Renal Part 1 Flashcards
Pre-Renal AKIs are caused by renal hypo-perfusion. What will the levels of BUN:Cr, Urine Na and FeNa be?
BUN:Cr > 20
Urine Na < 20
FeNa < 1%
Pre-Renal AKIs are caused by renal hypo-perfusion. What will the levels of BUN:Cr, Urine Na and FeNa be?
BUN:Cr > 20
Urine Na < 20
FeNa < 1%
Post-Renal AKIs are caused by an obstruction distal to the kidneys. What diagnostics should be pursued?
US or CT to assess etiology
If a Glomerulonephritis is causing the AKI, what casts will be seen in the urine?
RBC casts
What things cause AIN (acute interstitial nephritis)?
Infection
Drugs - TMP/SMX, Penicillin, Cephalosporins, NSAIDs, PPIs
If AIN is causing the AKI, what casts will be seen in the urine?
WBC casts
If AIN is causing the AKI, what casts will be seen in the urine?
WBC casts
In addition to WBC casts, what specific immune cell may or may not be seen in the urine if AIN is causing the AKI?
Eosinophils
What things can cause ATN (acute tubular necrosis)?
Ischemia
IV contrast
If ATN is causing the AKI, what casts may be seen in the urine?
Muddy brown casts
How will a patient present with nephrolithiasis?
Unilateral flank pain that radiates to the groin
Hematuria
For a regular patient with kidney stones, what is the diagnostic of choice?
NON-contrast CT
In what patients should you consider an US/KUB to assess for kidney stones?
Children or pregnant patients
A majority of kidney stones are radiopaque. What type if radio-lucent?
Uric acid
Calcium Oxalate stones are due to HIGH levels of?
Calcium
Oxalate
Citrate
Lowering dietary _____ can prevent Calcium Oxalate stones (not obvious)
Sodium
What causes Struvite kidney stones?
UTI with organisms such as Proteus Mirabilis
If you have a Uric Acid stone, what can be given in order to dissolve the stone?
K+ Citrate
Stones < ____ will likely pass on their own
< 5mm
Stones > ____ need surgery. Stones less than this but larger than 5 mm will need ____
> 3cm = surgery
In between 5 mm - 3 cm = Lithotripsy!
If Metabolic Acidosis is present, you will need to calculate the anion gap using what formula?
Na - (Cl + HCO3)
What level of the anion gap is considered NON-anion gap metabolic acidosis?
Anion gap < 12
What level of anion gap is considered (+) anion gap metabolic acidosis and what is the pneumonic?
Anion gap > 12
MUDPILES
MUDPILES
Methanol
Uremia
DKA
Propylene glycol
Isopropyl alcohol
Lactic acidosis
Ethylene glycol
Salicylates
MUDPILES
Methanol
Uremia
DKA
Propylene glycol
Isopropyl alcohol
Lactic acidosis
Ethylene glycol
Salicylates
With what etiology of anion gap metabolic acidosis will there be enveloped urine crystals?
Ethylene glycol
With what etiology of anion gap metabolic acidosis can there also be a respiratory alkalosis?
Salicylates
RTA type 1 is due to?
LOW H+ secretion
Urine pH with RTA 1?
– due to low H+ secretion = HIGH pH
RTA type 2 is due to?
LOW HCO3 reabsorption
Urine pH with RTA 2?
– due to low HCO3 reabsorption = LOW pH
RTA type 3 is due to?
LOW Aldosterone
What metabolic change may be present with RTA 4?
HIGH K+ – due to low aldosterone
Hypernatremia is usually due to free water loss. What is the treatment?
0.9% NaCl (normal saline)
If you correct Hypernatremia too quickly, what may result?
Cerebral edema
What are some things that can cause Hyponatremia?
HIGH ADH
Primary polydipsia
Excess solutes
Starvation
Treatment of Hyponatremia depends on volume status. State treatment for hypovolemic and hypervolemic?
Hypovolemic = Normal saline
Hypervolemic = Diuresis
When and only when do you use HYPERTONIC saline (3% NaCl) to treat Hyponatremia?
SYMPTOMATIC – seizures/etc.
If you correct the hyponatremia too quickly, what may result?
Osmotic demyelination
With Hyperkalemia, what EKG changes will be present? With Hypokalemia?
Hyperkalemia = Peaked T waves and widened QRS
Hypokalemia = U waves following T waves
What is the treatment options for Hypokalemia?
Replace K+ – oral or IV
What is the treatment options for Hyperkalemia?
- Calcium to stabilize heart
- Insulin + Glucose; Beta agonists; Na+ Bicarb.
- Kayexalate; Loop diuretics
What is the treatment options for Hyperkalemia?
- Calcium to stabilize heart
- Insulin + glucose; beta agonists; Na+ bicarb.
- Kayexalate; loop diuretics
If low potassium levels or calcium levels are not responding to treatment, what should be checked?
Magnesium
List PTH effects at bone, kidney and gut
Bone: (+) osteoclasts to raise Ca and P
Kidney: (+) Ca reabsorption and P excretion
Gut: (+) Vitamin D to reabsorb Ca and P
How may Hypocalceima present?
Chvostek or Trousseau sign
Tetany
Perioral tingling
Treatment for Hypocalcemia?
IV calcium
How may Hypercalcemia present?
“stones bones groans moans”
- Kidney stones
- Painful bones
- Abdominal groans (constipation)
- Psychiatric groans
How may Hypercalcemia present?
- Kidney stones
- Painful bones
- Abdominal groans (constipation)
- Psychiatric groans
What is the treatment for Hypercalcemia?
IV fluids + bisphosphonates OR calcitonin
