Renal: buzzwords Flashcards
1
Q
flat neck veins
A
hypovolemia
2
Q
poor skin tugor, dry mucous membranes
A
hypovolemia
3
Q
increased serum creatinine, incr serum protein, increased BUN:Cr >20:1
A
hypovolemia
4
Q
peripheral and vascular edema
A
hypervolemia
5
Q
pulmonary edema
A
hypervolemia
6
Q
JVD
A
hypervolemia
7
Q
decreased hematocrit, decr serum protein and decreased BUN: Cr ratio
A
hypervolemia
8
Q
pancreatitis
A
hypotonic hypovolemic hyponatremia
9
Q
diarrhea / vomiting
A
hypotonic hypovolemic hyponatremia
10
Q
cirrhosis
A
hypotonic hypervolemic hyponatremia
11
Q
CHF
A
hypotonic hypervolemic hyponatremia
12
Q
one of MCC of hyponatremia
A
SIADH
13
Q
polydipsia for cold water
A
hypernatremia
14
Q
what is hypernatremia almost always assoc with
A
hyperosmolarity
15
Q
lithium
A
NEPHROGENIC DI
16
Q
BUN/Cr ratio >20:1
A
hypovolemia
*decr circulating volume=decr flow to kidneys=more bound urea in blood=incr BUN
17
Q
low urine sodium and high serum sodium
A
DI
18
Q
decr BUN/Cr ratio
A
HYPOnatremia
or
HYPERvolemia
19
Q
seizures
A
hyponatremia
20
Q
causes for hypervolemia hypernatremia
A
iatrogenic
primary hyderaldosteronism
21
Q
euvolemia hypernatremia causes
A
DI (due to decr ADH)
hypodipsia
22
Q
hypovolemic hypernatremia causes
A
renal vs extra-renal loses
23
Q
hypovolemia hyponatremia causes
A
renal and extra-renal causes
24
Q
euvolemia hyponatremia
A
SIADH (incr ADH)
polydipsia
adrenal insufficiency
hypothyroidism
25
hypervolemia hyponatremia causes
CHF
cirrhosis
nephrotic syndrome
26
pink serum
in vitro hemolysis---pseudohyperkalemia
27
digoxin toxicity--what drug is contraindicated
calcium gluconate or calcium chloride
28
licorice
can incr htn and cause hypokalemia
29
hypomagnesemia
causes hypokalemia
30
U wave on EKG
hypokalemia
31
diarrhea causes----- metabolic_____
vomiting causes---metabolic ____
vomiting=metabolic alkalosis
diarrhea=metabolic acidosis
31
diarrhea causes----- metabolic_____
vomiting causes---metabolic ____
vomiting=metabolic alkalosis
diarrhea=metabolic acidosis
32
MCC hypokalemia
diuretics
33
what do you not add initially to a K+ chloride solution and why
bicarb and glucose
| -->beacuse they drive K+ into the cell
34
thiazide diuretics work where in the nephron
DCT
35
ADH acts on what in the nephron
straight segment of the DCT and CD
36
low PCO2
met acidosis
37
high PCO2
met alkalosis
38
osmolar gap calculation
measured-calculated
39
anion gap calculation
[NA] - (Cl + HCO3-)
40
Winters formula
- calcualtes what?
- what is the equation
calculates the expected PaCO2 aka how well are the lungs compensation for the metabolic acidosis
{(1.5 x HCO3) + 8}
41
normal pco2
35-45
42
normal bicarb
22-26
43
how do you know if there is respiratory compensation
if the PCO2 is going in the same direction as the ph
1. acidosis LOW ph so compensation= LOW CO2
2. alkalosis HIGH ph so compensation=HIGH CO2
44
oxalate crystals in urine
Ethylene glycol ingestion
| ***causing high osmolar gap acidosis
45
electrolyte values for metabolic acidosis
hyperCA
| hyperK
46
equation for calculated osmolality
2 (NA+) + (Glucose/18) + (BUN/2.8)
47
RTA type 1 causes
normal AG met. acidosis via bicarb loss
48
RTA type 2 causes
normal AG met acidosis via decrease acid secretion
49
RTA type 4 causes
normal AG met acidosis via decr acid secretion
50
two main causes of normal AG MA
diarrhea
| RTA (1, 2, 4)
51
potential compliaciton when giving bicarb in lactic acidosis?
it produced more lactacte production
52
(-) UAG
diarrhea is the cause aka extra renal
| -NH4 over excretion
53
(+) UAG
renal cause
- RTA
- NH4 excretion minimal/impaired
54
hyperaldosteronism causes what metabolic disturbance
| -hypoaldosteronism?
HYPER= met alkalosis bc increase secertion of H+ and causes HYPOK
HYPO=met acidosis and causes HYPERK
55
licorice
can cause met. alklaosis
56
when diff b/w measured and calculated osmolality is > 10, what are the causes
ETOH--ethanol, methanol, ethyelen gycol, isoproprly alchool
Osmotic diruetics--mannitol
***MET ACODISOS
57
oval fat bodies on urine sediment
hyperlipidemia---indicative of nephrotic syndrome
58
urine >3,000 PU in 24.hrs
nephrotic
59
fatty cast on urine sediment
high urinary protein nephrotic syndrome
60
maltese cross pattern under polarized light
high urinary protein nephrotic syndrome
61
microscopic blood +/- on urine sediment
nephrotic
62
urine "bland"
nephrotic
63
lab tests show hypoalbuminemia and hyperlipidemia
nephrotic syndrome
64
causes of secondary nephrotic syndrome
```
SLE
DM
HIV
HEp B and C
Antiphospholipid syndrome
```
65
young kid with unexplained edema or ascites
nephrotic syndrome
| **minimal change dz
66
MC primary cause of nephrotic syndrome
Membranous nephropathy
67
MC secondary causes of nephrotic syndrome
**SLE--both nephritic and nephrotic
**DM
Preeclampsia
68
edema + HTN + hematuria + RBC cats/dysmorphic RBCS + proteinuria <3,000
nephritic
69
"actie" urine sedement
nephritic
70
hematuria
nephritic
71
RBC casts
nephritic
72
WBC casts
nephritic
73
dysmorphic RBC on urine sed
glomerulonpehritis or nephritic
74
anti-GBM antibodies
nephritic
75
+ anti-streptlysin O titer
postinfecitous GN
90% upper resp and 50% in skin
76
low complement C3 C4 and high ASO titers
post infecitous GN
77
MCC of primary GN worldwide
IgA nephropathy
78
tram track apperance
Membranoproliferative GN
MPGN
**its the GBM splitting
79
hep c is highly associated with
MPGN
80
double counter apperance
MPGN
81
MCC of ARF in kids
HUS vasculitis
82
smokey brown tinged urine
lupus nephritis
83
C-ANCA (+)
Wegners aka Granulomatosis Polyangiitis
84
Anti-proteinase 3 (+)
Wegners aka Granulomatosis Polyangiitis
85
oral nasal ulcers
Wegners aka Granulomatosis Polyangiitis
86
P-ANCA (+)
microscopic polyangiitis
87
Goodpastures is what type of hypersensitivty
2--antibody mediated
88
foamy urine
nephrotic
89
normal 24/hr urine protein
<150 mg/day
90
effacement of visceral epithelial foot processes on EM
minimal change dz
91
3rd MCC of GMN in adults
minimal change dz
92
pathology shows fusion of visceral epithelial cell foot processes
minim change dz
93
MCC of nephrotic syndrome in adults
membranous
94
antigens against PLA2R
membranous nephrotic syndrome
95
MC GN leading to ESRD
focal segmental glomerulosclerosis (FSGS)
96
african americans 4x risk of what
ESRD if they have focal segmental glomerulosclerosis (FSGS)
97
assoc with heroine use
Focal Segmental Glomerulosclerosis (FSGS)
98
assoc with obesity
Focal Segmental Glomerulosclerosis (FSGS)
99
most common in non-diabetic adults assoc with malginancies and infection with HBV
Membranous nephropathy
100
thick basement membrane on renal biopsy
membranous nephropahty
101
podocyte damage on electron microscope
miniml chane dz
102
MCC of secondary HTN
RAS
103
abdominal bruit
RAS
104
string of beads apperance on angio
fibromuscular dysplasia of renal artery
105
severe flank pain
renal venous thrombosis
106
unexplained hypokalemia
primary aldosteronism
107
proxysmal elevations in BP
pheochromocytoma
108
rib notching on xray
coarcation of aorta
109
diet high in oxalate
nephrolithiasis
110
MC type of fusion
horseshoe kidney
111
MC inherited cause of kidney dz
polycystic kidney dz
112
dull aching flank pain
renal cell ca
113
MC kidney CA in adults
renal cell CA
114
2nd MC abd tumor in kids
wilms tumor
115
nitrogen in blood
azotemia
116
MCC of :
- pre renal AKI
- intra-renal AKI
- post-renral AKI
pre= renal hypoperfusion
intra= ATN
post=rare=urinary tract obstructions
117
MC type of AKI overall
Pre renal
118
MC type of AKI in hosp pt
ATN
119
high BUN: Cr ratio
AKI
| ***** >20:1 = high
120
rbc casts
glomerular in origin
121
wbc casts
suggesitive of inflammatory process that may or may no tbe infectious
122
waxy casts
not distinctive to diseases
technically a degenerative phase of a cast
-represents longstanding dz*********
123
broad casts
adv chronic kidney disease
124
granular casts
represent degenerated cells
-deeply pigmented MUDD BROWN or HEME-GRANULAR casts
attribued to ATN
125
muddy brown casts
ATN
126
Compares and contrast the following lab values for Prerenal AKI and ATN
1. Fractional NA excretion
2. BUN/Cr
3. Urinary sodium
4. urine osmolality
5. urine/serum creatinine
PRE-renal AKI
1. <1%
2. >20
3. <20
4. >500
5. >40
ATN
1. >2%
2. 10-15
3. >40
4. <350
5. <20
127
define normal BUN: Cr ratio
10-15: 1
128
fever, eosinophillia, red or white casts
allergic interstitial nephritis
129
urine in prerenal AKI vs intrinsic AKI
PRe-renal
**kidney reabsorbs water and NA thinking body is hypovolemic-->so urine is CONCENTRATED (no water) but LOW [ ] of NA... <20
intrinsic renal
**kidneys are damaged-- so cannot reabsorb---- very dilute water and high [ ] of NA >40 usually
130
major drugs causing ATN
Aminoglycosides
amphotericin B
NSAIDs
ACEI
131
WBC casts
Acute intersitial nephritis----from allergic response to a drug MC
132
drugs causing ATN vs drugs causing AIN
ATN
* acyclovir
* aminoglycosides
* amphotericin
* cyclosporine
* lithium
* NSAIDs
* pentamidine
* vanco
AIN
* Allopurinol
* cephalosproin
* NSAIds
* PCNs
* phenytoin
* PPIs
* quinolones
* rifampin
* sulfas
133
when do we never give abx
HUS
134
CKD----what electrolyte is LOW and why
Calcium
-kidneys activate vit d--- and vit d allows Ca to be absorbed from the diet--- so if theres no vit d---- no CA is being absorbed
135
Criteria to dx CKD
1. durtation >3 MO
2. GFR <60
3. kidney damage defined by structural abnm or functional abnm other than decr GFR
136
number ONE cause of CKD? second?
number one=DM
| two=HTN
137
target BP for CKD
<130/80
138
two most imp modifiable RF for progressive CKD
- HTN
| - PU
139
which RTA cause hypokalemia and hyperkalmeia?
HYPO=1-3
| HYPER=4
140
urine pH >5.5 in setting of metabolic acidosis
RTA type 1
141
WBC casts in urine
pyelonephritis
142
PT with chron's dz had bypass----what type of stones
since they cannot absorb oxalate----Calcium oxalate stones
143
mc stone type
ca oxalate
144
citrate is
a stone inhibitor
145
two mc s/s of urinary stone
flank pain and hematuria
146
GN occuring 1-2 DAYS after illness
IGA nephropathy
147
fever rash and eosinophilia
drug induced AIN
148
cerebral aneurysms (berry) assoc with
PKD
149
RBC casts
glonerulonephritis
150
wbc casts
pyelonephritis
151
flank pain, hematuria and palpable renal mass
triad for renal cell CA
152
whats imp for making [ ]ed urine
vasa recta
153
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