Renal & GU Flashcards
1
Q
best initial test in nephro
A
- urinalysis
- BUN
- Cr
2
Q
urinalysis consists of
A
- dipstick if positive
2. microscopic analysis
3
Q
normally excrete which protein
A
Tamm Horsfall (30-50mg/24hrs)
4
Q
transient proteinuria
A
BENIGN, 2-10% of population
5
Q
benign causes of proteinuria
A
exercise
orthostatic proteinuria
6
Q
single protein: creatinine = efficacy to
A
24hr urine collection
7
Q
urine dipstick detects
A
ALBUMIN ONLY
8
Q
normal protein excretion in 24hrs
A
less than 300mg
9
Q
best initial test proteinuria
A
urinalysis
10
Q
most accurate test proteinuria
A
protein:creatinine ratio
11
Q
P/Cr accuracy vs. 24hr urine
A
GREATER ACCURACY– faster and easier
12
Q
finding out cause of proteinuria
A
biopsy
13
Q
microalbuminuria
A
30-300mg/24hrs
14
Q
microalbuminuria can lead to….
A
worsening renal function
15
Q
tx of microalbuminuria in diabetic patient
A
ACEI/ ARB
16
Q
diabetic patient with kidney disease, do BIOPSY when there is…
A
NO OPHTHALMIC DISEASE (recall what’s going on in the kidneys, reflects what’s going on in the eyes of a diabetic)
17
Q
WBC’s in urine
A
inflammation– acute interstitial nephritis
infection
18
Q
eosinophils with NSAID induced kidney disease
A
NOOOOOOOPE!!!
19
Q
stains used to detect eosinophils in urine
A
Wright and Hansel stains
20
Q
common cause for mild recurrent haematuria
A
IgA nephropathy
21
Q
False positives for dipstick haematuria
A
Hb or Mb
22
Q
patient presents with trauma to kidneys and dark urine… what next
A
microscopic exam of urine– to detect if Hb/Mb present (Cannot tell the difference between the two, but can tell if its present or not)
23
Q
IVP nephro answer
A
ALWAYS WRONG– since slow and renal toxicity with contrast
24
Q
dysmorphic RBC’s
A
glomerulonephritis
25
cystoscopy indications
1. hematuria without infection or trauma
2. haematuria-- without cause on CT/US
3. hematuria with bladder mass on sonography
26
Diagnostic test for bladder cancer
cystoscopy with biopsy
27
hyaline casts
DEHYDRATION--tamm horsfall protein
28
mgmt of pre and post-renal azotemia
underlying cause; MOST ARE REVERSIBLE
29
obstruction with increasing creatinine
need BOTH kidneys to be obstructed for the creatinine to rise
30
weird cause of post-renal azotemia
retroperitoneal fibrosis
31
causes of retroperitoneal fibrosis
CTX: bleomycin, methylsergide
| RTX
32
HYPOtn causes of pre-renal azotemia
- sepsis
- anaphylaxis
- bleeding
- dehydration
33
HYPOvol causes of pre-renal azotemia
- diuretics
- burns
- pancreatitis
- decrease pump function: CHF/ constrictive pericarditis/tamponade
- low albumin
- cirrhosis
34
one other cause of pre-renal azotemia-- non-hypoTN/VOL
renal artery stenosis
35
ATN causes toxins
- NSAIDs
- aminoglycosides
- amphotericin
- cisplatin
- cyclosporine
36
miscellaneous causes of intrinsic renal azotemia
- rhabdomyolysis
- hyperuricaemia
- crystals
- contrast
- BJ proteins
- Post-strep infection
- heavy metals
- ethylene glycol
37
immediate increase in Cr cause
contrast induced nephropathy, within 1 day
38
2 days post CTX with cisplatin cause of increase Cr
tumor lysis syndrome
39
5-10 days, get increase in Cr
DRUGS-- cisplatin, ahminoglycosides etc.
40
PC AKI early
- N/V
| - malaise
41
PC AKI SEVERE
- confusion
| - pericarditis
42
Pre-Renal Azotemia
BUN:Cr >20:1
UNa: 500mOsm/kg, = HIGH specific gravity
43
Intra-Renal Azotemia
BUN:CR 20
FeNa: >1%
UOsm:
44
bladder distended and get a MASSIVE RELEASE of urine after catheter
POST-renal azotemia (Since obstruction now being relieved)
45
if AKI cause is not clear, NEXT BEST STEP
URINALYSIS
46
sickle cell trait AVOID
DEHYDRATION-- since get stuck in renal medulla, can't concentrate
47
Contrast induced nephropathy
HYDRATION---- both BEFORE and DURING contrast study
48
LABS in contrast induced nephropathy
YES IT'S ATN, BUT...contrast causes spasm of the afferent arteriole-- thus get BIG reabsorption water and Na thus...
UNa 500= HIGH specific gravity
49
how to prevent tumor lysis syndrome
- allopurinol
- rasburicase
- hydration
BEFORE CTX
50
ethylene glycol
calcium oxalate stones-- thus LOW CALCIUM
51
methanol ingestion...
INFLAMMATION OF RETINA
52
calcium levels with NSAID ingestion
NO CHANGE
53
toxins are more likely to develop ATN if...
HYPO perfusion of kidney and if there is..
| UNDERLYING RENAL INSUFF
54
risk of ATN with age
INCREASES with age-- body loses 1% of renal function for every year past 40yo
55
what may increase risk of amino glycoside or cisplatin toxicity
LOW MAGNESIUM
56
causes of rhabdomyolysis
1. trauma
2. crush injuries
3. immobility
57
initial test rhabdomyolysis
- positive urine dipstick for blood, NO cells
58
most accurate test rhabdomyolysis
urine test for myoglobin
59
labs in rhabdomyolysis
INCREASE CPK
hyperuricaemia
hyperkalaemia
hypocalcemia
60
tx of rhabdomyolysis
1. saline
2. mannitol
3. bicarb
61
need to tx hypocalcemia in rhabdomyolysis
NOOOOO-- it will correct itself
62
at risk of what with rhabdomyolysis
HYPERKALAEMIA--> LIFE THREATENING ARRHYTHMIA-- thus do an EKG
63
any proven therapy to benefit ATN
NOOOO, just have to correct the underlying cause
64
use of diuretics in ATN
DO NOT change the overall outcome
65
wrong answers for tx of ATN
- low dose dopamine
- diuretics
- mannitol
- steroids
66
indications for dialysis when...
RISK OF LIFE THREATENING condition which CANNOT be corrected any other way
67
hypocalcemia an indication for dialysis?
NOOOO-- because it can be corrected with calcium and it D
68
ototoxicity with furosemide based on
TOTAL DOSE and
| HOW FAST its injected
69
prerenal azotemia + cirrhosis
= hepatorenal syndrome
70
blue toe syndrome and lived reticularis
atheroemboli
71
scenario where you would get atheroemboli
catherization-- causes the cholesterol plaques to be broken off
72
urine findings for atheroemboli
EOSINOPHILURIA
73
EOSINOPHILURIA seen in...
- acute (allergic) interstitial nephritis-- EXCEPT NSAID
| - atheroemboli
74
most accurate diagnostic test for atheroemboli
BIOPSY
75
tx for atheroemboli
NONE-- the biopsy doesn't change the management
76
pulses with atheroemboli
NORMAL-- because the emboli are too small to occlude vessels
77
tx of acute interstitial nephritis
usually resolves SPONTANEOUSLY with stopping the drug or controlling the infection
78
if creatinine continues to rise after stopping drug for AIN give...
glucocorticoids
79
analgesic nephropathy causes..
- ATN
- AIN
- membranous glomerulonephritis
- vascular insufficiency
- papilary necrosis
80
triad of symptoms in acute interstitial nephritis
rash
fever
eosinophiluria
81
TWO MAIN symptoms in papillary necrosis
flank pain
| gross hematuria
82
most accurate test in diagnosis of papillary necrosis
CT scan-- shows bumpy contour of interior
83
description of urine in papillary necrosis
necrotic material in urine VISIBLY
84
tx of papillary necrosis
NO TREATMENT
85
MAIN difference between nephrotic and nephritic syndrome
AMOUNT OF PROTEINURIA
86
best initial test for good pastures
anti-GBM ab's
87
most accurate dx for good pastures
BIOPSY
88
tx of good pastures
- plasmapharesis
| - steroids
89
gross hematuria 1-2 days after URTI
synpharyngitis---berger disease/ IgA nephropathy
90
gross hematuria 1-2 WEEKS after URTI
PSGN
91
most accurate test for berger disease
kidney biopsy
92
tx of berger disease
NO TREATMENT PROVEN-- 30% resolve, 40-50%--> ESKD
93
tx of proteinuria in berger disease
ACE inhibitors and steroids
94
biopsy for PSGN
NOOOTTTT routineyl done
95
supportive tx for PSGN
antibiotics and diuretics
96
tx of alports
NOOO specific tx to reverse collagen defect
97
skin findings of PAN
livedo reticular and gangrene
98
MI in young person, or stroke in young person
PAN
99
ANCA in PAN
NOT present in most cases
100
best initial test for PAN
angiography
101
most accurate test for PAN
biopsy
102
tx of PAN
- prednisone
| - cyclophosphamide
103
biopsy in lupus
NOT for dx of lupus, it's to check severity-- FOCUS TREATMENT
104
mild lupus nephritis
steroids
105
severe lupus nephritis
steroids + mycophenolate OR cyclophosphamide
106
tx of renal amyloidosis
melphalan and prednisone
107
Ddx LARGE KIDNEYS
- amyloid
- HIV nephropathy
- PCKD
108
nephrotic syndrome based on....
SEVERITY> cause
109
edema in nephrotic vs. CHF
nephrotic= EVERYWHERE SWOLLEN; where as CHD goes to legs mainly
110
best initial test for nephrotic syndrome
urinalysis-- NOT sufficiently accurate
| albumin:Cr ratio, 5.4:1= 5.4g excreted over 24hrs
111
most accurate test for nephrotic syndrome
RENAL BIOPSY
112
initial tx of nephrotic syndrome
steroids
113
unresponsive to steroids for nephrotic syndrome....
cyclophosphamide
114
control proteinuria in nephrotic syndrome with..
ACE inhibitors/ ARBs
115
edema mgmt in nephrotic syndrome
- salt restriction and diuretics
116
uremia defined as
- met acidosis
- fluid overload
- encephalopathy
- hyperKalaemia
- pericarditis
117
efficacy of peritoneal and hemodialysis
EQUALLY as effective
118
accelerated what in ESKD
atherosclerosis and HTN
119
endocrinopathy in ESKD
anovulatory women
| low testosterone men-- erectile dysfunction
120
death in ESKD
CARDIAC DISEASE X3> mortality than infection
121
tx bleeding in ESKD
DDAVP
122
tx of pruritus in ESKD
UV light and dialysis
123
tx hyperphosphatemia in ESKD
- calcium carbonate/ citrate
- sevelamer
- lanthanum
124
tx of hyperMg in ESKD
RESTRICT-- high Mg foods, laxatives, antacids
125
tx of atherosclerosis in ESKD
dialysis
126
endocrinopathy tx in ESKD
dialysis
| replace-- estrogen and testosterone
127
with what calcium levels do you want to add sevelamer and lanthanum?
HIGH calcium levels, secondary to giving patient vit D
128
aluminum phosphate binders
NEVER NEVER NEVER USED--since cause DEMENTIA
129
living related kidney donor
95% 1 year survival
88% 3 year survival
72% 5 year survival
130
hLA matched kidneys last for
24 YEARS
131
deceased kidney donor
90% 1 ear survival
78% 3 year survival
58% 5 year survival
132
dialysis alone survival
1 and 3 year= variable
| 5 year= 30-40%
133
dialysis + DIABETIC survival
1 and 3 year= variable
| 5 year= 20%
134
HUS E.coli tx
RESOLVES SPONTANEOUSLY
135
what two things don't work in TTP
platelet transfusion (Worsens it) and steroids
136
simple cyst
echo free
smooth, thin
sharp demarcation
good through to back
137
complex--potentially malignant cyst
mixed echogeneticity
irregular thick walls
lower density on back wall
debris in cyst
138
mcc death in ADPCKD
RENAL FAILURE
139
causes of nephrogenic DI
- lithium
- demecloycyline
- chronic kidney disease
- HYPOkalaemia
- HYPERcalcemia
140
nocturia..... first clue to
diabetes insipidus
141
sodium disorders--->
NEURO symptoms
142
potassium disorders-->
MUSCLE/ HEART symptoms
143
hyper-osmolar blood (high Na)
hypo-osmotic urine
hypo-Na urine
diabetes insipidus
144
water deprivation test in diabetes insipidus
urine osmolality stays low
| urine volume stays high
145
response to ADH CDI
yes
146
response to ADH NDI
no
147
ADH level in CDI
low
148
ADH level in NDI
high
149
tx of hypernatremia
1. correct underlying cause of fluid loss
2. CDI: replace ADH= vasopressin= DDAVP
3. NDI: correct K/Ca; STOP Li/demeclo, give thiazide or NSAID if above didn't work
150
severe hypernatremia tx
0.9% saline
151
mild hypernatremia tx
glucose or 0.45% saline
152
causes of hyponatremia divided into
1. hypervolemia
2. hypovolemia
3. euvolemia
153
hypervolemia causes of hyponatremia
CHF
cirrhosis
nephrotic syndrome
154
hypovolaemia causes of hyponatremia
sweating/burns/ pneumonia/ diuretics/diarrhea etc.
BECAUSE-- will be treating with chronic replacement of free water-- thus a little sodium and a lot of water are lost in urine over time-- thus decreasing sodium
ADDISONS
155
euvolaemia causes of hyponatremia
- psychogenic polydipsia
- hyperglycemia
- hypothyroidism
- SIADH
156
slow loss of sodium
asymptomatic
157
quick loss of sodium
seizures
158
SIADH-- urine osmolality
HIGH urine osmolality
159
SIADH--urine sodium
HIGH urine sodium
160
SIADH vs. primary polydipsia
primary polydipsia: low sodium urine, urine osmolality
161
mild hyponatremia
asymptomatic-- restrict fluids
162
moderate hyponatremia
minimal confusion-- saline AND loops
163
severe hyponatremia
lethargy, seizures, coma-- hypertonic saline AND conivaptan, tolvaptan
164
conivaptan, tolvaptan
ADH antagonists
165
SIADH given saline AND....
LOOPS-- must give with loops
166
chronic SIADH tx
demecloycline-- ADH antagonist in kidneys
167
causes of hyperkalaemia divided into...
1. pseudohyperk
2. decreased excretion
3. cellular shifts
168
1. pseudohyperkalaemia
- hemolysis
- repeated fist clenching with tourniquet
- thrombocytosis or leukocytosis
169
2. decreased excretion of K+
- renal failure
- aldosterone decrease:
ACE, RTA 4, K+ sparing drugs, Addisons
170
3. cellular shift of K+--> hyperkalaemia
- tissue destruction: rhabdomyolyis, tumor lysis
- decreased insulin
- beta blockers
- digoxin
- acidosis
- heparin
171
PC hyperkaelamia
paralysis-- severe
- ileus
- weakness
- cardiac rhythm disorders
172
most urgent test in severe hyper K
ECG
173
ECG findings of hyperK
- PEAKED T WAVES
- prolonged Pr
- wide QRS
174
acronym for tx of hyperk
C-BIG-K
175
abnormal ECG/ life threatening hyperK tx
```
CBIG
- calcium chloride or gluconate (protective for heart only)
- bicarb-- esp. if acidosis caused it
- insulin and glucose
[consider dialysis]
```
176
hyperK tx without abnormal ECG
- kayexalate
| - loops
177
kayexalate
removes potassium from body via bowel
178
general causes of hypoK
shift into cells
GI loss
renal loss
179
shift into cells-- hypoK
- insulin
- beta 2 agonists
- alkalosis
180
GI losses of K
- diarrhea
- chronic laxative abuse
- vomiting, NG suction
181
renal losses of K
- loops
- increased aldosterone
- hypoMg
- RTA proximal and distal
182
increased aldosterone
- Conns
- volume depletion
- cushings
- bartters
- licorice
183
EKG findings of hypoK
U waves, and flat T
184
tx of hypoK
oral or IV K (be careful with IV--> may lead to fatal arrhythmia)
185
causes of type 1 RTA
amphotericin
| autoimmune diseases-- SLE or Sjogrens (since can damage the kidneys)
186
risk of what with type 1 RTA
kidney stones and nephrocalcinosis
187
tx of type 1 RTA
replace bicarb
188
urine pH in type 2 RTA
variabel
early: >5.5
later:
189
tx of type 2 RTA
thiazides--> volume depletion--> enhance bicarb reabsorption
190
mcc of type 4 RTA
diabetes
191
tx of type 4 RTA
fludrocortisone
192
RTA vs. diarrhea normal anion gap?
UAG= Na- Cl
193
UAG for RTA
positive
194
UAG for diarrhea
negative
195
normal AG levels
6-12
196
elevated AG levels
greater than 12
197
cause of lactic acidosis
hypotension
| hypoperfusion
198
tx of lactic acidosis
tx of the hypoperfusion
199
cause of ketacidosis
DKA/ starvation
200
test for ketoacidosis
acetone level
201
tx of ketoacidosis
insulin and fluids
202
cause of oxalic acid increase
ethylene glycol OD
203
test for oxalic acid
urinalysis-- crystals
204
tx of oxalic acid increase
fomepizole
| dialysis
205
cause of formic acid increase
methanol ingestion
206
test for formic acid
inflamed retina
207
tx of formic acid
fomepizole
| dialysis
208
what is more precise than respiratory rate
minute ventilation= RR x TV
209
analgesia used in nephrolithiasis
ketorolac= nSAID
210
best imaging for nephrolithiasis
non-contrast CT
211
stone passes spontaneously
less than 5mm
212
stone is 5-7mm what to use, to help them pass
nifedepine and tamsulosin
213
fat malabsorption and kidneys...
INCREASE stone formation
214
stone is between 0.5cm- 2cm, non-obstructive
lithotripsy-- upper half of the ureters
215
stone is LARGE and obstructing
stent placement
216
lower half of the ureters
basket
217
long term tx for nephrolithiasis
THIAZIDES-- hypercalcemia-- thus remove calcium from urine
218
tx for urge incontinence
- bladder training
- local anticholinergic: oxybutinin, tolterodine, solifenacin, dariferancin
- surgical tightening of urethra
219
goal blood pressure in diabetic
140/90mmHg
220
goal blood pressure if over 60yo
150/90
221
routine HTN screening for asymptomatic
- CAD
- CVD
- PAD
- CHF
- visual disturbance
- renal insufficiency
222
bruit in the flank
hypertension
223
PC of HTN if symptomatic
- bruit in flank
| - coarctation of aorta: UL> LL
224
number one/ FIRST tx for HTN
WEIGHT LOSS-- life style modifications for 3-6months before starting on anti-HTN
225
best initial tx for HTN
```
D-ABC
diuretics= thiazides
----
ACE/arb
Beta blocker
CCB
```
226
90% of HTN patients treated with...
2 medications
227
pregnancy and HTN
1st= beta blockers
- CCB
- hydralazine
- alpha methyldopa
228
CAD and HTN
beta blocker
| ACE/ARB
229
BPH and HTN
alpha blockers
230
depression and asthma with HTN
NOOOOOOOOOOOOOO beta blockers
231
hyperthyroidism and HTN
beta blockers
232
osteoporosis and HTN
thiazides
233
hypertensive crisis
HTN+ end organ damage
234
best initial tx for htn crisis
FIRST= LABETALOL...... then nitroprusside (because needs arterial line, thus never FIRST)
235
LOWERING BP IN HTN CRISIS
NOOOOOOOOTTTTTT to normal-- since can provoke a stroke
236
causes of type 2 RTA
- multiple myeloma
- amyloidosis
- fanconi syndrome
- heavy metals
- acetazolamide
