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Internal Medicine > Renal System > Flashcards

Renal System Flashcards

1
Q

Causes of Acute Tubular Necrosis

A

Causes leading to ischemic damage or toxin exposure: IV consrast, Myoglobin 2/2 crush injury, Aminoglycosides, Lead, Cisplatin, Hemoglobinuria

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2
Q

Cast seen with Acute Tubular Necrosis

A

Muddy brown cast

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3
Q

PPX for ATN 2/2 IV contrast

A

Vigorous hydration and N-acetyl-cysteine

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4
Q

Major Causes of AIN

A

Causes leading to pseudo-allergic rxn:

1) Drugs (TMP-SMX, PCNS, Cephalosporins, Rifampin)
2) Infections (Pyelonephritis)
3) Deposition Disease (Sarcoid, Amyloid)

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5
Q

Cast seen with AIN

A

White cell casts + eosinophils

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6
Q

Causes of papillary necrosis

A

1) S - Sickle Cell trait/Disease
2) A - Acute pyelonephritis
3) A - Analgesics (NSAIDs)
4) D - Diabetes

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7
Q

Common causes of respiratory acidosis

A

COPD, asthma, drugs (e.g. opioids, benzodiazepines, barbiturates, alcohol), chest wall problems (paralysis, pain), sleep apnea

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8
Q

Common causes of metabolic acidosis

A

Ethanol, diabetic ketoacidosis, uremia, lactic acidosis (e.g. sepsis, shock, bowel ischemia), methanol/ethylene glycol, aspirin/salicylate overdose, diarrhea and carbonic anhydrase inhibitors

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9
Q

Common causes of respiratory alkalosis

A

Anxiety/Hyperventilation and aspirin/salicylate overdose

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10
Q

Common causes of metabolic alkalosis

A

Diuretics (except CA inhibitors), vomiting, volume contraction, antacid abuse/milk-alkali syndrome, hyperaldosteronism

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11
Q

Presentation of aspirin overdose

A

Tinnitus, hypoglycemia, vomiting, h/o swallowing pills, metabolic acidosis + respiratory alkalosis

Tx: Alkalinization of urine with bicarbonate

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12
Q

Blood gas of a patient with asthma that changes from alkalotic to normal means..

A

Pt is about to CRASH b/c lungs are getting tired and are starting to retain more CO2! INTUBATE!

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13
Q

Signs and symptoms of hyponatremia

A 
Lethargy
Seizures
MS change or confusion 
Cramps
Anorexia
Coma
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14
Q

First step to determine cause of hyponatremia?

A

Look at volume status

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15
Q

Causes of hypovolemic hyponatremia

A

dehydration, diuretics, diabetes, Addison disease/hypo-aldosteronism (high K+)

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16
Q

Causes of euvolemic hyponatremia

A

SIADH, psychogenic polydipsia, oxytocin use

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17
Q

Causes of hypervolemic hyponatremia

A

Heart failure, nephrotic syndrome, cirrhosis, toxemia, renal failure

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18
Q

How to treat hypovolemic hyponatremia

A

Normal Saline

19
Q

How to treat euvolemic or hypervolemic hyponatremia

A

Water/fluid restriction

20
Q

Patient who presents with polyuria and polydipsia, what’s your differential?

A

Diabetes mellitus
Diuretics use
Diabetes insipidus
Primary polydipsia (psych, water deprevation helps urine osmolarity increase appropriately)

21
Q

Medication used to treat SIADH if water restriction fails?

A

Demeclocycline (induced nephrogenic DI)

22
Q

Central pontine myelinolysis

A

2/2 to quick correction of Sodium:

  • High to low brain blows
  • Low to high pons die
23
Q

Effect of serum glucose on sodium levels?

A

Once glucose gets above 200, it causes sodium to DECREASE (falsely) by 1.6 mEq/L for each rise of 100 mg/dL in glucose

24
Q

Adrenal insufficiency presents with:

A

Hyponatremia
Low BP
Elevated potassium

25
Q

What causes hyponatremia in pregnant patient about to deliver?

A

Oxytocin

26
Q

Most common cause of hypernatremia?

A

Dehydration caused by inadequate fluid intake relative to body needs

27
Q

How is hypernatremia treated?

A

Water replacement with Normal saline until pt is hemodynamically stable, then he can be switched to 1/2 normal saline. NEVER ADD D5 for hypernatremia.

28
Q

Signs and symptoms of hypokalemia?

A 
Muscular weakness (paralysis and ventilatory failure) 
ECG changes: loss T wave or T-wave flattening, the presence of U waves, PVAC and VTach or ATach
29
Q

Effects of potassium on digoxin.

A

Potassium levels should be monitored in all patients taking digoxin, especially if they are also taking diuretics. The heart is particularly sensitive to hypokalemia in patients with digoxin.

30
Q

What electrolyte to you check is hypokalemia persists even after oral replacement?

A

Check magnesium

31
Q

Signs and symptoms of hyperkalemia

A

Weakness and paralysis
ECG changes: tall peaked T waves –> widening QRS, prolongation of PR interval –> loss of P waves –> sine wave pattern

32
Q

Causes of hyperkalemia

A

Renal failure
Severe tissue destruction (since K+ is intracellular)
Hypoaldosteronism
Medications (Spironolactone, beta blockers, NSAIDs, ACE inhibitors, ARBS)
Adrenal insufficiency

33
Q

Hyperkalemic asymptomatic patient…r/o

A

Hemolyzed blood, so repeat the test!

34
Q

Treatment of Hyperkalemia:

A

1) First, if cardio-toxicity –> calcium gluconate (cardioprotective, although it does NOT change K+ levels)
2) Sodium bicarbonate (alkalosis causes potassium to shift into cells)
3) Glucose with insulin (insulin forces K+ into cells, glucose prevents hypoglycemia)
4) Beta2-agonists also work if none of the above are available
4) Dialysis if refractory to above management

35
Q

What is the first thing to correct for with hypocalcemia?

A

Recall that calcium exists in a free or bound form. So, first check albumin level and/or ioniced or free Ca2+ level to make sure TRUE hypocalcemia is present.

Correction: every 1g/dL decrease in albumin, add 0.8 mg/dL to calcium value

36
Q

Pseudohypoparathyroidism

A

Shift fingers, short stature, mental retardation, normal levels of parathyroid hormone with end -organ unresponsiveness to parathyroid hormone

37
Q

Relationship between calcium and phosphorus

A

Phosphorus and calcium levels usually go in opposite direction. In chronic renal failure, efforts are to increase calcium while reducing phosphorus.

38
Q

Outpatient cause of hypercalcemia?

A

Hyperparathyroidism

39
Q

Inpatient cause of hypercalcemia?

A

Malignancy

40
Q

Marker for Familial hypocalciuric hypercalcemia

A

Low urinary calcium despite hypercalcemia

41
Q

Treatment of hypercalcemia?

A

IV fluids, Furosemide

42
Q

Who typically gets hypomagnesemia?

A

Alcoholics

43
Q

Side effects of hypermagnesemia?

A

Decreased deep tendon reflexes
Hypotension
Respiratory failure

44
Q

What is the maintenance fluids of choice for patients who are not eating?

A

1/2 Normal saline with 5% dextrose in adults (consider adding potassium chloride)

Internal Medicine (12 decks)

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