or cerebral edema

Question 35

Tx for hyperkalemia

Answer 35

calcium gluconate IV* also sodium bicarb, D50, Insulin 10u, sodium polystyrene sulfonate

Question 36

Tx for hypokalemia

Answer 36

Oral K replacement, spironolactone | IV if cardiac abnormalities

Question 37

Tx for hypercalcemia

Answer 37

Fluids and bisphosphonates

Question 38

tx for hypocalcemia

Answer 38

IV calcium gluconate or calcium chloride (severe) | oral Ca and Vit D (mild)

Question 39

Tx for hypermagnesemia

Answer 39

mild IV fluids and furosemide | severe calcium gluconate

Question 40

Tx for hypomagnesemia

Answer 40

Oral mag oxide at 2x the estimated deficit | IV mag sulfate if severe

Question 41

Tx for isovolemic hyponatremia

Answer 41

water restriction

Question 42

tx for hypervolemic hyponatremia

Answer 42

water and salt restriction

Question 43

tx for hypovolemic hyponatremia

Answer 43

NS

Question 44

tx for severe isovolemic or hypervolemic hyponatremia

Answer 44

hypertonic saline and lasix

Question 45

treatment for hypernatremia

Answer 45

PO preferred with hypotonic fluids | pure water, D5W, 1/2NS, 0.2% saline.