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Step2CK > Renal step Up > Flashcards

Renal step Up Flashcards

1
Q

adverse of acetazolamide

A

mild metabolic acidosis, hypoK

nephrolithiasis

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2
Q

adverse of osmotic diuretics

A

no effect on Na excretion, hyponatremia followed by hyper

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3
Q

side effects of loops

A

ototoxicity, hyperuricemia, hypoK and hypoCa

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4
Q

side effects thiazides

A

hypoK
hypoNa
hyperuricemia
hypercalcemia

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5
Q

side effects K sparind diuretics

A

hyperkalemia, gynecomastia, menstrual irregularty

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6
Q

what scenarios do you use aldosterone antagonists

A

hyperaldosteronism, CHF
post MI
cirrhosis
acne and PCOS(spironolactone only)

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7
Q

cause of calcium oxalate stones

A

idiopathic hypercalciuria

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8
Q

cause of struvite stones

A

UTI(urease + bacteria)
more common in women
staghorn

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9
Q

what cuases Ca phosphate kidney stones

A

hyper PTH and RTA

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10
Q

what causes uric acid stones

A

chemo drugs, gout

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11
Q

what causes cystine kidney stones

A

cystinuria and aa transport defects

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12
Q

what are the radiolucent stones

A

uric acid

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13
Q

what occurs in those with polycystic kidney disease

A

subarachnoid

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14
Q

Tx ADPKD

A

ADH antagonists, amiloride
Tx HTN
pain control’dialysis or transplant

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15
Q

complications of polyscystic kidney disease

A

ESRD, heptic cysts, intracranial aneurysms, subarachnoid hemorrhage, MVP

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16
Q

What malignancies cause increased EPO

A

RCC
hepatocellular carcinoma
pheo
hemangioblastoma

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17
Q

what is risk factor for RCC

A

tobacco smoking, cadmium exposure and asbestos exposure

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18
Q

labs in renal cell carcinoma

A

polycytehmia from increased EPO

UA shows hematuris

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19
Q

Tx RCC

A

surgicallyr esect

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20
Q

Acute interstitial nephritis

A

damage to renal tubules or parenchyma

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21
Q

what meds can cause acute interstitial nephritis

A

beta lactams, sulfonamides, aminoglycosides, NSAIDs, allopurinol, PPIs, diuretics

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22
Q

signs Sx for acute interstitial nephritis

A

nausea, vomitnig, malaise and fever and rash

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23
Q

labs in acute interstitial nephritis

A

increased Cr. UA show granular or epithelial casts.

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24
Q

What is Acute tubular necrosis

A

progressive damage or renal tubules, acute or chronic renal failure, renal papillary necrosis, eSRD

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25
Q

Post infectious glomerulonephritis cause and Sx

A

GAS

recent infection, oligouria, edema, brown urine and HTN

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26
Q

labs for POst strep glomerulonephritis

A

hematuria, proteinuria
high ASO
subepithelial humps of IgG and C3 on BM

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27
Q

Tx psot strep gloemrulonephritis

A

supportive. dec edema and HTN

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28
Q

Sx IgA nephropathy

A

hematuria, flank pain, low grade fever

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29
Q

labs in AgA nephropathy

A

increased IgA, mesangial cell prolifeation

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30
Q

Tx IgA nephroapthy

A

ACEI and statins for proteinuria

corticosteroid if have nephrotic syndrome

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31
Q

signs goodpastures

A

dyspnea, hemopthysis, myalgias, hematuria

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32
Q

labs in goodpastures

A

serum IgG anti BM Ab, anemia, pulm infiltrates

linear IgG Ab on glomeruli

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33
Q

Tx goodpastures

A

plasmapheresis, corticosteroids, immunosuppressants

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34
Q

signs of alport syndrome

A

hematuria, Sx renal failure, hearing los s(high freq)

cataracts, lenticonus

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35
Q

labs in alport

A

RBC casts, hematuria, proteinuria and pyuria

split basement membrane

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36
Q

Sx of rapidly progressive crescenteric glomerulonephrtiis

A

sudden renal failure, weakness, nausea, weight loss, dyspnea, hemoptysis, myalgias, fever, oliguria

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37
Q

labs in RPGN

A

inflammatory cells deposition and fibrous material in bowman capsule
crescent formation
ANCA +

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38
Q

Sx lupus nephritis

A

HTN, renal failure

nephrotic syndrome

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39
Q

labs in lupus nephritis

A

ANA, anti DNA Ab

hematuria and possible proteinuria

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40
Q

cANCA

A

wegeners

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41
Q

minimal change disease Sx

A

HTN, increased infections.

in children

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42
Q

labs in minimal change

A

hyperlipidemia, hypoalbuminemia, proteinuria

flattening BM from loss of foot processes

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43
Q

Tx minmal change

A

corticosteroids and cytotoxic agents

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44
Q

Sx focal segmental glomerular sclerosis

A

HTN

common in blacks and latinos in US(most common cause of nephrotic syndrome)

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45
Q

labs in FSGS

A

hyperlipidemia, hypoalbuminemia, hematuria, high proteinuria

sclerotic changes

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46
Q

Sx membranous nephropathy

A

edema, dyspnea Hx infection or medication use

assoc with Hep B and C

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47
Q

labs in membranous nephropathy

A

hyperlipidemia, hypoalbuminemia, proteinuria

spike and dome on BM thickening

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48
Q

which renal pathology requires anticoagulation sometimes

A

membranous nephropathy when cause renal vein thrombosis

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49
Q

what are Sx membranoproliferative GN

A

edema
HTN
Hx infeciton or autoimmune
gradual prgression to renal failure

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50
Q

labs in MPGN

A

hyperlipidemia, hypoalbuminemia, hypoclomentemia, proteinuria and hematuria
IgG deposits
BM with train track double layer

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51
Q

labs in diabetic nephropathy

A

kimmelstiel wilson nodules (in nodular type)

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52
Q

labs of amyloidosis causing renal issues

A

elevated Cr
proteinuria
congo red stain show apple green birefringence

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53
Q

Fractional excretion Na

A

prerenal

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54
Q

BUN/Cr >20

A

pre renal

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55
Q

Sx signs of chronic kidney disease

A

gradual development or peripheral neuropathy, brownish skin

changes in mental status, HTN, pericarditis, anorexia, nausea vomiting, GI bleeding

56
Q

labs in chronic kidney disease

A 
increased K
low Na
increased phosphate
decreased Ca
anemia
metabolic acidosis
increased BUN and Cr
urine osmolality similar to serum
57
Q

complications CKD

A

ESRD
renal osteodystrophy from low serum Ca
encephalopathy
severe anemia (dec epo)

58
Q

indications for dialysis

A

severe hyperK, severe metabolic acidosis, fluid overload
uremic syndrome
Cr>12 and BUN >100

59
Q

Renal tubular acidosis has what anion gap

A

no anion gap!!! trick question

60
Q

type I RTA

A

distal

impaired H secretion causing secondayr hyperaldosteronisms

61
Q

what causes type I RTA

A

idiopathic, autoimmune, drugs, chronic infeciton, nephrocalcinosis, cirrhosis, SLE, obstructive nephropathy

62
Q

labs in type I RTA

A

urine pH >5.3
low K in serum with variable HCO3
possible stones

63
Q

type II RTA

A

HCO reabsorption problem in proximal tubule

64
Q

cause of type II RTA

A

idiopathic, MM, fanconi, wilson, amyloid, vit D def, autoimmune

65
Q

labs in type II RTA

A
66
Q

Type IV RTA

A

low renin/aldosterone from primary or secondary hypoaldosteronism

67
Q

cause of type IV RTA

A

primary renin or aldosterone deficiency, DM, addison, sickle cell
interstitial disease

68
Q

labs in IV RTA

A
69
Q

Tx type IV RTA

A

fludrocortisone, K restriction

70
Q

normal anion gap

A

8-12

71
Q

normal anion gap suggests what

A

HCO3 loss

72
Q

increased anion gap acidosis

A

H+ excess

73
Q

causes of high anion gap acidosis

A 
Methanol, Uremia, Diabetic Ketoacidosis
Propylene glycol
Isoniazid/Iron
Lactic acidosis
Ethylene glycol
salicylates
74
Q

Sx hypernatremia

A

oliguria, thirst, weakness, lethargy, decreased consciousness, mental status changes, seizures

75
Q

tx hypernatremia

A

gradual hydration with normal saline

76
Q

how to rehydrate in hypernatremia

A

half of water deficit in first 24 hours and second half over 24-48 hours

77
Q

rapid hydration of hypernatremia leads to

A

cerebral edema

78
Q

What can cuase central DI

A

failure of post pituitary to release ADH

can be from idiopathic cause, cerebral trauma, pituitary tumors, hypoxic encephalopathy or anorexia nervosa

79
Q

causes of nephrogenic DI

A

hereditary renal disease
lithium toxicity
hyperCa
hypoK

80
Q

what causes psuedohyponatremia

A

artificat of hyperlipidemia

81
Q

What causes hyponatremia

A

renal H2O retention from CHF, SIADH, thiazide diuretics, hyperglycemia or high fluid intake

82
Q

signs hypoNa

A

confusion, nausea, weakness, decreased consciousness

83
Q

complications hypoNa

A

CNS damage

84
Q

what occurs if you correct hypoNa to quickly

A

central pontine myelinolysis

85
Q

Tx hypoNa

A

salt administration, H2O restriction

86
Q

what can cause SIADH

A

CNS pathology, sarcoid, paraneoplastic syndromes, psychiatric drugs, major surgery, pneumonia, HIV

87
Q

what causes pseudohyperK

A

RBC hemolysis from blood collection

so measure K immediately after transfusion

88
Q

what can cause hyper K

A

metabolic acidosis, aldosterone def, tissue breakdown, insulin deficiency, adrenal insufficiency, renal failure, K sparing diuretics

89
Q

Sx hyperkalemia

A

weakness, nausea, vomiting, arrhythmias, paralysis or paresthesia in severe cases

90
Q

ECK hyperkalemia

A

tall peaked T waves

91
Q

Tx hyperkalemia

A

Ca gluconate
NaHCO3, glucose with insulin to encourage K uptake
Na polystyrene sulfonate binds K

92
Q

what can cause hypokalemia

A

metabolic respiratory alkalosis, hypothermia, vomiting, diarrhea, hyperaldosteronism, insuline excess, K wasting diuretics, RTA I II

93
Q

signs hypoK

A

fatigue, weakness, paresthesias or paralysis, hyporeflexia, arrhythmias

94
Q

EKG hypoK

A

T wave flattening, ST depression, U waves

95
Q

which Vitamins can cause hyperCa

A

Vit A overload and Vit D overload

96
Q

EKG with hyperCa

A

shortened QT interval

97
Q

familial hypocalciuric hypercalcemia

A

disorder of Ca sensing R

98
Q

EKG hypoCa

A

prolonged QT

99
Q

effect of thiazides on Ca

A

Ca sparing

100
Q

next step in man with suspected UTI

A

perform workup for STIs

101
Q

urge incontinence is from

A

detrusor overactivity

102
Q

Tx urge incontinence

A

antimuscarinics like oxybutynin or tolterodine or solifenacin and bladder training

103
Q

cause of stress incontinence

A

inc abdominal P and decrease anatomic support and funciton of sphincter

104
Q

cause of overflow incontinence

A

incomplete bladder emptying
more commin in men
from impaired detrusor, BPH, neurogenic bladder

105
Q

Tx overflow incontinence

A

decompress bladder with foley

106
Q

common bladder CA

A

transitional cell

107
Q

risk factors for bladder cancer

A

tobaccon, schistosomiasis, cyclophosphamide, aniline dyes, petroleum byproducts, recurrent UTI
male >female

108
Q

signs Sx bladder cancer

A

painless gross hematuria, suprapubic pain, frequency, dysuria and urgency

109
Q

cause of urethritis

A

N gonn

C tracho

110
Q

signs of urethritis

A

burning, purulent discharge, dysuria, frequency and urgency

111
Q

Tx urethritis

A

single dose ceftriaxone with doxy or azithromycin

treat sexual partners

112
Q

Tx prostatitis

A

TMP SMX for 4-6 weeks

113
Q

where does BPH occur in prostate

A

central area

114
Q

signs Sx BPH

A

urinary hesitancy, straining, weak or intermittent stream, dribbling, frequency, urgency, nocturia and overflow incontinence

115
Q

Tx for BPH

A

a1 blockers(terazosin)
5alpha reductase inhibitors like finasteride
TURP

116
Q

where does prostate cancer arise

A

adenocarcinoma in peripheral zone

117
Q

risk factors prostate CA

A

increased age, FMH, high fat diet and prostatitis

118
Q

supporting the scotrum relieves pain in what

A

epididymitis

119
Q

what causes epididymitis

A

prostatitis, STDs(chlamydia), urinary reflux

120
Q

Tx epididymitis

A

ceftriaxone and doxy or fluoroquinolone, NSAIDs

121
Q

what twists in testicular torsion

A

spermatic cord

122
Q

testes displaced superiorly

A

testicular torsion

123
Q

Tx testicular torsion

A

emergen surgical reduction

124
Q

complications of testicular torsion

A

testicular ischemia or infarction

125
Q

types of testicular cancer

A

germ cell (seminomatous, nonseminomatous) or stromal cell (leydig, sertolie or granulosa cell)

126
Q

signs of testicular cancer

A

painless testicular mass, gynecomastia, low abdomen pain

GI or pulm Sx

127
Q

labs for testicular CA

A

increased bhCG, and increased alpha fetoprotein in germ cell tumors, increased estrogen in stromal cells

128
Q

Tx for seminoma

A

radical orchiectomy

129
Q

Tx nonseminomas

A

radical orchiectomy

130
Q

most common CA in men between 15 and 35

A

testicular CA

131
Q

labs in impotence

A

dec testosterone sometimes
dec LH sometimes
increased prolactin possible

132
Q

wilms tumor

A

renal malignant tumor in children

133
Q

signs wilms tumor

A

weight loss, nausea, vomiting, dysuria, polyuria, palpable abdominal or flank mass, HTN, fever

134
Q

Tx wilms tumor

A

resection, chemo and possible radiation

135
Q

Tx cryptorchidism

A

exogenous hCG, orchioplexy before age 5 to reduce risk CA

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