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BOARD PREP > Renal II > Flashcards

Renal II Flashcards

1
Q

Acidosis of any kind can lead to what electrolye imbalance?

A

hyperkalemia

b/c cells are exchanging K for H ions to increase pH

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2
Q

What is the form of pH imbalance if the pH & bicarb move in the same direction?

If they move in opposite directions?

A

same: metabolic
opposite: respiratory

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3
Q

What is Winter’s formula?

A

calculates expected CO2 in metabolic acidosis

pCO2 = 1.5(HCO3-) + 8+/-2

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4
Q

What is the equation to determine the expected pCO2 in metabolic alkalosis?

A

increse in pCO2 0.7mmHg per 1.0meq/L increase in [HCO3-]

delta pCO2 = 0.7 * (delta[HCO3-])

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5
Q

Why does aspirin overdose initially cause respiratory alkalosis?

A

stimulates the medulla

leads to hyperventilation

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6
Q

What are the risk factors for uric acid kidney stone formation?

A

increased uric acid excretion (gout, myeloproliferative disorders)

increased urine concentration (hot + arid climates, dehydration)

low urine pH (chronic diarrhea, metabolic syndromes/DM)

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7
Q

typical presentation of renal tubular acidosis?

A

low [HCO3-] and abnormal K+

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8
Q

What is a type II tubular acidosis?

Seen in what conditions?

A

defect in proximal tubule HCO3- resorption

Fanconi Syndreom

Multiple myeloma

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9
Q

general bicarb levels for type II, I, and IV renal tubular acidosis?

A

II: 12-20

I: <10

IV: >17

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10
Q

What is type I renal tubular acidosis?

Presentation?

Associated w/ what conditions?

A

impaired acidification of urine by distal nephron

alkaline urine & chronic kidney stones

rickets (d/t suppressed calcium resorption) & growth failure in childen

autoimmune diseases (Sjogren’s, rheumatoid arthritis), amphotericin B

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11
Q

How do you calculate the urinary anion gap?

A

UAG = Na + K - Cl

(shoudl be negative in acidosis w/ functioning kidneys)

positive in RTA type I and type IV

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12
Q

What is a type IV renal tubular acidosis?

Symptom?

Associated conditions?

Treatment?

A

distal tubule fails to respond to aldosterone (deficiency or resistance) - decreased NH4 excretion, loss of urinary buffering and causes decreased urine pH + hyperkalemia

low renin activty, decreased aldosterone production, diabetes, NSAIDS

treatment: fludrocortisone

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13
Q

What are the causes of intracellular translocation hypokalemia?

A

insulin

B-adrenergic activity (drugs / stress)

alkalosis

increased cell reproduction

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14
Q

What is the difference in osteoporosis caused by aging vs. primary hyperparathyroidism?

A

aging: mainly affects trabecular bone

PHPT: mainly affects cortical bone

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15
Q

What cells in the kidney produce erythropoietin?

A

peritubular fibroblasts in the interstitial cortex

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16
Q

What is the treatment for infants with nephrogenic diabetes insipitus?

A

frequent water supplementation & thazide diuretics

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17
Q

What is one of the earliest counterregulators for maintaining appropriate phosphate levels in patients with chronic kidney disease?

A

inhibits synthesis of 1,25-dihydroxyvitamin D

suppresses renal sodium/phosphate cotransporter IIa

(net effect is to greater elimination of phosphate)

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18
Q

What is the pentad of symptoms for thrombotic microangiopathy?

A

fever, neurologic symptoms, renal failure, anemia, and thrombocytopenia w/ schistocytes

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19
Q

Why are patients on dialysis predisposed to developing intravascular calcifications?

A

hyperphosphatemia & hypercalcemia (iatrogenic)

chronic inflammation

atherosclerosis

20
Q

Describe the histology of renal cell carcinoma

A

cuboid or polygonal cells w/ abundant, clear cytoplasm

branching “chicken wire” vasculature

21
Q

What is the pneumonic associated with anion gap metabolic acidosis?

A
  • M - methanol
  • U - uremia
  • D - diabetic ketoacidosis
  • P - propylene glycol
  • I - iron tablets or INH
  • L - lactic acidosis
  • E - ethylene gycol
  • S - salicylates
22
Q

key features of methanol induced acidosis?

metabolized into?

A

confusion, vision loss, coma

formic acid

23
Q

key features of ethylene glycol nduced acidosis?

metabolized into?

A

kidney toxins

glycolate (toxic to renal tubules) & oxalate (precipitates calcium oxalate crystals)

24
Q

key features of propylene glycol nduced acidosis?

metabolized into?

A

CNS depression

metabolized into pyrivic acid, acetic acid, lactic acid

25
Q

What is likely the substance ingested if it is an industrial solvent that causes non-ion gap acidosis?

A

isopropyl alcohol

26
Q

What are the classic causes of lactic acidosis?

A

shock (decreased tissue perfusion)

ischemic bowel

metformin therapy

seizures

27
Q

Symptoms of initial iron poisoning? Later? Weeks later?

A
  • 0-6 hrs
    • abdominal pain
  • 24 hrs
    • cardiovascular toxicity (shock)
    • coagulopathy
    • hepatic dysfunction
    • acute lung injury
    • anion gap metabolic acidosis (from ferric ions)
  • Weeks later
    • GI obstruction d/t scarring
28
Q

key features of isoniazid induced anion gap acidosis?

A

seizures (status epilepticus)

lactic acidosis

29
Q

Key features of aspirin overdose?

A
  • shortly after ingestion
    • respiratory alkalosis (stimulted the medulla & lead to hyperventilation)
  • house after ingestion
    • anion gap metabolic acidosis
      • uncouple oxidative phosphorylation
      • accumulation of pyruvate, lactate, ketoacids
30
Q

What conditions can cause a low anion gap acidosis?

A

hypoalbuminemia

multiple myeloma

31
Q

Signs & symptoms of hyperkalemia?

A
  • arrhythmia
    • sinus arrest
    • AV block
  • muscle weakness (can lead to paralysis)
    • lower extremities -> trunk -> upper extremities
  • EKG changes
    • peaked T waves
    • QRS widening
32
Q

Causes of increased K released from cells?

A

acidosis

insulin deficiency

beta blockers

digoxin

lysis of cells (tumor lysis syndrome)

hyperosmolarity

33
Q

Signs & symptoms of hypokalemia?

A
  • arrhythmias
    • PAC, PVC
    • bradycardia
  • muscle weakness (leading to paralysis)
    • lower extremity -> trunk -> upper extremity
  • EKG changes
    • u waves
    • flattened T waves
34
Q

Common cuases of hypokalemia?

A
  • increased renal losses
    • diuretics, type I/II RTA
  • increased GI loss
    • vomit / diarrhea
  • increased K entry into cells
    • hyperinsulinemia states
    • beta agonist: albuterol, terbutaline, dobutamine
    • alkalosis
  • hypomagnesemia
    • promote urinary K loss
    • cannot correct K until Mg is corrcted
35
Q

Signs / symptoms hypercalcemia?

A
  • often asymptomatic
  • recurrent kidney stones
  • “stones, bones, groans & psychiatric overtones”
  • acute hypercalcemia
    • polyuria (nephrogenic diabetes insipidus)
36
Q

Common causes of hypercalcemia?

A

hyperparathyroidism

malignancy

hypervitaminosis D (sarcoidosis)

milk alkali syndrome

37
Q

Signs / symptoms hypocalcemia?

A
  • tetany
    • muscle twitches (calcium blocks Na channels in neurons)
    • Trousseau’s sign
      • hand spasm w/ BP cuff inflation
    • Chvostek’s sign
      • facial contraction w/ tapping on nerve
  • seizures
38
Q

Common causes of hypocalcemia?

A

hypoparathyroidism

renal failure

pancreatitis

magnesium (hypo / hyper)

39
Q

Common causes of hyperphosphatemia?

A

acute & chronic kidney disease

hypoparathyroidism

huge phosphate load (tumor lysis syndrome, rhabdomyolysis, large amount of phosphate laxative)

40
Q

Signs/symptoms hyperphosphatemia?

A
  • most are asymptomatic
  • signs + symptoms usually from hypocalcemia
    • phosphate precipitate serum calcium
    • metastatic calcifications
      • vascular wall calcifications
      • painful nodules / skin necrosis
41
Q

Signs & symptoms of hypophosphatemia?

A

weakness (ATP depletion) - often presents as respiratory muscle weakness

if chronic: bone loss, osteomalacia

42
Q

common causes of hypophosphatemia?

A
  • primary hyperparathyroidism
  • diabetic ketoacidosis
  • refeeding syndrome
    • low PO4 from poor nutrition
    • food intake -> metabolism -> further decrease PO4
  • antacids
  • urinary wasting (Fanconi syndrome)
43
Q

Signs / symptoms hypomagnesemia?

Cause?

A
  • Mg blocks Ca & K
  • neuromuscular toxicity
    • decreased reflexes, paralysis
  • bradycardia, hypotension, cardiac arrest
  • hypocalcemia (inhibits PTH secretion)

renal insuficiency

44
Q

Signs & symptoms hypomagnesemia?

A
  • neuromuscular excitability
    • tetany, tremor
  • cardia arrhythmia
  • hyopcalcemia
  • hypokalemia
45
Q

common causes hyopmagnesemia?

A
  • GI losses
    • diarrhea
  • pancreatitis
  • renal losses
    • loop & thiazie diuretics
    • alcohol abuse
  • drus
    • omeprazole (impaired absorption)
    • foscarnet

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