Renal Tx And Tests Flashcards
0
Q
How do you treat hypovolemic hypernatremia with unstable VS?
A
NS
1
Q
How do you treat hypovolemic hypernatremia?
A
D5W
2
Q
How do you treat euvolemic hypernatremia?
A
D5W or 1/2NS
3
Q
How do you treat hypervolemic hypernatremia?
A
Diuretics + D5W
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
5
Q
What do you do if serum osmolality is less than 280?
A
Assess extra cellular volume and take a urine sodium
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
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
8
Q
What if the urine sodium is greater than 10 and the patient has hypervolemic hyponatremia?
A
AKI
CKD
9
Q
What if the urine sodium is less than 10 and patient is hypervolemic hyponatremia?
A
Cirrhosis
CHF
Nephrotic syndrome
10
Q
What is the treatment for hypervolemic hyponatremia?
A
Water restriction
May use diuretics
Treat underlying problem
11
Q
What is the treatment for euvolemic hyponatremia?
A
Water restriction
12
Q
What is the treatment for hypovolemic hyponatremia?
A
NS
13
Q
How quickly should hyponatremia be fixed?
A
No more than 0.5 mEq/l/hr
14
Q
How do you confirm the diagnosis of hyperkalemia?
A
Repeat blood draw
15
Q
When there is extreme leukocytosis or thrombocytosis and hyperkalemia, what should you do?
A
Check plasma potassium
16
Q
What is the first step in treating hyperkalemia?
A
Give calcium gluconate
17
Q
What is the treatment protocol for hyperkalemia?
A
C BIG K
Calcium gluconate
Bicarbonate/b2 agonist, insulin and glucose
Kayexakalate
18
Q
What are the drugs used for increased excretion of potassium?
A
Kayexalate
Loop diuretics
19
Q
What are the contraindications to using kayexalate?
A
Ileus
Bowel obstruction
Ischemic gut
Pancreatic transplants
20
Q
How do you distinguish renal from GI loss as the cause of hypokalemia?
A
24 hour or spot urine potassium
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
22
Q
What should you think if a patient has hypokalemia and metabolic acidosis?
A
RTA
23
Q
What should you watch out for with hypokalemia?
A
Digitalis toxicity
AV nodal block
24
How do you diagnose hypercalcemia?
```
Order total and ionized calcium
Albumin
Phosphate
PTH
PTHrP
Vit D
ECG
```
25
What is the treatment for hypercalcemia?
IVF + furosemide
26
What drugs can be sued for severe or refractory cases of hypercalcemia?
```
Bisphosphonates
Calcitonin
Glucocorticoids
Calcimimetics
Dialysis
```
27
How do you diagnose hypocalcemia?
```
Order an ionized calcium
Magnesium
PTH
Albumin
25-OH vit D
1,25 vit D
ECG
```
28
What is the treatment of hypocalcemia?
Magnesium depletion
Oral calcium supplements
IV calcium if severe
29
How do you diagnose hypomagnesemia?
Serum level less than 1.5
Concurrent hypocalcemia and hypokalemia
ECG changes with increased PR interval and QT
30
What is the treatment of hypomagnesemia?
IV and oral supplements
31
What is the treatment for RTA 1?
Replace bicarb
32
What is the treatment for RTA type II?
Thiazides
| Volume depletion to increase absorption
33
What is the treatment for RTA type 4?
Furosemide
| Mineralocorticoid +\- glucocorticoid replacement
34
How do you diagnose AKI?
Check serum electrolytes
| Check urine for RBCS, WBCS, casts and eosinophils
35
What can you do to rule out obstruction in AKI?
Catheter
| Renal US
36
When do you obtain a renal biopsy?
Only when the etiology of intrinsic renal disease is not clear
37
What is the tx for AKI?
Balance fluids and electrolytes
Look for nephrotoxicity drugs and stop them
Dialysis if needed
38
What are the indications for urgent dialysis?
AEIOU
Acidosis
Electrolyte abnormalities
Ingestion (salicylates, theophylline, methanol, barbs, lithium, ethylene glycol)
Overload
Uremic (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus)
39
What is the tx for CKD?
ACEi/ARBs and HTN control
Fluid restriction (low Na and K and phosphate)
Oral phosphate binders
Calcitriol
40
What should be given for anemia of chronic disease in CKD?
EPO
41
What should be given for bleeding abnormalities in CKD?
Desmopressin
42
What has been shown to decrease the progression of CKD?
ACEi/ARBs
| HTN control
43
What is the best first step in diagnosing post infectious GN?
UA
44
What is the tx for post infectious GN?
Supportive with diuretics
45
What is the tx for Berger's disease?
Corticosteroids
| ACEi if have proteinuria
46
What is th tx for Wegener's?
High dose corticosteroids
| Cyclophosphamide
47
What is the tx for microscopic polyangitis?
Corticosteroids and cyclophosphamide
48
What is the tx for Goodpasture's?
Plasma exchange + steroids
49
What is the tx for Alport's?
Transplant
50
What is the tx of minimal change dz?
Steroids
51
What is the tx of focal segmental GN?
Prednisone
Cytotoxic therapy
ACEi/ARBs to decrease proteinuria
52
What is the tx of membranous GN?
Prednisone and cytotoxic therapy
53
What is the tx for Type I DM nephropathy?
ACEi
54
What is the tx for Type II DM nephropathy?
ARBs
55
What is the tx for diabetic nephropathy?
Tight blood sugar control
| ACE/ARB
56
What can slow disease progression in SLE related nephropathy?
Prednisone and cyclophosphamide
57
What is the tx of renal amyloidosis?
Prednisone
Melphalan
BM transplant for multiple myeloma
58
What can be used to help MPGN?
Corticosteroids and cytotoxic agents
59
How do you diagnose nephrotic syndrome?
UA - shows over 3.5 g of protein, lipids
| Blood chem - shows albumin less than 3 and hyperlipidemia
60
What is done to definitively diagnose the underlying etiology?
Renal biopsy
61
How do you treat nephrotic syndrome?
```
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
How do you diagnose a kidney stone?
UA shows hematuria and altered urine ph
63
What is the gold standard for diagnosing a kidney stone?
Noncontrast CT
64
What is the preferred imaging choice for children and pregnant people?
Ultrasound
65
What is the tx for calcium oxalate/phosphate stones?
Hydration
Sodium and protein restriction
Thiazides
Citrate
66
What is the tx for struvite (mg,ammonium, phosphate) stones?
Hydration
Treat UTI
Surgical removal if staghorn
67
What is the tx for uric acid stones?
Hydration
Alkalinization the urine with citrate
Allopurinol
Dietary purine restriction
68
What is the tx of cystine stones?
Hydration
Alkalinization of urine with citrate
Penicillamine
Dietary sodium restriction
69
What size stones can pass through the urethra?
Less than 5 mm
70
What can you do for stones that are between 0.5 - 3 cm?
Extracorporeal shockwave lithotripsy - first choice
Percutaneous nephrolithotomh
Retrograde ureteroscopy
71
What are the dietary changes to prevent calcium stones?
Sodium restriction, protein and oxalate restriction
| Increase calcium
72
What is the imaging choice to diagnose hydropnephrosis?
US
73
What other imaging can be used to diagnose hydropnephrosis?
CT
74
What is the tx of hydropnephrosis?
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
How do you diagnose VUR?
Get a voiding cystourethrogram
76
How do you classify VUR.
Get a VCUG
77
What so you so with a child having first febrile UTI?
Get US
| Only get VCUG if there is evidence of scarring or hydropnephrosis
78
Who gets surgical urethral implantation?
Children with high grade reflux III-V
79
What is the tx of low grade VUR?
Amoxicillin if under 2 months
| Bactrim or nitrofurantoin until reflux resolves
80
What is tx of cryptorchidism?
Orchiopexy by 6-12 months
81
What if cryptorchidism is discovered later than 1 year of age?
Must do orchiectomy
82
How do you evaluate for an inguinal hernia or a testicular cancer?
US
83
What is the tx for a hydrocele?
None unless herniation or persists beyond 12-18 months
84
How do you diagnose a varicocele?
US
85
How do you treat a varicocele?
Varicocelectomy
| Ligation or embolization by IR
86
What is the tx of epididymitis?
Tetracycline
Fluoroquinolones
NSAIDs
87
How do you dx epididymitis?
US - increase blood flow to testes
| UA - pyuria, culture!
88
What is the tx for testicular torsion?
Orchiopexy of both testes
Unsalvageable after 6 h
89
What is the diagnostic imaging study for testicular torsion?
US - don't wait though
| Go to immediate surgery
90
What is the tx for ED?
PDE 5 inhibitors
91
What is the tx for psychogenic ED?
Psychotherapy
92
What is the tx for ED secondary to hypogonadism or pituitary problems?
Testosterone
93
What are the treatment options for patients with ED who fail PDE5i?
Vacuum pumps
Penile implants
PG injections
94
What labs should be drawn to evaluate ED?
Prolactin
Testosterone
Gonadotropins
95
What should you do when evaluating for BPH?
DRE
UA and culture
Creatinine levels
96
What is the tx of BPH for moderate/severe sx?
TURP or open prostatectomy
97
What is the medical tx for BPH?
Alpha blockers
| 5 alpha reductase inhibitors
98
How do you definitively dx prostate cancer?
US-guided transrectal bx
99
What do you do to look for mets from prostate cancer?
CXR
| Bone scan
100
What is the treatment for elderly patients with low grade prostate cancer?
Watchful waiting
101
How do you treat metastatic prostate disease?
Androgen ablation (gnrh agonist, orchiectomy, flutamide) and chemo
102
When should screening begin?
Age 50 with DRE
103
Who should have prostate cancer screening earlier than 50?
African Americans
| If have a first degree relative with it
104
What is diagnostic of bladder cancer?
Cystoscope with bx
105
What is recommended in the eval of bladd cancer?
Cystoscope with bx
UA
cytology
MRI, CT and bone scan
106
What is the tx for CIS of the bladder?
Intra vesicular chemo
107
What is the tx for superficial cancer of the bladder?
Transurethral resection
Or
Intra vesicular chemo with mitomycin C or BCG
108
What is the tx for high grade recurrent large lesions of the bladder?
Intravesicular chemo
109
What are the tx options for invasive cancer of the bladder without mets?
Radiotherapy (for poor candidates)
| Radical cystectomy
110
What is the tx for invasive cancers of the bladder with mets?
Chemo
111
How do you diagnose renal cell carcinoma?
US
| CT
112
What is the curative tx of RCC?
Surgical resection
113
What are some of the new drugs for tx of RCC?
Sorafenib
Sunitinib
These are tyrosine kinase inhibitors that decrease angiogenesis
114
How do you diagnose testicular cancer?
US
115
How do evaluate for mets with testicular cancer?
CXR
| Ab/pelvic CT
116
What is the tx for testicular cancer?
Radical orchiectomy
117
What is the tx for seminomas?
Radiation and chemo
| Extremely radiosensitive
118
What kind of chemo is used for nonseminomatous germ cell tumors?
Platinum based chemo
119
What kind of chemo can be used for seminomas?
Etoposide
120
What is the tx for penile fx?
Retrograde urethrogram + surgical exploration of the penis
121
What is the tx of choice for phimosis or balanitis?
Circumcision
122
What is the tx for acute prostatitis?
TMP-SMX
123
What is the tx for chronic prostatitis?
Fluoroquinolones
124
How do you diagnose prostatitis?
UA and urine culture
125
What is recommended to do for every patient suspected of BPH?
UA and culture
| serum creatinine
126
What is the tx for renal artery stenosis?
Angioplasty with stent placement
127
What is the tx for renal artery stenosis in patients who cannot undergo surgery?
ACEi
128
What are the steps in diagnosing Wegener's?
C-Anca
| Tissue bx
129
What is the imaging test for RCC?
Abdominal CT
130
What is the management for a simple renal cyst?
None
| No follow up needed
131
When are patients candidates for erythropoietin?
When hematocrit is below 30 and Hb is below 10
132
What are the side effects of erythropoietin?
Worsening of HTN
Headaches
Flushing
Red cell aphasia
