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COMAT - IM > Renal Part 1 > Flashcards

Renal Part 1 Flashcards

1
Q

Pre-Renal AKIs are caused by renal hypo-perfusion. What will the levels of BUN:Cr, Urine Na and FeNa be?

A

BUN:Cr > 20
Urine Na < 20
FeNa < 1%

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2
Q

Pre-Renal AKIs are caused by renal hypo-perfusion. What will the levels of BUN:Cr, Urine Na and FeNa be?

A

BUN:Cr > 20
Urine Na < 20
FeNa < 1%

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3
Q

Post-Renal AKIs are caused by an obstruction distal to the kidneys. What diagnostics should be pursued?

A

US or CT to assess etiology

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4
Q

If a Glomerulonephritis is causing the AKI, what casts will be seen in the urine?

A

RBC casts

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5
Q

What things cause AIN (acute interstitial nephritis)?

A

Infection
Drugs - TMP/SMX, Penicillin, Cephalosporins, NSAIDs, PPIs

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6
Q

If AIN is causing the AKI, what casts will be seen in the urine?

A

WBC casts

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7
Q

If AIN is causing the AKI, what casts will be seen in the urine?

A

WBC casts

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8
Q

In addition to WBC casts, what specific immune cell may or may not be seen in the urine if AIN is causing the AKI?

A

Eosinophils

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9
Q

What things can cause ATN (acute tubular necrosis)?

A

Ischemia
IV contrast

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10
Q

If ATN is causing the AKI, what casts may be seen in the urine?

A

Muddy brown casts

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11
Q

How will a patient present with nephrolithiasis?

A

Unilateral flank pain that radiates to the groin
Hematuria

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12
Q

For a regular patient with kidney stones, what is the diagnostic of choice?

A

NON-contrast CT

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13
Q

In what patients should you consider an US/KUB to assess for kidney stones?

A

Children or pregnant patients

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14
Q

A majority of kidney stones are radiopaque. What type if radio-lucent?

A

Uric acid

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15
Q

Calcium Oxalate stones are due to HIGH levels of?

A

Calcium
Oxalate
Citrate

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16
Q

Lowering dietary _____ can prevent Calcium Oxalate stones (not obvious)

A

Sodium

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17
Q

What causes Struvite kidney stones?

A

UTI with organisms such as Proteus Mirabilis

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18
Q

If you have a Uric Acid stone, what can be given in order to dissolve the stone?

A

K+ Citrate

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19
Q

Stones < ____ will likely pass on their own

A

< 5mm

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20
Q

Stones > ____ need surgery. Stones less than this but larger than 5 mm will need ____

A

> 3cm = surgery
In between 5 mm - 3 cm = Lithotripsy!

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21
Q

If Metabolic Acidosis is present, you will need to calculate the anion gap using what formula?

A

Na - (Cl + HCO3)

22
Q

What level of the anion gap is considered NON-anion gap metabolic acidosis?

A

Anion gap < 12

23
Q

What level of anion gap is considered (+) anion gap metabolic acidosis and what is the pneumonic?

A

Anion gap > 12
MUDPILES

24
Q

MUDPILES

A

Methanol
Uremia
DKA
Propylene glycol
Isopropyl alcohol
Lactic acidosis
Ethylene glycol
Salicylates

25
Q

MUDPILES

A

Methanol
Uremia
DKA
Propylene glycol
Isopropyl alcohol
Lactic acidosis
Ethylene glycol
Salicylates

26
Q

With what etiology of anion gap metabolic acidosis will there be enveloped urine crystals?

A

Ethylene glycol

27
Q

With what etiology of anion gap metabolic acidosis can there also be a respiratory alkalosis?

A

Salicylates

28
Q

RTA type 1 is due to?

A

LOW H+ secretion

29
Q

Urine pH with RTA 1?

A

– due to low H+ secretion = HIGH pH

30
Q

RTA type 2 is due to?

A

LOW HCO3 reabsorption

31
Q

Urine pH with RTA 2?

A

– due to low HCO3 reabsorption = LOW pH

32
Q

RTA type 3 is due to?

A

LOW Aldosterone

33
Q

What metabolic change may be present with RTA 4?

A

HIGH K+ – due to low aldosterone

34
Q

Hypernatremia is usually due to free water loss. What is the treatment?

A

0.9% NaCl (normal saline)

35
Q

If you correct Hypernatremia too quickly, what may result?

A

Cerebral edema

36
Q

What are some things that can cause Hyponatremia?

A

HIGH ADH
Primary polydipsia
Excess solutes
Starvation

37
Q

Treatment of Hyponatremia depends on volume status. State treatment for hypovolemic and hypervolemic?

A

Hypovolemic = Normal saline
Hypervolemic = Diuresis

38
Q

When and only when do you use HYPERTONIC saline (3% NaCl) to treat Hyponatremia?

A

SYMPTOMATIC – seizures/etc.

39
Q

If you correct the hyponatremia too quickly, what may result?

A

Osmotic demyelination

40
Q

With Hyperkalemia, what EKG changes will be present? With Hypokalemia?

A

Hyperkalemia = Peaked T waves and widened QRS
Hypokalemia = U waves following T waves

41
Q

What is the treatment options for Hypokalemia?

A

Replace K+ – oral or IV

42
Q

What is the treatment options for Hyperkalemia?

A
  • Calcium to stabilize heart
  • Insulin + Glucose; Beta agonists; Na+ Bicarb.
  • Kayexalate; Loop diuretics
43
Q

What is the treatment options for Hyperkalemia?

A
  • Calcium to stabilize heart
  • Insulin + glucose; beta agonists; Na+ bicarb.
  • Kayexalate; loop diuretics
44
Q

If low potassium levels or calcium levels are not responding to treatment, what should be checked?

A

Magnesium

45
Q

List PTH effects at bone, kidney and gut

A

Bone: (+) osteoclasts to raise Ca and P
Kidney: (+) Ca reabsorption and P excretion
Gut: (+) Vitamin D to reabsorb Ca and P

46
Q

How may Hypocalceima present?

A

Chvostek or Trousseau sign
Tetany
Perioral tingling

47
Q

Treatment for Hypocalcemia?

A

IV calcium

48
Q

How may Hypercalcemia present?

A

“stones bones groans moans”
- Kidney stones
- Painful bones
- Abdominal groans (constipation)
- Psychiatric groans

49
Q

How may Hypercalcemia present?

A
  • Kidney stones
  • Painful bones
  • Abdominal groans (constipation)
  • Psychiatric groans
50
Q

What is the treatment for Hypercalcemia?

A

IV fluids + bisphosphonates OR calcitonin

COMAT - IM (17 decks)

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