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renal shiz Flashcards

1
Q

nephrotic syndrome associated with:

  • African American or Hispanic
  • obesity
  • HIV
  • heroin use
A

Focal segmental glomerulosclerosis

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2
Q

nephrotic syndrome associated with:

  • adenocarcinoma (solid tumors of breast, lung)
  • NSAIDS
  • Hep B
  • SLE
A

Membranous nephropathy

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3
Q

nephrotic syndrome associated with:

  • Hep B and C
  • lipdystrophy
A

Membranoproliferative glomerulonephritis

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4
Q

nephrotic syndrome associated with

  • NSAIDs
  • lymphoma
  • children
A

Minimal change disease

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5
Q

nephrotic syndrome associated with

-URI

A

IgA nephropathy

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6
Q

dysmorphic red cells

A

glomerulonephritis

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7
Q

red cell casts

A

glomerulonephritis

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8
Q

white cell casts

A

pyleonephritis

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9
Q

eosinophil casts

A

Acute (allergic) interstitial nephritis (except won’t show up with NSAIDs)

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10
Q

hyaline casts

A

dehydration (normal Tamm-horsfall protein)

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11
Q

broad waxy casts

A

chronic renal disease

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12
Q

granular “muddy brown” casts

A

ATN (collections of dead tubular cells)

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13
Q

sudden rise in Cr and BUN

A

Acute Kidney Injury
usually symptomatic but may have N+V, malaise
shortness of breath, edema, and fluid overload
very severe: confusion, arrhythmia from hyperkalemia, pleurtic chest pain from PERICARDITIS

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14
Q

hypoperfusion of kidney
BUN rises more than Cr
BUN:Cr >20:1
urine Na 500mOsm

A

Pre-renal

hypotension systolic

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15
Q

obstruction of urinary system

BUN: Cr >20:1

A

Post-renal
must block BOTH ureters for Cr rise
prostate hypertrophy, stone in ureter, cervica cancer, urethral sricture, neurogenic/atonic bladder, retroperitoneal fibrosis (bleomycin)
usually reversible

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16
Q

BUN:Cr ~10:1
high amount of sodium in urine >20 mEq
high FeNA >1%
low urine osmol

A

Intrinsic renal disease
acute interstiail nephritis (ofte penicillin)
USUALLY Acute Tubular Necrosis (ATN) due to toxins or ischemia
rhabdomyalsis/hemoglobinuria
contrast and NSAIDs
crystals like hyperuricemia, hypercalcemia, hyperoxaluria
Bence-jones proteins from multiple myeloma
post strep infection
Tumor lysis syndrome–>hyperuricemia

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17
Q

urine osmol of >500mOsm

A

high osmol=more concentrated
usually in hypovolemic state
more ADH–>concentrates
(but still expect low urine Na+ becuase aldosterone is preserving to keep up intravasc volume)

18
Q

urine osmol 300mOsm

A

relatively dilute

often in intrinsic renal damage because damage causes loss of ability to concentrate

19
Q

Acute Tubular Necrosis

A 
toxins cause sloughing of tubular cells-->lose Na+ into urine and have dilute urine because cannot concentrate
Tx: reverse underlying cause
-HYDRATE and correct electrolyte abnormalities
-dialysis when:
1. fluid overload
2.encephalopathy
3.pericarditis
4. metabolic acidosis
5. hyperkalemia
20
Q

prevention of contrast induced nephropathy

A

1-2 L normal saline before and during angiography

21
Q

prevent renal failure from tumor lysis syndrome

A

allopurinol, hydration, rasburicase

22
Q

cardiac cath after chest pain–> AKI!, purple lesions on fingers/toes, ocular problems, livedo reticularis
PLUS eosinophils in urine and high in blood

A

atheroemboli all over including to kidney causing AKI

can biopsy skin purple lesions and find cholesterol

no treatment

23
Q

drug causes of acute interstitial nephritis

also cause drug rashes, Stevens-Johnson, TEN, hemolysis!

DO Hansel and Wright stain for eosinophils!!!!!!!!!!!!!!!!!!

A 
eosinophils attack tubular cells
penicillins/cephalosporins
sulfa drugs and diuretics
phenytoin
rifampin
quinolones
allopurinol
proton pump inhibitors

other: SLE, Sjogren, sarcoidosis

24
Q

papillary necrosis

A

sudden onset of flank pain
fever
hamturia
in patient with sickle cell, DM, obstruction, or chronic pyelo AND taking NSAIDs

will look like pyelo

best test= CT showing loss of papillae

no treatment

25
Q

lung and kidney (hematuria, red cell casts, protienuria) problems only
NO upper respiratory

A

Goodpasture
dx: antiglomerular basement membrane antibodies
biopsy kidney or lung (kidney-linear deposits)
tx: plasmapheresis, steroids

26
Q

Asian with gross hematuria 1-2 days after URI

A 
IgA nephropathy/Berger disease
increased IgA in 50%
kidney biopsy
no tx
some resolve, some progress to ESRD
27
Q 
glomerulonephritis 1-2 WEEKS after strep throat r impetigo
cola colored urine
LOW COMPLEMENT levels
periorbital edema
HTN
oluguria
A

post-strep golmerulonephritis

dx: antistreptolysin O titers (ASO titers)
antiDNAse antibody
LOW COMPLEMENT LEVELs

tx: antibiotics as needed, diuretic if fluid overload

28
Q

hearing loss
visual disturbances
PLUS glomerulonephritis

A

Alport syndrome
type IV collagen defect
no tx

29
Q

glomerulonephritis
fever malaise myalgias
all organs BUT NOT LUNGS, skin-GI pain, stroke in young person, gangrene, livedo reticularis
Hep B

A 
Polyarteritis Nodosa
anemia
ESR and CRP elevated 
angiography of area with suspected problem-renal, mesenteric
check for Hep B
tx: prednisone
30
Q

Lupus and the kidney

A

most likely to have membranous glomerulonephritis or glomerulosclerosis
biopsy!!!!!
tx: glucorticoids

31
Q

large kidneys on sonogram

history of rheumatoid arthritis, cancer, Crohns, chronic infection

A

Amyloidosis
biopsy fat pad
green birefringence wit Congo red stain
treat underlying disease

32
Q

nephrotic sydnrome

A

protienuria >3.5 g/24 hours
edema
hyperlipidemia
thrombosis (URINARY LOSS OF PROTEIN C

33
Q

metabolic acidosis with normal anion gap (between 6-12)

A

Renal Tubular Acidosis
diarrhea
Na+ - (Cl- + HCO3-)= anion gap
due to hyperchloremic in each

34
Q

high urine pH above 5.5 plus hyperchloremic and nonanion gap metabolic acidosis
hypokalemic
nephrolithiasis

A

Type I-distal tubule damaged and therefore bicarb not made and acd not excreted–>alkaline urine
test by giving ammonium chloride–>should cause decrease in urine pH as able to excrete acid again (BUT will not happen in distal RTA

damage secondary to SLE, Sjogren, amphotericin

Tx; give more bicarb

high urine pH could also be due to infection with proteus and staghorn calculus

35
Q

intially high urine pH then gradually becomes acidic
nonanion gap metabolic acidosis, hyperchloremic
hypokalemic

A 
bicarb reabsorbed at proximal tubule normally
proximal RTA (type II) damage due to amyloid, myeloma, Fanconi, acetazolamide, heavy metals

deplete bicarb until urine acidic (osteomalacia

test: give bicarb and see if able to resabsorb–>type II if urine becomes alkaline
tx: deplete volume with thiazide diuretic to increase bicarb reabsorption

36
Q

persistently high urine sodium in spite of sodium depleted diet
hyPERkalemic
urine pH

A

Type IV RTA-hyporeninemia, hypoaldo
decreased amount or effect of aldosterone–>hyperkalemia, hyponatremia, retain hydrogen ions

tx: fludrocortisone to replace aldosterone

37
Q

urine anion gap

A

urine sodium minus urine chloride
distinguish between diarrhea and RTA as cause of NONANION GAP METABOLIC ACIDOSIS

RTA= positive urine anion gap
diarrhea=negative urine anion gap

38
Q

Elevated anion gap metabolic acidosis

Na+ - (Cl- + HCO3-) = greater than 12

A 
lactate in hypotension/hypoperfusion
ketoacids in DKA/starvation
oxalic acid in ethylene glycol OD
formic acid in methanol OD
uremia in renal failure
salicylates in aspirin OD
39
Q

increased serum pH
slight increase in pCO2
increased bicarb

A

metabolic alkalosis-always with resp compensation increasing pCO2

40
Q

stones with gout or tumor lysis

A

uric acid stones- require CT due to not visualized on x-ray

41
Q

hypertensive crisis!!

A

htn w/ end organ damage
tx: labetalol
or nitroprusside

step 2 (11 decks)

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