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U World Step 2 > Renal, Urinary Systems, and Electrolytes > Flashcards

Renal, Urinary Systems, and Electrolytes Flashcards

1
Q

Glomerular versus nonglomerular hematuria

  1. Type of hematuria
  2. Common etiologies
  3. Clinical presentation
  4. Urinalysis
A
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2
Q
A

Red cell casts

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3
Q
A

Granular, muddy-brown casts

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4
Q

Renal osteodystrophy pathway

A
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5
Q

Differential diagnosis of urinary incontinence

  1. Etiology
  2. Symptoms
A
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6
Q

Neuroanatomy of urinary voiding

A
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7
Q

Hypovolemic hyponatremia

  1. Extrenal losses
  2. Renal losses
  3. Decreased effective circulating volume
A
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8
Q
  1. Calculating serum osmolality
  2. Normal serum osmolality
A
  1. (2 x Na) + (BUN/2.8) + (Glucose/18)
  2. 275-295 mOsm/kg H2O
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9
Q

Nephrotic syndrome classic features

A

Edema

Proteinuria (>3.5 g/day)

Hypoalbuminemia

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10
Q

Most common cause of nephrotic syndrome in adults

A

Focal segmental glomerulosclerosis

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11
Q

Risks associated with nephrotic syndrome

A

Infection (loss of immunoglobulins)

Thrombosis (loss of antithrombin and plasminogen)

Protein malnutrition

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12
Q

IgA nephropathy

A

Can present with nephrotic or nephritic symptoms

Gross hematuria following an upper respiratory tract infection

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13
Q

Rapidly progressive glomerulonephritis (RPGN)

A

Nephritic syndrome

Rapidly worsening renal function

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14
Q

Primary renal causes of nephrotic syndrome

  1. Etiology
  2. Clinical Associations
A
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15
Q

Treaments for urge incontinence

A

Bladder training (first line): Delaying micturition and resisting the urge to void

Antimuscarinic: Oxybutynin

Beta 3 adrenergic agonist: Mirabegron

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16
Q

Natural history of diabetic nephropathy

A
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17
Q

Single most effective intervention for slowing the progression of diabetic nephropathy

A

Tight blood pressure control

  1. Drug therapy to lower blood pressure <140/90 mm Hg
  2. Additional lifestyle measures (weight loss, sodium restriction)

First-line medications: ACE inhibitors, ARBs

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18
Q

JNC 8 recommendations for treatment hypertension

A
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19
Q

False positive dipstick test for blood

A

Tests for hemoglobin, which is structurally similar to myoglobin

Will be falsely positive in a patient with myoglobinuria (secondary to rhabdomyolysis)

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20
Q

Bladder catheterization in patients with traumatic spinal cord injuries

A

Urinary catheter placement can assess for urinary retention and prevent acute bladder distension and damage.

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21
Q

Palpable purpura

Proteinuria

Hematuria

HCV

Low complement

A

Mixed cryoglobulinemia

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22
Q

Potter sequence

A
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23
Q
A

Posterior urethral valves

Most common cause of urinary tract obstruction in newborn boys

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24
Q

Iga Nephropathy versus Postinfectious Glomerulonephritis

  1. Clinical presentation
  2. Diagnosis
  3. Prognosis
A

IgA nephropathy is the most common cause of glomerulonephritis in adults

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25
Q

Initial treatment for severe hypovolemic hyponatremia

A

0.9% Saline

The most common cause of hypernatremia is hypovolemia. Mild cases can be treated with 5% dextrose in 0.45% saline.

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26
Q

Treatment for euvolemic hypernatremia

A

5% dextrose in water (D5W)

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27
Q

Dietary recommendations for patients with renal calculi

A
  1. Increased fluid intake
  2. Decreased sodium intake
  3. Normal dietary calcium intake
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28
Q

Sickle cell trait

  1. Clinical features
  2. Laboratory findings
  3. Complications
A
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29
Q

Differential diagnosis of metabolic alkalosis

A
30
Q
A

Simple renal cyst

31
Q

Characteristics of renal cysts

  1. Simple renal cyst
  2. Malignant cystic mass
A
32
Q
A

Hydronephrosis

33
Q

Cause of refractory hypokalemia (difficult to correct with potassium replacement) in alcoholics

A

Hypomagnesemia

34
Q

Diagnostic tests in urinary tract infections

  1. Serum BUN and creatinine
  2. Urine dipstick
  3. Urinalysis
  4. Urine culture
A

Patients in diapers should undergo straight catheterization to obtain a steril specimen and avoid contamination with stool or skin flora

35
Q

Cystinuria

A

Inherited disease causing recurrent renal stone formation

Group of disorders characterized by impaired amino acid transport – Defective transport of dibasic amino acids

Stones are hard and radioopaque with hexagonal crystals

Urinary cyanide nitroprusside test is used to screen

36
Q

Side effects of loop diuretics in cirrhotic patients with volume overload and ascites

A

Hypokalemia

Metabolic alkalosis

Prerenal kidney injury

Loop diuretics inhibit Na-K-2Cl carrier in the loop of Henle, increasing sodium delivery to distal tubule, producing elevated hydrogen and potassium secretion in the urine.

37
Q

Management of hypercalcemia

  1. Severe
  2. Moderate
  3. Asymptomatic or mild
A
38
Q

Most important intervention for preventing contast nephropathy

A

Adequate pre-CT hydration

Contrast-induced nephropathy presents as a transient spike in creatinine within 24 hours of contrast administration, with a return to normal renal function within 5-7 days

39
Q

Treatment of acute cystitis and pyelonephritis in nonpregnant women

  1. Uncomplicated cystitis
  2. Complicated cystitis
  3. Pyelonephritis
A

Uncomplicated cystitis has a low chance of treatment failure and can be treated without a culture

40
Q

Management of acute oliguria

A
41
Q

Cause of coagulopathy in chronic kidney disease

A

Platelet dysfunction

PT, PTT, and platelet count are normal

Bleeding time is prolonged

DDAVP is the treatment of choice, if needed: Increases release of factor VIII: von Willebrand factor multimers from endothelial storage sites.

Platelet transfusion not indicated bc transfused platelets become inactive.

42
Q

Aminoglycosides

A

E.g. Amikacin

Used to treat serious (multi-drug resistant) gram negative infections.

Potentially nephrotoxic

43
Q

Pre-renal azotemia

A

BUN: creatinine ratio > 20:1

Due to volume depletion with hypoperfusion to kidneys

44
Q

Clinical features of crystal-induced acute kidney injury

1. Common etiologies

  1. Clinical presentation
  2. Treatment
A

Drug precipitates in renal tubules, causing intratubular obstruction and direct renal tubular toxicity

45
Q

Acute interstitial nephritis

  1. Common etiologies
  2. Timing
  3. Clinical presentation
A
  1. Associated with beta lactams and proton pump inhibitors
  2. 7-10 days after drug exposure
  3. Skin rash, eosinophilia, eosinophiluria, and pyruria
46
Q

Nephrotic versus nephritis syndrome

  1. Clinical features
  2. Pediatric etiologies
  3. Adult etiologies
A
47
Q

Symptoms consistent with typical renal colic but no stones identified on conventional X rays.

A
  1. Radiolucent stones (uric acid stones, xanthine stones)
  2. Calcium stones <1-3 mm diameter
  3. Non-stone ureteral obstruction (e.g., blood clot, tumor)
48
Q

Treatment for uric acid kidney stones

A

Highly soluble in alkaline urine

Alkalinization of the urine to pH 6.0-6.5 with potassium citrate

Radiolucent but may be seen on US or CT

49
Q

Diuretic used in managment of recurrent hypercalciuric renal stones

A

Hydrochlorothiazide

Decreases urinary calcium

50
Q

Muddy brown granular cast

A

Acute tubular necrosis

51
Q

RBC casts

A

Glomerulonephritis

52
Q

WBC casts

A

Interstitial nephritis and pyelonephritis

53
Q

Fatty casts

A

Nephrotic syndrome

54
Q

Broad and waxy casts

A

Chronic renal failure

55
Q

Acute interstitial nephritis

Presentation:

Caused by:

Treatment:

A

Presentation: Fever, rash, arthralgias

Peripheral eosinophilia, hematuria, sterile pyuria, eosinophiluria

Caused by:

Cephalosporins

Penicillins

Sulfonamides

Sulfonamide-containing diuretics

NSAIDs

Rifampin

Phenytoin

Allopurinol

Treatment: discontinue offending agent

56
Q

Clinical clues to renovascular disease (renal artery stenosis)

  1. HTN-related symptoms
  2. Supporting evidence
A
57
Q

Management of patients with hypertension and renal artery stenosis

A

ACE or ARB

Renal artery stenting or surgical revascularization is reserved for patients with resistant hypertension or recurrent flash pulmonary edema and/or refractory heart failure due to severe hypertension.

58
Q

Sodium nitroprusside

A

Potent arterial and venous vasodilator often used for hypertensive emergencies.

Prolonged influsion can lead to cyanide toxicity, especially in patients with CKD.

Treatment includes sodium thiosulfate

59
Q

Manifestations of cyanide accumulation & toxicity

Skin:

CNS:

Cadiovascular:

Respiratory:

GI:

Renal:

A

Combustion of carbon and nitrogen contaning compounds (wool, silk)

Industrial exposure (metal extraction in mining)

Medications (sodium nitroprusside)

60
Q

Site of bladder rupture causing peritonitis

A

Bladder dome (only peritoneal structure)

WIll cause referred shoulder pain

61
Q

Clinical features of analgesic nephropathy

  1. Clinical presentation
  2. Diagnosis
A
62
Q

Asymptomatic bacteriuria

  1. Risk factors
  2. Common pathogens
  3. First-line treatment
A

Associated with an increased risk of preterm labor and low birth weight

63
Q

Metformin in acutely ill patients

A

Metforming should not be given to acutely ill patients with acute renal failure, liver failure, or sepsis, as these conditions increase the risk of lactic acidosis.

64
Q

Effect of hypovolemia on the renin-angiotensin-aldosterone system

A
65
Q

Prerenal acute kidney injury

  1. Etiology
  2. Clinical features
  3. Treatment
A
66
Q

Stimuli for secretion of antidiuretic hormone

  1. Osmotic
  2. Nonosmotic
A
67
Q

Acid Base Disorders (Primary disorder, appropriate compensation)

  1. Metabolic acidosis
  2. Metabolic alkalosis
  3. Acute respiratory acidosis
  4. Acute respiratory alkalosis
A
68
Q

Most common type of kidney stone

A

Calcium oxalate

(70-95% of kidney stones)

69
Q

Alport’s syndrome

A

Recurrent episodes of hematuria

Sensorineural deafness

Family hx of renal failure

70
Q

Medications that can cause hyperkalemia

  1. Medication
  2. Mechanism
A

U World Step 2 (22 decks)

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