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Step2CK > Renal Uworld > Flashcards

Renal Uworld Flashcards

1
Q

in whatMVA scenario is it okay to do bladder catheterization

A

on obvious pelvic fracture or blood from urethral meatus

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2
Q

what happens with inclusion body myositis

A

adult onset distal muscular weakness and atrophy

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3
Q

Tx for severe hypovolemic hypernatremia

A

isotonic 0.9% saline

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4
Q

rate for plasma sodium correction

A

1mEq/L/h

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5
Q

Tx for less severe hypovolemic hypernatremia

A

5% dextrose in 0.45% saline

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6
Q

cascade of decreased renal blood flow

A

RAAS activated. constricts efferent arteriole more than afferent to maintain GFR

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7
Q

what factors aggravate prerenal azotemia

A

decreased fluid intake, ACEI, aspirin

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8
Q

edema, hypoalbuminemia, elvated urine protein

A

nephrotic syndrome

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9
Q

what are the nephrotic syndromes

A

minimal change in kids

FSGS in adults and membranouse nephropathy in adults

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10
Q

Significant risk factor for membranous nephropathy

A

hep B

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11
Q

labs in Heb B related membranous nephropathy

A

low C3

protein excretion over 24 hours > 3g/day

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12
Q

all patients with epidural anesthesia require what

A

bladder catheterization from overflow incontinence

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13
Q

child with abdominal pain, lower extremity purpura, arthritis, hematuria

A

HSP, IgA mediated vasculitis of small vessels

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14
Q

arthralgias in IgA nephropathy (HSP)

A

knees and ankles, transient

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15
Q

renal involvement in HSP IgA nephropathy

A

microscopic hematuria, RBC casts, mild to mod proteinuria

slightly elevated Cr

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16
Q

what drugs cause interstitial nephritis

A

penicillins, cephalosporins, sulfonamides

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17
Q

clinical features of durg induced cephalosporins

A

patient will have fever, rash, arthralgias. can have darker urine (hematuria) sterile pyuria and eosinophiluria

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18
Q

Tx drug induced interstitial nephritis

A

remove causative agent

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19
Q

what drugs can you use for UTI in pregnancy

A

Nitrofurantoin
amoxicillin or augmentin
fosfomycin single dose

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20
Q

when to avoid TMP-SMX in pregnancy

A

1st and 3rd trimester

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21
Q

what not to Tx UTI with in pregnancy

A

fluoroquinolones

TMP-SMX

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22
Q

when to screen for aSx bacteriruia

A

12-16 weeks

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23
Q

What are common causes of early post op renal transplant dyfunction

A

ureteral obstruction
acute rejection
cyclosporine toxicity
vascular obstruction and ATN

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24
Q

Biopsy of kidney transplant 3 days later shows heavy lymphocyte infiltration and vascular involvement with swelling of intima? what is it and how to Tx?

A

acute rejection

IV steroids

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25
Q

Leukocye esterase

A

significant pyuria

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26
Q

nitrates

A

presence of enterobacteriaceae

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27
Q

expected dipstick for acute pyelonephritis

A

+ nitrites and leukocyte esterase

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28
Q

which drug is known to increase risk bladder CA

A

cyclophosphamide

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29
Q

how do you know if metabolic alkalosis is from vomiting or prior diuretic use

A

low urine Cl

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30
Q

metabolic alkalosis with high urine Cl and hypervolemia

A

primary hyperaldosteronism
cushing
ACTH production

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31
Q

pretibial myxedema

A

graves

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32
Q

edema in nephritis is caused how

A

decreased GFR and retention Na and water

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33
Q

vomiting causes what acid base

A

metabolic alkalosis because lose H+ and K+

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34
Q

how to decrease Ca oxalate stones

A

minimize Na intake

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35
Q

most common drug induced chrnoic renal failure in US

A

analgesic nephropathy

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36
Q

what happens in analgesic nephropathy

A

papillary necrosis and chronic tubulointerstitial nephritis

HTN, mild proteinuria, impaired concentration of urine

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37
Q

WBC casts are seen in

A

allergic interstitial nephritis

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38
Q

Adult with proteinuria and transient gross hematuria following acute pharyngitis

A

IgA nephropathy

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39
Q

asterixis causes

A

hepatic encephalopathy

uremic encephalopathy and hypercapnia

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40
Q

alkalotic urine

pH >5.5

A

RTA I

problem with H secretion into urine

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41
Q

infant with normal anion gap acidosis and failure to thrive

A

renal or GI acidosis likely

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42
Q

fanconi syndrome

A

glucosuria, aminoaciduria, phosphaturia

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43
Q

Renal tubular acidosis presentation in infants

A

growth failure
low serum bicarb
hyperCl

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44
Q

What drugs cause increased potassium

A 
nonselective beta blockers
ACEI, ARB
digitalis
cyclosporine
heparin
NSAIDs
succinylcholine
TMP-SMX
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45
Q

how does TMP SMX cause hyperkalemia

A

blocks epithelial Na channels in collecting tubules like amiloride does

can also cause small increase in Cr

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46
Q

how do ACEI work

A

dilate the efferent arterioles

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47
Q

signs of aspirin intoxication

A

tinnitus, fever and tachypnea

nausea, GI irritation

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48
Q

why acid base happens with aspirin OD

A

respiratory alkalosis
high respirations blowing CO2 off
then causes metabolic acidosis by uncoupling ox phos in mitochondira resulting in low HCO3 from high acid buildup

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49
Q

pH in aspirin OD

A

near normal from mixed acid base

resp alkalosis and metabolic acidosis

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50
Q

Tx aspirin OD

A

alkalinization or dialysis

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51
Q

skin rash, joint pains, myalgias and fatigue
past IV drug abuser
palpable purpura and HSM
UA show hematuria, RBC cast and proteinuria
BUN 30 Cr 2.0 C’ low and + anti HCV

A

mixed essential cryoglobulinemia

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52
Q

triad mixed essential cryoglobulinemia

A

palpable purpura, proteinuria, hematuria

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53
Q

HCV is related to what renal dysfunction

A

mixed essential cryoglobulinemia

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54
Q

pathogenesis contrast induced nephropathy

A

renal vasoconstriction and tubular injury

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55
Q

weight gain, facial edema HTN
4+ proteinuria no glucose in urine
no RBC and some fatty casts
greatest risk for?

A

hypercoagulability– nephrotic syndrome

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56
Q

nephrotic syndrome

A

proteinuria >4.5
hypoalbuminemia
edema
hyperlipidemia and lipiduria

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57
Q

why does nephrotic syndrome cause hypercoagulability

A

increased urinary loss antithrombin 3, altered levels protein C and S, increased platelet aggregation, hyperfibrinogenemia form increased hepatic synthesis and impaired fibrinolysis

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58
Q

complications nephrotic syndrome

A

protein malnutrition, iron resistent microcytic hypochromic anemia, increased infections
vit D deficiency

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59
Q

low complement levels with nephritic syndrome

A

postinfectious, lupus, MPGN or mixed cryoglobulinemia with HepC

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60
Q

What are depositied in mixed cryoglobulinemia

A

IC of IgM Ab and IgG anti Hep C Ab

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61
Q

Dx of mixed cryoglobulinemia

A

viral serology

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62
Q

Tx mixed cryoglobulinemia

A

plasmapheresis to remove cryoglobulins and immunosuppressants

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63
Q

ADAMTS13

A

thrombotic thrombocytopenia purpura

fever, microangiopathic hemolytic anemia, renal fialure and neuro signs.

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64
Q

what to check for in antiphospholipid Ab syndrome

A

anti cardiolipin Ab

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65
Q

clinical assocations with minimal change disease

A

NSAIDs and lymphoma

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66
Q

clinical associations with FSGS

A

african american and hispanics
obesity
HIV
heroin use

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67
Q

clinical associations with membranous nephropathy

A

adenocarcinoma
NSAIDs
hep B
SLE

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68
Q

clinical associations with Membranoproliferative glomerulonephritis

A

Hep B and C

lipodystrophy

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69
Q

clinical associations with IgA nephropathy

A

URI

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70
Q

Hepatorenal syndrome

A

severe liver cirrhosis can increase NO and cause systemic vasodilation causeing decreased vascular resistance and BP which will cause renal hypoperfusion which then activates RAAS
patients do not respond to fluids or removal of diuretics

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71
Q

Tx hepatorenal syndrome

A

splanchnic vasoconstrictores like midodrine, octreotide and norepi

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72
Q

FeNa

A

hepatorenal syndrome

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73
Q

patient came into hospital acidemic, 3 days later now mildy alkalemic

A

loop diuretic

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74
Q

electrolyte abnormality in addisons

A

hyponatremia

hyperkalemia

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75
Q

what drugs can induce urinary retention

A

TCAs

76
Q

recurrent gross hematuria, proteinuria, sensorineural deafness with splitting of GBM

A

alports

77
Q

causes of non anion gap acidosis

A 
diarrhea
fistulas
acetazolamide
RTA
ureteral diversion
iatrogenic
78
Q

hyperkalemic RTA

A

type 4 RTA

seen in elderly with poorly controlled DM

79
Q

needle shaped crystals in urine

A

Uric acid, need CT because radiolucent

80
Q

complication of ureteral colic

A

ileus

81
Q

oliguria, azotemia and elevated BUN/Cr >20 in post op patient

A

acute prerenal failure from hypovolemia

give IV fluids

82
Q

when do you do renal and bladder US for children

A

infants

83
Q

hypovolemic hypernatremic - not Sx

A

5% dextrose

84
Q

euvolemic hypernatremia Tx

A

free water

85
Q

amikacin is what type Antibiotic

A

aminoglycoside

86
Q

which part of urethra when damaged causes inability to void

A

posterior

87
Q

clinical presentation of interstitial cystitis

A

bladder pain with filling, relief with voiding
increased frequency, urgency
dyspareunia

88
Q

Tx for recurrent interstitial cystitis

A

TCAs
analgesics
trigger avoidance

89
Q

immediate Tx for hyperkalemia with EKG changes

A

Ca carbonate

90
Q

Tx for hyperkalemia without EKG changes in patients with CKD

A

diuretics, cation exchange resins and hemodialysis

want emphasis on removing K

91
Q

how to correct metabolic alkalosis in patient with bulimia

A

normal saline

92
Q

comlication of Vesicoureteral reflux

A

renal scarring

93
Q

HTN
bilateral abdominal masses
microhematuria

A

ADPKD

94
Q

complications constipation in children

A

anal fissures, hemorrhoids, encopresis
enuresis/UTIs
vomiting

95
Q

risk factors for constipation in children

A

initiation solid food and cows milk
toilet training
school entry

96
Q

nephrosclerosis

A

hypertrophy and intimal medial fibrosis of renal arterioles

97
Q

glomerulosclerosis

A

progressive loss gomerular capillary surface with glomerular and peritubular fibrosis

98
Q

gross hematuria

A

bladder- cystitis or cancer
renal- glomerulonephritis
ureteral- nephrolithiasis
prostate-BPH

99
Q

gross hematuria with normal RBC

A

extra-glomerular

100
Q

renal complication sickle cell trait

A

painless hematuria from renal papillary necrosis or ischemia
or
inability to concentrate urine from vasa rectae damage and distal renal tubular acidosis
renal medullary cancer

101
Q

GU complications DM

A

erectile dysfunction and retrograde ejaculation
decrased libido and dysparenunia in women

–Neurogenic: decreased ability to sense bladder causing incomplete emptying and decreased urination
recurrent UTIs and overflow incontinence

can get diabetic nephropathy

102
Q

in a cocaine abuser, greatest GU complication

A

acute renal failure from rhabdomyolysis

103
Q

urine dip + for blood but no RBC on microscopy

A

myoglobin in the urine from muscle breakdown

104
Q

signs of acute renal injury from diuretic therapy

A

elevated Cr
elevated BUN with ratio>20
elevated anion gap

105
Q

presenting features of post strep glomerulonephrtiis

A

periorbital swelling, hematuria and oliguria

106
Q

Complement levels in post strep glomerulonephritis

A

low

107
Q

WBC cast

A

tubulo interstitital nephritis

108
Q

RBC casts

A

post strep glomerulonephritis

109
Q

low complement levels

A

post strep GN

membranoproliferative GN

110
Q

goal in patient with EKG findings and hyperkalemia. also has Hx of active coronary artery disease

A

give insulin with glucose

beta 2 agonists could cause angina and tachycardia

111
Q

isolated proteinuria in child

A

if around 1-2+ and all other values normal

repeat urine dip on 2 subsequent occasions

112
Q

glomerulonpehritis: post strep vs IgA

A

post strep happens 10-21 days post infection

IgA 5 days post infection

113
Q

post obstructive diuresis

A

obstruction causing difficulty urinating and occasionally having intermettent episodes of high volume urination because obstruction is temporarily relieved

114
Q

bleeding at end of urination

A

prostatic or bladder cause

115
Q

post seizure angion gap metabolic acidosis

A

results from lactic acidosis

116
Q

Tx lactic acidosis in seizure patient

A

observation and repeat Chem P in 2 hours to check acidosis

117
Q

Tx uric acid stones

A

hydration, alkalinization with potassium citrate and low purine diet

118
Q

most common cause of AA amyloidosis in US

A

rheumatoid arthritis

119
Q

envelope shaped stones

A

Ca oxalate

120
Q

hyperPTH likely to have what kidney stones

A

calcium phosphate

121
Q

signs BPH but also worsening Cr

A

do a renal US to look for hydronephrosis secondary to obstruction

122
Q

signs of cyanide toxicity

A 
flushing, cyanosis
headache, altered mental status, seizures
arrhythmias
tachypnea and pulmonary edema
abdominal pain, nausea, vomiting
metabolic acidosis from lactic acidosis
123
Q

how does Na nitroprusside work

A

vaso and veno dilates

124
Q

Tx for cyanide toxicity

A

Na thiosulfate

125
Q

if K is greater than 6.5 and have EKG changes

A

Ca gluconate

126
Q

Dx for posterior urethral injury

A

retrograde urethrogram

127
Q

what happens to BUN and Cr in pregnancy

A

decrease because renal plasma flow and GFR increase

128
Q

girl who was potty trained starts wetting bed and drinking alot uncontrollably

A

Diabetes I

129
Q

metabolic effect of chlorthalidone

A

hyperglycemia

thiazide diuretic

130
Q

how do thiazides cause hyperglycemia

A

impair insulin release from pancreas and glucose utilization in peripheral tissues

131
Q

what diseases haveCa oxalate stones

A

fat malabsorption syndromes

increase absorption of oxalate

132
Q

urine Ca Cr ratio in familial hypocalciuric hypercalcemia

A
133
Q

lab finding in acude tubular necrosis

A

muddy brown casts

134
Q

large blood on UA but none on microscopy

A

rhabdomyolysis

135
Q

urinary cyanide nitroprusside test

A

cystine stones

136
Q

hexagonal crystals stones

A

cystine stones

137
Q

patient is becoming septic. discontinue what metabolic drug

A

metformin because can cause lactic acidosis in AKI

138
Q

effect of beta agonists on K

A

decrease it

139
Q

HIV kidney disease

A

FSGS

140
Q

when given metabolic acidosis with high anion gam if given osmolality (osmolal gap) >10 high

A

ethylene glycol
methanol
propylene glycol

141
Q

high anion gap metabolic acidosis with rectangular envelop shaped Ca oxalate crystals!!!

A

ethylene glycol

142
Q

methylene glycol can lead to

A

blindness

143
Q

CI to using succinylcholine in rapid induction

A

hyperkalemia

144
Q

SLE

A

HA, photosensitive skin
thrombocytopenia
glomerulonephritis with low C3 and C4

145
Q

HUS

A

usually with shiga toxin E coli making microangiopathic hemolytic anemia, thrombocytpenia and renal failure

146
Q

Tx severe Sx hypercalcemia

A

IV normal saline

147
Q

long term management hypercalcemia of malignancy

A

bisphosphonates

148
Q

what med helps to pass a idney stone

A

tamsulosin

149
Q

nephrotic syndrome increases risk for what

A

atherosclerosis. because low oncotic pressure causes holding onto cholesterol and TG to keep pressure

150
Q

steril pyruia and WBC casts

A

tubulointerstitial nephritis

151
Q

Tx for dehydration in elderly

A

IV crystalloid- usually normal saline

152
Q

risk of correcting hyponatremia too quickly

A

osmotic demyelination

153
Q

pH PaCO2 HCO3 K and Cl in oyloric stenosis

A

inc pH, PaCO2, HCO3

dec K and Cl

154
Q

what causes hypovolemic hyponatremia

A

acute blood loss, renal (diuretics) diarrhea and vomiting and primary adrenal insufficiency

155
Q

Heb B GN

A

membranous nephropathy

156
Q

lymphoma renal disease

A

minimal change

157
Q

adenocarcinoma related renal pathology

A

membranous nephropathy

158
Q

drug therapy to preven calcium stones

A

thiazides to lower Ca excretion

159
Q

Tx for recurring uric acid stones

A

allopurinol

160
Q

bleeding with chronic renal failure

A

common. from platelet dysfunction
BT is prolonged
normal aPTT and PT

161
Q

abrnomal bleeding in chronic renal failure

A

from platelet dysfunciton.
normal count
normal PT and PTT
long BT

162
Q

how does DDAVP help with platelet dysfunction

A

increases release of factor VIII, Vw multimers from endothelial sites

163
Q

nephrotic range proteinuria with hematuria

A

membranoproliferative GN

164
Q

finding in membranoproliferative GN

A

dense intramembranous deposits that stain for C3

dense deposit disease

165
Q

what causes memrbanoproliferative GN

A

IgG Ab for C3 “nephritic factor” directed against C3 convertase
leads to persistent C’ activation and kidney damage

166
Q

what are the IC GN

A

SLE, post strep

167
Q

cell mediated injury Glomerulonephritis

A

crescenteric

168
Q

what are the non immunoogic kidney GN

A

diabetic nephropathy

HTN nephropathy

169
Q

Tx uncomplicated cystitis in non pregnant

A

nitrofurantoin
TMP-SMX
fosfomycin

170
Q

Tx complicated cystitis

A

fluoroquinolones

171
Q

Tx outpatient pyelonephritis

A

fluoros

172
Q

Tx inpatient pyelo

A

IV fluoro or aminoglycoside and ampicillin

173
Q

hyponatremic
euvolemic
after bolus of saline and urine Na increases while serum Na does not change

A

SIADH

174
Q

why in alcoholics is K hard to correct

A

hypoMg

175
Q

Tx SIADH with moderate Sx of confusion

A

hypertonic saline

176
Q

Tx severe SIADH having seizures

A

bolus hypertonic saline with Vasopressin antagonists like conivaptan

177
Q

first renal abnormality in diabetic nephropathy

A

glomerular hyperinfiltration

178
Q

first renal change that can be quantified for diabetic nephropathy

A

thickeness of GBM

179
Q

what cuase crystal induced acute kidney injury

A 
acyclovir
sulfonamides
MTX
ethylene glycol
protease inhibitors
180
Q

what is crystal induced acute kidney injury

A

crystal obstruction and direct renal tubular toxicity

181
Q

Tx for cushing like syndrome

A

spironolactone, aldosterone antagonist

182
Q

cause of potter sequence

A

posterior urethral valve

183
Q

Renal vein thrombosis is a complciation of what

A

nephrotic syndrome from loss of antithrombin III

184
Q

patient with nephropathy but on salt restriction and diuretics then suddenly develops severe sided pain with fever and gross hematuria

A

membranous nephropathy causing renal vein thrombosis

185
Q

most sensitive test to screen for diabetic nephropathy

A

random urine for microalbumin/Cr ratio

186
Q

electrolyte abnormality in TB

A

well if causing primary adrenal insufficiency then can cause hyperkalemia, hypoglycemia and also will cause decreased aldosterone secretion so lose Na save K and H causing normal anion gap with hyperkalemia and hyponatremic metabolic acidosis

Step2CK (26 decks)

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