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x Medicine 200 > Renal Step UP > Flashcards

Renal Step UP Flashcards

1
Q

What improves the prognosis of CRF patients?

A

Protein restriction and the use of ACE inhibitors

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2
Q

When do ACE inhibitors actually hurt CRF?

A

When the Cr is >3-3.5

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3
Q

Captopril is a….

A

ACE inhibitor

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4
Q

What doesn’t affect CRF prognosis?

A

Salt restriction and potassium restriction

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5
Q

HIV kidney damage is

A

Collapsing focal and segmental glomerulosclerosis

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6
Q

Typical presentation of focal segmental glomerulosclerosis

A

Nephritic range proteinuria, azotemia, and normal sized kidneys

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7
Q

Nitrites signify what

A

The presence of Enterobacteriaceae

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8
Q

Elderly patient with bone pain, renal failure, and hypercalcemia has

A

Multiple myeloma until proven otherwise

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9
Q

Initial hematuria

A

Urethral damage

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10
Q

Terminal hematuria

A

Bladder/Prostatic damage

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11
Q

Total hematuria

A

Kidney/Ureter damages

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12
Q

Clots and kidney disease

A

Not seen

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13
Q

BPH starts where in the prostate

A

Center

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14
Q

Prostate cancer starts where in the prostate

A

Peripheral

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15
Q

Metformin is bad for what

A

RF, hepatic failure or sepsis, it causes Lactic Acidosis! which RF and HF already make worse

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16
Q

Nephritic syndrome presents with

A

Dependent edema, HTN, hematuria (dysmorphic RBCs and red cell casts). May also see Rash, low-grade fever, and proteinuria.

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17
Q

Workup of BPH starts with

A

Serum Cr and UA

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18
Q

Signs of dehydration

A

Dry Mucosa, higher values for Hct and serum electrolytes, BUN/Cr >20. Use crystalloid

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19
Q

What to do for testing in an old person with irritative voiding symptoms and negative urine culture

A

R/o bladder cancer: e.g. urinary cytology and cystoscopy

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20
Q

Treating recurrent hypercalciuric renal stones

A

Increased fluid intake, sodium restriction, and a thiazide.

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21
Q

Cystinuria presents with

A

H/o recurrent kidney stones from childhood and positive FH. Stones are radiopaque, hexagonal.

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22
Q

Test for cystinuria

A

Urinary cyanide nitroprusside test positive

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23
Q

Most common kidney stones?

A

Calcium oxalate 75-90%

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24
Q

Small bowel disease, surgical resection, or chronic diarrhea can lead to what

A

Calcium oxalate stones from malabsorption of fatty acids and bile salts….???

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25
Q

Acyclovir and the kidney

A

Can precipitate in renal tubules and cause ARF. Prevent with adequate hydration.

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26
Q

Acute pyelonephritis: UCx/BCx or Abx first

A

UCx/BCx before starting Abx

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27
Q

Hodgkin’s lymphoma causes what

A

Minimal change disease: nephrotic syndrome

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28
Q

Most common nephropathy associated with cancer

A

Membranous nephropathy

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29
Q

Renal vein thrombosis and what condition connected

A

Membranous glomerulonephritis: nephrotic syndrome

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30
Q

Most common nephrotic syndrome

A

Membranous glomerulonephritis in adults

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31
Q

Contrast-induced nephropathy risk factors

A

Patients with diabetes and elevated baseline Cr

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32
Q

How to prevent contrast damage

A

IV hydration with isotonic bicarb and acetylcysteine

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33
Q

Most common nephrotic syndrome in blacks

A

FSGS

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34
Q

Nephrotic syndrome in HIV and IV drug abuse

A

FSGS

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35
Q

Fibromuscular disease can present in children?

A

Yes with a bruit or venous hum at CVA. Angiogram reveals string of beads sign.

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36
Q

Signs of diabetic nephropathy

A

Glomerular hyperfiltration is the earliest sign, which also causes the glomerular injury.

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37
Q

The first sign of diabetic nephropathy that can be quantitated

A

Thickening of the glomerular basement membrane

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38
Q

Presence of hematuria in a patient with irritative voiding…

A

Bladder cancer

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39
Q

BPH and hematuria

A

Not related, neither is suprapubic pain and systemic complaints

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40
Q

Most common cause of overflow incontinence in old males

A

Enlarged prostate

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41
Q

What to do when you have isolated proteinuria

A

Dipstick on at least two other occasions

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42
Q

Most common causes of interstitial nephritis

A

Cephalosporins, penicillins, sulfonamides, lasix, NSAIDs, rifampin, phenytoin, allopurinol.

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43
Q

Treatment for drug induced interstitial nephritis

A

Discontinue the drug

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44
Q

Medullary cystic disease presents with

A

Recurrent UTI, renal stones, and contrast filled cysts demonstrated by IVP

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45
Q

Old patients with poor oral intake and NSAIDs, ACEIs, and diuretics can have

A

Prerenal azotemia due to intravascular volume depletion and poor renal perfusion

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46
Q

Causes of acute pericarditis

A

Viral infection (most common), bacterial infections, connective tissue diseases, uremia

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47
Q

How to treat patients with pericarditis and RF

A

Hemodialysis to get rid of the uremia that is causing the pericarditis

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48
Q

Indications for hemodialysis

A

Refractory hyperkalemia, volume overload not responding to diuretics, refractory metabolic acidosis (pH<7.2), uremic pericarditis, uremic encephalopathy or neuropathy, coagulopathy due to renal failure

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49
Q

Treating pericarditis

A

NSAIDs can help, but they are bad in RF

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50
Q

Most common glomerulonephritis

A

IgA nephropathy

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51
Q

IgA Nephropathy presents with

A

Episodes of gross hematuria, beginning 1-3 days after an upper respiratory infection. Serum complement levels are normal.

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52
Q

What to do first in complicated acute pyelonephritis

A

Start empiric antibiotics

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53
Q

Signs of drug induced interstitial nephritis

A

Eosinophiluria, rash, arthralgias, renal failure

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54
Q

MOA of cyclosporine

A

Calcineurin inhibitor

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55
Q

Most common SE of cyclosporine

A

Nephrotoxicity. Most serious as well.

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56
Q

MOA of tacrolimus

A

Calcineurin inhibitor, same as cyclosporine

57
Q

Other SEs of cyclosporine

A

Nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hirsutism, and tremor.

58
Q

Tacrolimus SEs

A

Nephrotoxicity, hyperkalemia, HTN, and tremor

59
Q

Major toxicity of azathioprine

A

Dose-related diarrhea, leukopenia, and hepatotoxicity

60
Q

Major toxicity of mycophenolate

A

bone Marrow suppression

61
Q

Meds that cause hyperkalemia

A

ACEIs, NSAIDs, potassium-sparing diuretics

62
Q

Potassium-sparing diuretics

A

Spironolactone and amiloride

63
Q

Cholesterol embolization

A

Follows surgical or interventional manipulation of the arterial tree. Renal failure, livedo reticularis, systemic eosionphilia, and low complement levels should make you think of cholesterol embolism.

64
Q

Tx of cholesterol embolization

A

Conservative, stop anticoagulation to allow healing of ruptured plaques, steroids don’t help.

65
Q

Tx of contrast-induced nephropathy

A

Hydration, low-osmolality contrast (non-ionic too), limiting amount of contrast. With borderline RF, use prophylactic N-acetylcysteine and fenoldopam (dilates vessels).

66
Q

DM nephropathy and eosinophils

A

NOPE!

67
Q

DM nephopathy time course

A

Takes a long time, rapid decline over months is not diabetes

68
Q

Post-strep glomerulonephritis

A

Nephritic syndrome with strep throat or skin infections. Low complement.

69
Q

Acute Allergic Interstitial Nephropathy signs

A

Rash, RF, eosinophilia, eosinophiliuria (Hansel stain)

70
Q

most common causes of Acute allergic interstitial nephropathy

A

Antibiotics, NSAIDs, Thiazides, Phenytoin, Allopurinol

71
Q

High protein diet and stones

A

Increased risk of calcium stones

72
Q

Recommendations for patients with renal calculi

A
  1. Decreased dietary protein and oxalate.
  2. Decreased sodium intake
  3. increased fluid intake
  4. Increased dietary sodium
73
Q

Tx for uric acid stones

A

Alkalinize the urine with Oral Sodium Bicarb or Sodium Citrate to dissolve the stones

74
Q

Classic triad of Renal cell carcinoma

A

Flank pain, hematuria, and a palpable abdominal renal mass (rare triad tho)

75
Q

Persistent varicocele should make you worry about….

A

RCC

76
Q

RCC can produce what

A

Paraneoplastic conditions like too much erythropoetin.

77
Q

tx of BPH

A

Finasteride or alpha-1 blockers.

78
Q

Finasteride MOA

A

5-alpha reductase inhibitors, acts on epithelial hyperplasia

79
Q

Terazosin MOA

A

Alpha-1 antagonist: Acts on smooth muscle hyperplasia in BPH

80
Q

Collagen predominance in BPH

A

Neither finasteride or alpha-1 blockers work

81
Q

Most common causes of rhabdo

A
  1. Alcoholism. 2. Cocaine use, electrolyte abnormalities (e.g. hypokalemia, hypophosphatemia)
82
Q

signs of rhabdo

A

Positive dipstick blood, no RBCs. Disproportionate elevation of Cr compared to BUN.

83
Q

Tx rhabdo

A

IV hydration and alkalinize the urine, possible osmotic diuresis

84
Q

Rhabdo histology

A

Acute Tubular Necrosis. measure serum CK

85
Q

Cryoglobulinemia presentation

A

Palpable purpura, glomerulonephritis, non-specific systemic symptoms, arthralgias, hepatosplenomegaly, peripheral neuropathy, and hypocomplementemia.

86
Q

What dz makes you think of Cryoglobulinemia

A

Hep C

87
Q

Henoch-Schonlein purpura

A

Childhood, palpable purpura on butt, abd. pain, arthalgias, proteinuria, and hematuria with RBC casts on UA. normal serum complement. No HCV connection.

88
Q

Microscopic Polyangiitis presentation

A

Constitutional symptoms of fever and malaise. Abd. pain, hematuria, with active urinary sediment and purpura. Positive ANCAs. Normal serum complement, serology usually negative.

89
Q

Membranoproliferative glomerulonephritis

A

Nephrotic-range proteinuria and hematuria.

90
Q

Membranoproliferative glomerulonephritis histology

A

Dense intramembranous deposits that stain for C3.

91
Q

Membranoproliferative glomerulonephritis type 2 cause

A

IgG against C3 taht leads to persistent complement activation and kidney damage

92
Q

Goodpasture’s syndrome big sign

A

Anti-GBM antibodies

93
Q

What diseases have immune-complex mediated

A

SLE, post-streptococcal glomerulonephritis

94
Q

cause of idiopathic crescentic glomerulonephritis

A

Cell-mediated injury

95
Q

Definition of Nephrotic syndrome

A

Proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipiedmia, and lipiduria

96
Q

Most common Nephrotic syndrome in adults and kids

A

Adults: Membranous glomerulopathy
Kids: Minimal Change disease

97
Q

Complications of Adult Polycystic Kidney Disease

A

Rupture of brain aneurysm and AAA

98
Q

Pulmonary hemorrhage in what disease

A

Goodpastures and Wegeners

99
Q

Nephrotic syndrome and blood clotting

A

Hypercoagulable: watch for venous or arterial thrombosis

100
Q

Classic findings of amyloidosis

A

Renal amyloid deposits that show apple-green birefringence under polarized light after congo red staining

101
Q

Most common cause of painless hematuria in adults

A

Bladder tumors

102
Q

Post-streptococcal glomerulonephritis presentation

A

hematuria, HTN, red cell casts, and mild proteinuria

103
Q

Goodpasture’s syndrome tx

A

Emergency plasmapharesis

104
Q

Wegener’s granulomatosis tx

A

Cyclophosphamide and steroids

105
Q

Simple renal cysts tx

A

Benign and require no further evaluation. They look very simple and cyst like, anything that looks a little different than a thinly walled globe needs more evaluation.

106
Q

What to do for pyelonephritis that doesn’t respond after 48-72 hrs of appropriate Abx

A

U/S or imaging

107
Q

Pathology of DM nephropathy

A

nodular glomerulosclerosis but diffuse glomerulosclerosis is more common

108
Q

Tx for serious-gram negative infections

A

Aminoglycosides like amikacin which are nephrotoxic

109
Q

Most common cause of priapism

A

Prazosin, but think of trazodone

110
Q

Most common cause of acute epididymitis in young vs. old men

A

Chlamydia and gonorrhea in young men. Gram-negative rods in Older men

111
Q

Non-inflammatory chronic prostatitis presentation

A

Afebrile and irritative voiding

112
Q

Most common cause of abnormal hemostasis in CRF

A

Platelet dysfunction due to uremia

113
Q

Treating uremic coagulopathy

A

DDAVP to release factor VII von Willebrand factor

114
Q

Anemia and ESRD

A

Deficiency of erythropoeitein. Normocytic/normochromic. Most common side effect of giving erythropoetin is HTN, HA, and flu like symptoms

115
Q

HTN nephropathy pathology

A

Arterioslecrotic lesions of afferent and efferent renal arterioles and glomerula capillary tufts

116
Q

Diabetes nephorpathy pathology

A

Increased extracellular matrix, BM thickening, mesangial expansion, and fibrosis

117
Q

How to treat fibromuscular dysplasia

A

percutaneous angioplasty with stent placement.

118
Q

Cause of hepatorenal syndrome

A

Renal vasoconstriction

119
Q

Hepatorenal syndrome tx

A

liver transplantation

120
Q

Analgesic nephropathy presentation

A

Woman with chronic headaches with painless hematuria caused by papillary necrosis.

121
Q

Analgesic nephropathy cause

A

Chronic tubulointerstial damage leading to papillary necrosis

122
Q

Tx acute rejection

A

IV steroids

123
Q

Most common cause of death in dialysis patients

A

CV dz

124
Q

Alport’s syndrome presentation

A

Familial disorder with recurrent gross hematuria and proteinuria. Sensorineural deafness too.

125
Q

Alport’s syndrome pathology

A

Alternating areas of thinned and thickened capillary loops with splitting of the GBM

126
Q

When to suspect Alport’s syndrome?

A

Recurrent hematuria, sensorineural deafness, and FH of RF

127
Q

Preferred treatment for UTIs

A

Oral Bactrim for uncomplicated cystitis

128
Q

UCx for uncomplicated cystitis?

A

Not done

129
Q

Muddy brown granular casts are from

A

ATN

130
Q

RBC casts

A

Glomerulonephritis

131
Q

WBC casts

A

interstitial nephritis and pyelonephritis

132
Q

Fatty casts

A

Nephrotic syndrome

133
Q

Broad and wazy casts

A

Chronic renal Failure

134
Q

What causes diabetic glomerulosclerosis

A

Diabetic microangiopathy

135
Q

Young black male with painless hematuria is

A

Sickle Cell Trait

136
Q

ADPKD signs

A

HTN, hepatic cysts, intracranial berry aneurysms.

137
Q

Hep B infection and nephrotic syndrome

A

Membranous glomerulonephritis

138
Q

Why wouldn’t you be able to pee if you have BPH and pain

A

You can’t valsalva

139
Q

Most common cause of acute bacterial prostatitis in old men

A

e.coli

x Medicine 200 (14 decks)

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