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Step 2 High Yield > Renal Tx And Tests > Flashcards

Renal Tx And Tests Flashcards

0
Q

How do you treat hypovolemic hypernatremia with unstable VS?

A

NS

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1
Q

How do you treat hypovolemic hypernatremia?

A

D5W

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2
Q

How do you treat euvolemic hypernatremia?

A

D5W or 1/2NS

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3
Q

How do you treat hypervolemic hypernatremia?

A

Diuretics + D5W

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4
Q

How quickly should you correct chronic hypernatremia?

A

No more than 0.5 mEq/L/hr

Over the course of 48-72 to prevent cerebral edema

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5
Q

What do you do if serum osmolality is less than 280?

A

Assess extra cellular volume and take a urine sodium

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6
Q

What does it mean if urine sodium is less than 10 and the patient had hypovolemic hyponatremia?

A

GI losses, NG tube, vom, diarrhea
Skin losses, burns
Third spacing

Because the RAS is activated so holding onto to sodium

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7
Q

What does it mean if urine sodium is greater than 10 and the patient has hypovolemic hyponatremia?

A

Due to diuretic use
Adrenal insufficiency
Urinary obstruction
RTA metabolic alkalosis

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8
Q

What if the urine sodium is greater than 10 and the patient has hypervolemic hyponatremia?

A

AKI

CKD

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9
Q

What if the urine sodium is less than 10 and patient is hypervolemic hyponatremia?

A

Cirrhosis
CHF
Nephrotic syndrome

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10
Q

What is the treatment for hypervolemic hyponatremia?

A

Water restriction
May use diuretics
Treat underlying problem

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11
Q

What is the treatment for euvolemic hyponatremia?

A

Water restriction

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12
Q

What is the treatment for hypovolemic hyponatremia?

A

NS

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13
Q

How quickly should hyponatremia be fixed?

A

No more than 0.5 mEq/l/hr

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14
Q

How do you confirm the diagnosis of hyperkalemia?

A

Repeat blood draw

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15
Q

When there is extreme leukocytosis or thrombocytosis and hyperkalemia, what should you do?

A

Check plasma potassium

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16
Q

What is the first step in treating hyperkalemia?

A

Give calcium gluconate

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17
Q

What is the treatment protocol for hyperkalemia?

A

C BIG K

Calcium gluconate
Bicarbonate/b2 agonist, insulin and glucose
Kayexakalate

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18
Q

What are the drugs used for increased excretion of potassium?

A

Kayexalate

Loop diuretics

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19
Q

What are the contraindications to using kayexalate?

A

Ileus
Bowel obstruction
Ischemic gut
Pancreatic transplants

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20
Q

How do you distinguish renal from GI loss as the cause of hypokalemia?

A

24 hour or spot urine potassium

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21
Q

What is the treatment for hypokalemia?

A

Treat underlying cause
Give potassium oral or IV - do not exceed 20 mEq/L/h
Replace magnesium
Monitor ECG and plasma potassium levels frequently during replacement

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22
Q

What should you think if a patient has hypokalemia and metabolic acidosis?

A

RTA

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23
Q

What should you watch out for with hypokalemia?

A

Digitalis toxicity

AV nodal block

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24
Q

How do you diagnose hypercalcemia?

A 
Order total and ionized calcium
Albumin
Phosphate
PTH
PTHrP
Vit D 
ECG
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25
Q

What is the treatment for hypercalcemia?

A

IVF + furosemide

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26
Q

What drugs can be sued for severe or refractory cases of hypercalcemia?

A 
Bisphosphonates
Calcitonin
Glucocorticoids
Calcimimetics
Dialysis
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27
Q

How do you diagnose hypocalcemia?

A 
Order an ionized calcium
Magnesium 
PTH
Albumin 
25-OH vit D 
1,25 vit D
ECG
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28
Q

What is the treatment of hypocalcemia?

A

Magnesium depletion
Oral calcium supplements
IV calcium if severe

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29
Q

How do you diagnose hypomagnesemia?

A

Serum level less than 1.5
Concurrent hypocalcemia and hypokalemia
ECG changes with increased PR interval and QT

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30
Q

What is the treatment of hypomagnesemia?

A

IV and oral supplements

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31
Q

What is the treatment for RTA 1?

A

Replace bicarb

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32
Q

What is the treatment for RTA type II?

A

Thiazides

Volume depletion to increase absorption

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33
Q

What is the treatment for RTA type 4?

A

Furosemide

Mineralocorticoid +- glucocorticoid replacement

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34
Q

How do you diagnose AKI?

A

Check serum electrolytes

Check urine for RBCS, WBCS, casts and eosinophils

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35
Q

What can you do to rule out obstruction in AKI?

A

Catheter

Renal US

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36
Q

When do you obtain a renal biopsy?

A

Only when the etiology of intrinsic renal disease is not clear

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37
Q

What is the tx for AKI?

A

Balance fluids and electrolytes
Look for nephrotoxicity drugs and stop them
Dialysis if needed

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38
Q

What are the indications for urgent dialysis?

A

AEIOU
Acidosis
Electrolyte abnormalities
Ingestion (salicylates, theophylline, methanol, barbs, lithium, ethylene glycol)
Overload
Uremic (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus)

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39
Q

What is the tx for CKD?

A

ACEi/ARBs and HTN control
Fluid restriction (low Na and K and phosphate)
Oral phosphate binders
Calcitriol

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40
Q

What should be given for anemia of chronic disease in CKD?

A

EPO

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41
Q

What should be given for bleeding abnormalities in CKD?

A

Desmopressin

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42
Q

What has been shown to decrease the progression of CKD?

A

ACEi/ARBs

HTN control

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43
Q

What is the best first step in diagnosing post infectious GN?

A

UA

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44
Q

What is the tx for post infectious GN?

A

Supportive with diuretics

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45
Q

What is the tx for Berger’s disease?

A

Corticosteroids

ACEi if have proteinuria

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46
Q

What is th tx for Wegener’s?

A

High dose corticosteroids

Cyclophosphamide

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47
Q

What is the tx for microscopic polyangitis?

A

Corticosteroids and cyclophosphamide

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48
Q

What is the tx for Goodpasture’s?

A

Plasma exchange + steroids

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49
Q

What is the tx for Alport’s?

A

Transplant

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50
Q

What is the tx of minimal change dz?

A

Steroids

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51
Q

What is the tx of focal segmental GN?

A

Prednisone
Cytotoxic therapy
ACEi/ARBs to decrease proteinuria

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52
Q

What is the tx of membranous GN?

A

Prednisone and cytotoxic therapy

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53
Q

What is the tx for Type I DM nephropathy?

A

ACEi

54
Q

What is the tx for Type II DM nephropathy?

A

ARBs

55
Q

What is the tx for diabetic nephropathy?

A

Tight blood sugar control

ACE/ARB

56
Q

What can slow disease progression in SLE related nephropathy?

A

Prednisone and cyclophosphamide

57
Q

What is the tx of renal amyloidosis?

A

Prednisone
Melphalan
BM transplant for multiple myeloma

58
Q

What can be used to help MPGN?

A

Corticosteroids and cytotoxic agents

59
Q

How do you diagnose nephrotic syndrome?

A

UA - shows over 3.5 g of protein, lipids

Blood chem - shows albumin less than 3 and hyperlipidemia

60
Q

What is done to definitively diagnose the underlying etiology?

A

Renal biopsy

61
Q

How do you treat nephrotic syndrome?

A 
Protein and salt restriction 
Diuretics
Antihyperlipidemics
ACEi for patients with renal scarring to decrease proteinuria and diminish progression of the disease 
Vaccinate for pneumococcus
62
Q

How do you diagnose a kidney stone?

A

UA shows hematuria and altered urine ph

63
Q

What is the gold standard for diagnosing a kidney stone?

A

Noncontrast CT

64
Q

What is the preferred imaging choice for children and pregnant people?

A

Ultrasound

65
Q

What is the tx for calcium oxalate/phosphate stones?

A

Hydration
Sodium and protein restriction
Thiazides
Citrate

66
Q

What is the tx for struvite (mg,ammonium, phosphate) stones?

A

Hydration
Treat UTI
Surgical removal if staghorn

67
Q

What is the tx for uric acid stones?

A

Hydration
Alkalinization the urine with citrate
Allopurinol
Dietary purine restriction

68
Q

What is the tx of cystine stones?

A

Hydration
Alkalinization of urine with citrate
Penicillamine
Dietary sodium restriction

69
Q

What size stones can pass through the urethra?

A

Less than 5 mm

70
Q

What can you do for stones that are between 0.5 - 3 cm?

A

Extracorporeal shockwave lithotripsy - first choice
Percutaneous nephrolithotomh
Retrograde ureteroscopy

71
Q

What are the dietary changes to prevent calcium stones?

A

Sodium restriction, protein and oxalate restriction

Increase calcium

72
Q

What is the imaging choice to diagnose hydropnephrosis?

A

US

73
Q

What other imaging can be used to diagnose hydropnephrosis?

A

CT

74
Q

What is the tx of hydropnephrosis?

A

Surgical correction of anatomical abnormality
ESWL for stones
Foley or suprapubic catheter for lower UT problems like BPH, neurogenic bladder
Stent placement or nephrostomy tubes to relieve pressure

75
Q

How do you diagnose VUR?

A

Get a voiding cystourethrogram

76
Q

How do you classify VUR.

A

Get a VCUG

77
Q

What so you so with a child having first febrile UTI?

A

Get US

Only get VCUG if there is evidence of scarring or hydropnephrosis

78
Q

Who gets surgical urethral implantation?

A

Children with high grade reflux III-V

79
Q

What is the tx of low grade VUR?

A

Amoxicillin if under 2 months

Bactrim or nitrofurantoin until reflux resolves

80
Q

What is tx of cryptorchidism?

A

Orchiopexy by 6-12 months

81
Q

What if cryptorchidism is discovered later than 1 year of age?

A

Must do orchiectomy

82
Q

How do you evaluate for an inguinal hernia or a testicular cancer?

A

US

83
Q

What is the tx for a hydrocele?

A

None unless herniation or persists beyond 12-18 months

84
Q

How do you diagnose a varicocele?

A

US

85
Q

How do you treat a varicocele?

A

Varicocelectomy

Ligation or embolization by IR

86
Q

What is the tx of epididymitis?

A

Tetracycline
Fluoroquinolones
NSAIDs

87
Q

How do you dx epididymitis?

A

US - increase blood flow to testes

UA - pyuria, culture!

88
Q

What is the tx for testicular torsion?

A

Orchiopexy of both testes

Unsalvageable after 6 h

89
Q

What is the diagnostic imaging study for testicular torsion?

A

US - don’t wait though

Go to immediate surgery

90
Q

What is the tx for ED?

A

PDE 5 inhibitors

91
Q

What is the tx for psychogenic ED?

A

Psychotherapy

92
Q

What is the tx for ED secondary to hypogonadism or pituitary problems?

A

Testosterone

93
Q

What are the treatment options for patients with ED who fail PDE5i?

A

Vacuum pumps
Penile implants
PG injections

94
Q

What labs should be drawn to evaluate ED?

A

Prolactin
Testosterone
Gonadotropins

95
Q

What should you do when evaluating for BPH?

A

DRE
UA and culture
Creatinine levels

96
Q

What is the tx of BPH for moderate/severe sx?

A

TURP or open prostatectomy

97
Q

What is the medical tx for BPH?

A

Alpha blockers

5 alpha reductase inhibitors

98
Q

How do you definitively dx prostate cancer?

A

US-guided transrectal bx

99
Q

What do you do to look for mets from prostate cancer?

A

CXR

Bone scan

100
Q

What is the treatment for elderly patients with low grade prostate cancer?

A

Watchful waiting

101
Q

How do you treat metastatic prostate disease?

A

Androgen ablation (gnrh agonist, orchiectomy, flutamide) and chemo

102
Q

When should screening begin?

A

Age 50 with DRE

103
Q

Who should have prostate cancer screening earlier than 50?

A

African Americans

If have a first degree relative with it

104
Q

What is diagnostic of bladder cancer?

A

Cystoscope with bx

105
Q

What is recommended in the eval of bladd cancer?

A

Cystoscope with bx
UA
cytology
MRI, CT and bone scan

106
Q

What is the tx for CIS of the bladder?

A

Intra vesicular chemo

107
Q

What is the tx for superficial cancer of the bladder?

A

Transurethral resection
Or
Intra vesicular chemo with mitomycin C or BCG

108
Q

What is the tx for high grade recurrent large lesions of the bladder?

A

Intravesicular chemo

109
Q

What are the tx options for invasive cancer of the bladder without mets?

A

Radiotherapy (for poor candidates)

Radical cystectomy

110
Q

What is the tx for invasive cancers of the bladder with mets?

A

Chemo

111
Q

How do you diagnose renal cell carcinoma?

A

US

CT

112
Q

What is the curative tx of RCC?

A

Surgical resection

113
Q

What are some of the new drugs for tx of RCC?

A

Sorafenib
Sunitinib
These are tyrosine kinase inhibitors that decrease angiogenesis

114
Q

How do you diagnose testicular cancer?

A

US

115
Q

How do evaluate for mets with testicular cancer?

A

CXR

Ab/pelvic CT

116
Q

What is the tx for testicular cancer?

A

Radical orchiectomy

117
Q

What is the tx for seminomas?

A

Radiation and chemo

Extremely radiosensitive

118
Q

What kind of chemo is used for nonseminomatous germ cell tumors?

A

Platinum based chemo

119
Q

What kind of chemo can be used for seminomas?

A

Etoposide

120
Q

What is the tx for penile fx?

A

Retrograde urethrogram + surgical exploration of the penis

121
Q

What is the tx of choice for phimosis or balanitis?

A

Circumcision

122
Q

What is the tx for acute prostatitis?

A

TMP-SMX

123
Q

What is the tx for chronic prostatitis?

A

Fluoroquinolones

124
Q

How do you diagnose prostatitis?

A

UA and urine culture

125
Q

What is recommended to do for every patient suspected of BPH?

A

UA and culture

serum creatinine

126
Q

What is the tx for renal artery stenosis?

A

Angioplasty with stent placement

127
Q

What is the tx for renal artery stenosis in patients who cannot undergo surgery?

A

ACEi

128
Q

What are the steps in diagnosing Wegener’s?

A

C-Anca

Tissue bx

129
Q

What is the imaging test for RCC?

A

Abdominal CT

130
Q

What is the management for a simple renal cyst?

A

None

No follow up needed

131
Q

When are patients candidates for erythropoietin?

A

When hematocrit is below 30 and Hb is below 10

132
Q

What are the side effects of erythropoietin?

A

Worsening of HTN
Headaches
Flushing
Red cell aphasia

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