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CK - IM > SUM - CH7 - Renal > Flashcards

SUM - CH7 - Renal Flashcards

1
Q

Acute Kidney Injury: RIFLE Criteria

A

Risk: GFR 4 weeks
ESRD: Loss of function > 3 months

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2
Q

NSAIDS –> AKI: how

A

Prostaglandins dilate afferent arteriole

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3
Q

ACE inhibitors –> AKI: how

A

Angiotensin constricts efferent

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4
Q

Rhabdomyolysis: K+, Ca++, urea

A

Hyperkalemia, Hypocalcemia, hyperuricemia

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5
Q

Rhabdo: treat

A

Mannitol (osmotic diuretic), IV fluids, Bicarb (drives K+ into cells)

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6
Q

Prerenal AKI: casts

A

Hyaline

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7
Q

AKI: Complications: K+ eitiology

A

Hyperkalemia:

Dt/ decreased excretion, and decreased uptake into cells due to acidosis and tissue destruction

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8
Q

AKI: Most common early mortal complication (2)

A

Pulmonary oedema

Hyperkalemic cardiac arrest

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9
Q

AKI: most common late complication

A

Infection:

dt/ uremia disrupting normal WBC function (cellular and humoral immunity)

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10
Q

Radiographic contrast –> ATN (how?)

A

vasospasm of afferent arteriole

prevent with saline hydration

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11
Q

Chronic renal insufficiency

A

Kidney function is irreversibly comprimised but not failed.

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12
Q

Calciphylaxis

A

Hyperphosphatemia –> PHosphate binding Ca++ –> vascular calcifications –> necrotic skin lesions

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13
Q

CKD: treatment: Diet

A

Low protein, low Potassium, low phosphate, low magnesium

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14
Q

CKD: treatment: Blood pressure

A

ACEi: also dilate efferent arteriole –> less progression of proteinuria

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15
Q

CKD: treatment: Hyperphosphatemia

A

Calcium citrate (potassium binder)

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16
Q

CKD: treatment: Secondary hyperparathyroidism

A

Calcium, and vitamin D

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17
Q

CKD: treatment: Anemia

A

Erythropoetin

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18
Q

CKD: treatment: Pruritis

A

Cholestyramine, capsaicin cream, UV light

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19
Q

Dialysis: absolute indications

A 
Acidosis
Electrolytes
Intoxications - methanol, ethylene glycol, lithium, aspirin
Overload - hypervolemia (unmanagable)
Uremia
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20
Q

Best form of permanent dialysis access

A

Arteriovenous fistula (or implantable graft)

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21
Q

Advantage of hemodialysis

A

High flow rates and efficient dialyzers = Quick

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22
Q

Disadvantage of hemodialysis

A

Can cause fluid compartment shifts

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23
Q

Advantage of peritoneal dialysis

A

Can be taught to patient to do on their own

Mimics normal kidney function more accurately

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24
Q

Disadvantage of peritoneal dialysis

A

Risk of peritonitis

Risk of hyperglycemia / hypertriglyceridemia dt/ high osmolar solution

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25
Q

Diagnosis of proteinuria

A
  1. Urine dipstick test (for albumin)

2. If positive, Urinalysis

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26
Q

Test for microalbuminuria

A
  1. Special dipstick
  2. If positive, perform radioimmunoassay (most sensitive and specific test for microalbuminuria)
    (early sign of diabetes)
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27
Q

Treatment of symptomatic proteinuria

A
  1. Treat underlying disease
  2. ACEi - especially diabetics w HTN
  3. Diuretics - edema
  4. Antihyperlipidemics
  5. Limit dietary sodium and protein
  6. Vaccinate
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28
Q

Tamm-Horsfall protein

A

Protein secreted by tubules

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29
Q

Orthostatic proteinuria

A

transient, dt/ standing for too long

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30
Q

Microalbuminuria =

A

30 - 300 mg / 24h

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31
Q

Eosinophils in urine

A

Acute interstitial nephritis (non-nsaid induced)

Eosinophils detected by wright and hansel stains

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32
Q

dysmorphic RBCs in urine

A

glomerulonephritis

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33
Q

Cytoscopy: when?

A

Hematuria (w/o h of infection or trauma)
+ normal renal ultrasound / CT
+ bladder sonography shows mass

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34
Q

AKI: Best initial imaging test

A

Renal sonogram. Avoid contrast studies

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35
Q

AKI: BUN:Creatinine ratio

A

Prerenal / post renal = 20:1

Intrinsic = 10:1

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36
Q

AKI: Unknown etiology followup

A
  1. Urinalysis

2. UNa, FeNa, [U]

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37
Q

Isosthenuria

A

[Urine] = [plasma]

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38
Q

Rhabdo Diagnosis

A

Blood on dipstick, no cells on microscopy

39
Q

Rhabdo: K+, Ca++, PO4-, Urea

A

Hyperkalemia - released from cells
Hypocalcemia - binding damaged muscle
Hyperphosphatemia
Hyperuricemia - nuclei chromatin lysis

40
Q

Rhabdo: treatment (3)

A

Saline
Mannitol - osmotic diuretic –> quicker passage of MB = less time for damage
Bicarb - Drives K+ back into cells / prevents precipitation of MB in urine

41
Q

Hepatorenal syndrome (labs, dt/)

A

Lab values: Mimic Pre-renal azotemia

Dt/ severe liver disease

42
Q

Hepatorenal syndrome treatment

A

Midodrine, ocreotide, albumin

43
Q

Atheroemboli: AKI - S/S

A

Livedo reticularis - blue/purplish skin lesions in fingers and toes
Ocular lesions

44
Q

Atheroemboli: AKI - Diagnosis

A

Eosinophillia, low Compliment levels, Eosinophiluria, Elevated ESR

45
Q

Atheroemboli: AKI - Most accurate diagnostic test

A

Biopsy of purplish skin lesion = cholesterol crystals

unneccessary because there is no specific treatment for this

46
Q

Gross, Painless, Hematuria (2)

A

RCCa, or bladder cancer

47
Q

Hematuria: Diagnosis (3)

A
  1. Dipstick
  2. Urinalysis
  3. If pyuria; send for urine culture
    …
48
Q

Membranoproliferative glomerlulonephritis: eitiology

A

Hep C,

Hep B, Syphilis, lupus, cryoglobulinemia

49
Q

Post strep GN: timeframe

A

10-14 days

50
Q

Post strep GN: treatment

A

Supportive: anti-HTN, Loop diuretics for edema

51
Q

Goodpastures: treatment

A

Plasmaphoresis for Ab, cyclophosphamide and steroids block new Ab formation

52
Q

Renal papillary necrosis: diagnosis

A

Excretory urogram

53
Q

Renal tubular Acidosis: Broad Def

A

Inability to lose H+ in urine –> non-anion gap hyperchloremic metabolic acidosis

54
Q

RTA: Type 1: Pathophys

A

Inability to secrete H+ ions in distal tubule

55
Q

RTA: Type 1: Urinalysis / Blood

A

pH>6, increased excretion of Na+, Ca++, PO4-, K+, SO4-,

56
Q

RTA: Type 1: Problems / s/s

A
  1. Decreased ECF
  2. Hypokalemia
  3. Renal stones, nephrocalcinosis
  4. Rickets, osteomalacia in children
57
Q

RTA: Type 1: Causes

A

COngenital, multiple myeloma, nephrotoxicity, autoimmune disease, medullary sponge kidney, analgesic nephropathy

58
Q

RTA: Type 1: Treatment

A

Correct acidosis with sodium Bicarb (also prevent kidney stones)
Administer phosphate salts (promotes excretion of acid)

59
Q

RTA: Type 2: Pathophys

A

Inability to reabsorb HCO3- in PCT

60
Q

RTA: Type 2: Urinalysis / blood

A

K+ Loss, Na+ loss

61
Q

RTA: Type 2: Causes

A
  1. Fanconi syndrome

2. Cystinosis, Wilson disease, Lead toxicity, MM, Nephrotic syndrome, Amyloidosis

62
Q

RTA: Type 2: S / S

A

Hypokalemia

No Nephrolithiasis, nephrocalcinosis

63
Q

RTA: Type 4: Pathophys

A

Inability to reabsorb Na+,

Decreased K+/H+ secretion

64
Q

RTA: Type 4: Cause

A

Any condition that causes Hypoaldosteronism

65
Q

RTA: Type 4: urinalysis / blood

A

Hyperkalemia, acidic urine

66
Q

Hartnup syndrome: Defect

A

Neutral amino acid Transporter

67
Q

Hartnup syndrome: Deficiency

A

Tryptophan, (NAD; niacin)

68
Q

Hartnup syndrome: S / s

A

Pellagra: dementia, diarrhea, ataxia, psychiatric disturbances

69
Q

Hartnup syndrome: Treat

A

Supplement nicotinamide

70
Q

Fanconi syndrome treatment

A 
Phosphate
Potassium
Alkali
Salt 
Hydration
71
Q

Renal failure in ADPKD: cause

A

Recurrent pyelonephritis and nephrolithiasis

72
Q

ADPKD: treatment (3)

A

Drain cysts if symptomatic
Treat infection
Control HTN

73
Q

AIN: Clinical features

A

Rash, Fever, Eosinophils,

Pyuria and hematuria may be present

74
Q

Risk Factor for Nephrolithiasis: Gender?

A

Male

75
Q

Risk Factor for nephrolithiasis: Diet

A

Low Ca++ / High Oxalate

76
Q

Calcium stones: Content

A

Calcium oxalate or calcium phosphate

77
Q

Calcium stones: appearance

A

Bipyramidal (envelope) or biconcave ovals (dumbell)

78
Q

Calcium sotnes: X-Ray

A

Radiopaque

79
Q

Calcium stones: cause

A

Secondary to hypercalciuria and hyperoxaluria

80
Q

Uric Acid stones: Precipitation

A

Acidic urine, hyperuricemia

81
Q

Uric Acid stones: Appearance

A

Flat square plates, rhomboid or rossette

82
Q

Uric acid stones: X-Ray

A

Radiolucent (require CT, ultrasound, or IVP for detection)

83
Q

Struvite stones: X-Ray

A

Radiodense

84
Q

Struvite stones: Appearance

A

Rectangular prisms Coffin lid

85
Q

Struvite stones: precipitation factors

A

UTI (urease producing organisms), High pH in urine,

86
Q

Struvite stones: Composition

A

Ammonium / magnesium or Ammonium / phosphate

87
Q

Cystine stones: Appearance

A

Hexagonal shaped crystals (radioluscent)

88
Q

Kidney stones: Size to pass

A
89
Q

Kidney stone: S/S

A

Renal colic, Hematuria, UTI

90
Q

Kidney stone Diagnosis:

A

Urinalysis, Urine culture, 24h urine, serum chemistry. X-Ray, CT, IVP, renal ultrasoundography if can’t have radiation (pregnancy

91
Q

Kidney stone: Treatment - Mild to moderate pain

A

High fluid intake,

oral analgesia while waiting for stone to pass

92
Q

Kidney stone: Treatment - Severe pain (with vomiting)

A

IV fluids and pain control,
Obtain KUB and IVP,
If no stone after 3 days consider urology

93
Q

Kidney stone: Treatment - Surgery neccesary

A

(when pain not controlled by narcotics)

Extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy

94
Q

Kidney stone: Indications for admission

A
  • Pain not controlled with oral meds
  • Anuria
  • Renal colic + UTI / Fever
  • Large stone > 1cm

CK - IM (7 decks)

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