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Nephrology > Test #2 > Flashcards

Test #2 Flashcards

1
Q

Nephritic characteristics

A

hematuria

rbc and mixed cell casts

variable proteinuria

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2
Q

Nephrotic characteristics

A

Marked proteinuria (>3.5 g/day)

Lipiduria

Fatty casts

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3
Q

Nephritic causes

A

Post-infectious/proliferative glomerulonephritis

IgA neuropathy/vasculitis (HSP)

Lupus nephritis

Thin basement membrane disease

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4
Q

Nephrotic causes

A

Systemic disease

  • Diabetic neuropathy
  • Amyloidosis

Minimal change disease

Focal segmental glomerulosclerosis (FSGS)

Membranous neuropathy

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5
Q

Focal Nephritic Patterns

A

ex: IgA nephropathy

Inflammatory lesions in <1/2 glomeruli

UA: rbc, ~rbc casts, mild protein

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6
Q

Diffuse Nephritic Patterns

A

ex: post-strep glomerulonephritis (PSGN)

Affects > 1/2 glomeruli

UA: lots of protein, rbc and rbc casts

Edema, HTN, may have renal insufficiency

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7
Q

Nephrotic Patters

A

Affects many glomeruli

No inflammation/immune complex deposits

Edema, hyperlipidemia, hypoalbuminemia

Ex: Diabetic neuropathy

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8
Q

Poststreptococcal glomerular nephritis (PSGN)

A

Most common acute nephritic cause

1-3 weeks post strep/3-6 weeks post GABHS

MOA: Glomerular immune complex disease, viral/parasitic infection (rare)

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9
Q

Poststreptococcal glomerular nephritis symptoms and diagnosis

A

Often asx; discolored urine w/ sediment, edema, HTN

Hx of strep infection w/in 3-6 weeks

UA: gross hematuria, proteinuria

Streptozyme test: antistreptolysin

Biopsy only to r/o other glomerular dx, late presentations w/o clear strep history

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10
Q

Recurrent hematuria episodes indicate:

A

IgA nephropathy

Not PSGN

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11
Q

Poststreptococcal glomerular nephritis treatment

A

Supportive

Sodium and water restriction w/ loop diuretic (edema and HTN)

Dialysis w/ acute renal failure

Recovery begins w/in 1st 2 wks

Late renal complications are rare: HTN, proteinuria, renal insufficiency

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12
Q

IgA Neuropathy/Berger’s Disease

A

Most common primary GN cause

Rare in blacks; 80% 15-35 yo

MOA: Mesangial depositions of IgA complexes

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13
Q

IgA Nephropathy Presentation

A

1: Gross recurrent hematuria possibly after URI (synpharyngitic)
- flank pain and fever
2: Microscopic hematuria which may progress, mild proteinuria
3: Nephrotic syndrome: protein and lipid urea, fatty casts
- edema, renal insufficiency, HTN, hematuria

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14
Q

IgA Nephropathy diagnosis and treatment

A

Dx: kidney biopsy -> IgA deposits in mesangium

-Can also indicates cirrhosis, celiac disease, HIV

Tx: BP control (ACEI)

-Severe/progressive: Corticosteroids +/- immunosuppressants

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15
Q

Henoch-Scholein Purpura (HSP)/IgA vasculitis

A

Systemic vasculitis from IgA complex deposits in tissue

Most common vasculitis in children (3-15 years)

Generally mild in kids, worse in adults

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16
Q

Henoch-Scholein Purpura symptoms

A

Tetrad:

1: Palpable purpura w/o thrombocytopenia or coagulopathy
2: Arthritis or arthralgia
3: Abdominal pain
4: Renal disease (GN)

Develops over days-weeks, presentation order varies

Spectrum w/ kids to adults: Kids: mild hematuria +/-proteinuria, adults: severe nephrotic syndrome/renal failure

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17
Q

Henoch-Scholein Purpura diagnosis and treatment

A

Dx: kidney bx - only w/ uncertain dx or severe renal involvement - marked proteinuria/impaired renal function

Tx: Crescentic GN - pulse IV methylprednisone, then oral prednisone

Rare progression to ESRD -> dialysis and transplant

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18
Q

Rapidly progressive glomerulonephritis (RPGN)

A

Acute GN w/ rapid progression to ESRD

Morphological crescent formation w/in glomerular vessel wall

-fibrin formation w/ macrophage, T cells, cytokines in Bowman’s space

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19
Q

Types of RPGN

A

1: Anti-glomerular basement membrane (GBM/Goodpasture syndrome)
- anti-GBM abs in lungs and glomerulus
2: Immune complex RPGN - deposit in glomeruli
- IgA Nephropathy, PSGN, lupus nephritis
3: Pauci-immune RPGN - necrotizing GN and vasculitis
- ANCA positive, systemic vasculitis symptoms

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20
Q

RPGN symptoms

A

Insidious - fatigue and edema

Acute - macroscopic hematuria, oliguria, edema, renal insufficiency

GBM - pulmonary hemorrhage, hemoptysis, pulmonary infiltrates, dyspnea

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21
Q

RPGN Diagnosis and Treatment

A

UA: hematuria, rbc casts, proteinuria

Increase BUN/Creat, renal bx to confirm

Serologic assay for type

Tx: Pulse methylprednisolone, PO cyclophosphamide, consider plasmapheresis

-treatment gets more specific w/ bx results

Catch early to minimize irreversible injury

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22
Q

Dark granular and epithelial casts in urine indicate:

A

Pure acute tubular necrosis

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23
Q

Crystal particles in urine

A

Crystalluric acute renal failure

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24
Q

wbc and wbc casts in urine:

A

Acute interstitial nephritis

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25
Q

rbc and rbc casts in urine:

A

Proliferative/necrotizing glomerulonephritis

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26
Q

Prerenal UNa, BUN/Creat, FENa

A

Urine Na: <20

BUN/Creat: >20:1 (>20)

FENa: <1

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27
Q

Intrinsic UNa, BUN/Creat, FENa

A

Urine Na: >20

BUN/Creat: <10:1 (<20)

FENa: >2

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28
Q

Postrenal UNa, BUN/Creat, FENa

A

Urine Na: variable

BUN/Creat: 10-20:1 (<20)

FENa: variable

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29
Q

Acute Interstitial Nephritis

A

Renal lesion causes creatinine clearance decline

Drugs most common cause - PCN, cephalosporin, sulfa, NSAIDs, Rifampin, Dilantin, Allopurinol

Infections dx also cause: strep, leptospirosis, CMV, Histoplasmosis, Rocky Mountain Spotted Fever

Immunologic causes: Lupus, Sjogren’s Sarcoidosis, Cryoglobulinemia

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30
Q

Acute Interstitial Nephritis sx and tx

A

Sx: fever, hematuria, peripheral eosinophilia, rash

-UA: rbc, +/- wbc/wbc casts, proteinuria (NSAIDS)

Tx: Supportive, remove cause

  • 1-2 week high dose steroids if persistent
  • rare progression to ESRD
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31
Q

Proteinuria monitoring

A

Initial assessment w/ new HTN, DM, hematuria, decreased GFR

Annual monitoring: Bx proven GN, reflux neuropathy, DM

Routinely monitor pts on nephrotoxic agents

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32
Q

Common CKD microorganisms

A

Staphylococcus

E. coli

Klebsiella (hospitalized pts w/ pulmonary infections)

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33
Q

Endocarditis prophylaxis

A

2g Amoxicillin OR 600 mg Clindamycin 1 hour before dentist

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34
Q

Immunizations and Dialysis

A

Screen for Hep B and C before you start on dialysis/put on transplant list

Influenza and Pneumococcus vaccine (revaccinate every 5 years)

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35
Q

CKD Medications to avoid

A

NSAIDs

Metformin if SCr >1.5 (men) 1.4 (women)

Magnesium-containing meds (laxatives, antacids)

Caution w/ Abx (PCN, cephalosporin, sulfa, fluroquinolones)

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36
Q

Renal Cell Carcinoma

A

1 renal cancer - men (60-80yo)

Originates in renal cortex

Rick: smoking, HTN, obesity, acquired kidney cystic dx

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37
Q

Clear Cell Carcinoma

A

PCT - most common RCC, Chromosome 3P deletion

Solid/less cystic, typically invades vasculature

Microscopic: lipid and glycogen cytoplasm, bland cells w/ poor differentiation

-forms solid nest, tubules w/ fine vasculature

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38
Q

Papillary Carcinoma (Chromophil)

A

PCT, trisomy 7, 16,17

Better prognosis than clear cell

Microscopic: delicate vascular cores w/ overlying tumor cell layer

-Psammoma bodies = necrosis/calcification @ tips

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39
Q

Chromophobe RCC

A

Cellular sheets darker than clear cell

Arise in CD intercalated cells, lower progression risk than clear cell

Microscopic: pink (eosinophilic) cell sheet w/ perinuclear halos

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40
Q

Collecting duct carcinoma (Bellini duct carcinoma)

A

Aggressive, affects young and Black

Rare

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41
Q

Oncocytoma

A

Oncocytes - C-met oncogene mutation

Well-differentiated, very eosinophilic granular cytoplasm

CD intercalated cells

Usually unilateral and single, mets are rare

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42
Q

RCC Clinical features

A

Triad: Flank pain, gross hematuria, palpable renal mass

Nonspecific features: fever, fatigue, weight loss, scrotal varicocele, paraneoplastic syndrome

Usually present late, asx early

Dx: US then CT

Refer cysts to urologist

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43
Q

RCC common metastasis sites

A

Lung

Abdominal lymph nodes

Bone

CT w/ a suspicious X-ray, bone scan/PET scan to locate

44
Q

RCC Treatment

A

Surgical removal - radical nephrectomy or

-Partial if <4 cm, unilateral tumor

Radical = take everything to Gerota’s fascia and adrenal, +/- part of IVC

45
Q

RCC Staging

A

Stage 1: <7cm, limited to kidney - 95% 5 year survival

Stage 2: >7cm, limited to kidney - 88%

Stage 3: tumor in major vein/adrenal/Gerota’s fascia/regional lymph node - 59%

Stage 4: Tumor beyond Gerota’s fascia or in >1 regional lymph node - 20%

46
Q

Wilm’s Tumor (Nephroblastoma)

A

Most common renal tumor in kids

Abnormal renal development - metanephric blastoma proliferation w/o tubular or glomerular differentiation

Risk: aniridia (iris), hemihypertrophy, undescended testes, hypospadias (ureter)

47
Q

Wilm’s Tumor symptoms and diagnosis

A

Sx: palpable mass, abdominal pain, HTN, hematuria, rarely bilateral

Dx: US and contrast CT, excision/bx for definitive diagnosis

48
Q

Wilms Tumor staging

A

Stage 1: unilateral, completely removable

Stage 2: cancer is beyond the kidney, but still completely removable

Stage 3: cancer is contained to abdomen, cannot remove completely

Stage 4: mets to lungs/liver/bone/brain

Stage 5: cancer in both kidneys (bilateral tumors are rare)

49
Q

Wilms Tumor treatment and appearance

A

Chemo for all

Radical nephrectomy for stages 1-4, get as much out as possible

Stage 5 - radical nephrectomy, pt must be on transplant list

Large, single, well-circumscribed tumor

-less hemorrhage than RCC, can have cyst formation

50
Q

Benign renal tumors

A

Renal papillary adenoma - Cortical tubules, trisomy 7 and 17

Renal fibroma/Hamartoma - small, benign fibrous nodule in renal pyramids

Angiomyolipoma - blood vessels, muscle, and fat => occur w/ tuberou sclerosis, easy to spot on radiograph

Can’t distinguish benign from malignant until excised and biopsied

51
Q

Transitional Cell Carcinoma (TCC)

A

Transitional epithelium in urinary tract - calyces to uretal orifice

Smoking, male, 60-70 yo, black

Sx: hematuria, renal colic, hydronephrosis

w/u: urine cytology, cystoscopy, IVP

Tx: radical nephroureterectomy and chemo

52
Q

Renal Sarcoma

A

Rare, mesenchymal cell tumor

Grow fast and big, peak incidence ~5th decade

Sx: abdominal pain, palpable mass, gross hematuria

Dx: CT

Tx: surgical excision

53
Q

Renal abscess

A

Hematogenous or UTI origin with obstruction

Enterococcus (E. coli) or staph

Sx: fever, chill.s abdominal pain, weight loss, hematuria

-looks like acute pyelonephritis

Dangerous w/ DM or advanced

54
Q

Renal abscess diagnosis and treatment

A

Ua: wbc, bacteria, protein hematuria, pyuria

CT for dx after UA, CBC (leukocytes), ESR/CRP = inflammation

Tx: Ampicillin + aminoglycosides + I&D if >5cm

Nephrectomy is last resort

55
Q

Acute pyelonephritis

A

Affects renal cortex, spares glomeruli and vessels

UA: wbc casts - formed in DCT

E. coli, proteus, Klebsiella, enterobacter

Treat aggressively in DM, pregnancy to prevent abscess

56
Q

Emphysematous Pyelonephritis

A

Necrotizing infection w/ gas formation

In poorly controlled DM, immunocompromised

Rapidly progressive -> fulminant sepsis w/ high mortality

57
Q

Acute Pyelonephritis symptoms and diagnosis

A

Sx: Shaking chills, fever, arthralgia/myalgia, flank/CVA pain

-urgency/frequency urination, V/D in peds

Dx: UA: wbc casts, bacteria, hematuria - culture

Get blood cultures and CBC (left shift)

CT for dx - hydronephrosis or inflammation/infection

US for obstruction

58
Q

Acute Pyelonephritis Treatment

A

Ampicillan (IV) - until 24 hours after fever resolves

Cipro/ofloxacin/Aminoglycosides/Bactrim PO 14 days after

Follow up w/ urine culture to confirm resolved

Refer if complicating factor (stone, reflux, tumor, neurogenic bladder)

Watch for sepsis: tachypnea, AMS

59
Q

Chronic Pyelonephritis hallmarks

A

Recurrent/persistent renal infections, usually w/ major anatomical abnormalities (VUR)

Asymmetric corticomedullary scarring/thyroidization

Eosinophilic casts in tubule

Chronic Pye and TEA: thyroidization, eosinophilic casts, asymmetric scarring

60
Q

Vesicoureteral reflux (VUR)

A

Kids w/ UTI - screen

Hydronephrosis @ birth, frequent UTIs, bedwetting

Primary: congenital muscular deficiency

Secondary: bladder outlet/functional obstruction

Detect w/ UA, VCUG and US - febrile/male UTI, <5yo w/ UTI

61
Q

Chronic Pyelonephritis symptoms and diagnosis

A

Sx: fever, lethargy, N/V, flank pain, dysuria, failure to thrive (kids)

Dx: UA: wbc, bacteria, hematuria

IVP is test of choice - calyceal dilation and blunting w/ cortical scars

VCUG, cystoscopy to document VUR

62
Q

Chronic Pyelonephritis Treatment

A

Stage 1&2: Chronic Abx prophylaxis until puberty - Amox, Bactrim, Septra, Nitrofurantoin

Stage 3&4: VUR = surgery w/ ureter reimplantation

-Surgery indicated w/ noncompliance, reflux past puberty, breakthrough infections

Aggressively tx UTIs

Dietary and BP control, routinely screen pregnant and FH

63
Q

Xanthogranulomatous pyelonephritis (XPN)

A

Chronic obstruction complication w/ infected stones

Massive kidney destruction, need immediate nephrectomy

Sx: adults - looks like pyelo w/ palpable flank mass and CVA tenderness

Children: type 1 affects genders equally, hits entire kidney

Type 2 hits girls, looks like Wilm’s tumor

1/2 have palpable mass, growth/weight retardation

64
Q

XPN diagnosis and treatment

A

Dx: UA: pyuria, bacteriuria, culture reveals G(-) organism

-E. coli, Proteus, Klebsiella; staph is rare

Anemia, increased ESR, LFTs w/ hepatomegaly

Tx: surgical removal + Abx

-can be partial if localized (kids) or bilateral dx

65
Q

Cystitis

A

Coliform (E.coli)/G+ (entercoccus) bladder infection

-Viral may occur in kids

Sx: irritative voiding, suprapubic pain, hematuria

Dx: UA - leukocyte esterase, nitrites, +/- blood

Tx: 1-3 days Nitrofurantion (pregnancy), Bactrim/Septra, fluroquinolones

Additional testing if male, recurrent, anatomic abnormality

66
Q

Nephrotic Syndrome Pathophysiology

A

Glomerular capillary wall breakdown/Electrostatic charge lost

Proteinuria occurs = Vit D deficiency, PTH increase (low Ca)

-24 hour UA to quantify protein loss

Hypoalbuminemia = decreased oncotic pressure = edema and hyperlipidemia

Hyperlipidemia from increased hepatic synthesis = lipiduria

67
Q

Minimal Change Disease

A

Nephrotic Syndrome in kids

Children, Adults w/ NSAIDs

Mild mesangial cell proliferation, flattened podocytes

Idiopathic, drugs, allergies, HL/Leukemia

Tx: Steroids 4-8 wks, 16 for adults

-continue after proteinuria resolves

68
Q

Focal Segmental Glomerulosclerosis (FSGS)

A

Nephrotic syndrome

Mesangial collapse and sclerosis in 1/2 glomeruli

Black, idiopathic nephrotic syndrome

Secondary cause: HIV, obesity, DM, lupus, nephrotoxic meds/chemicals

Tx: primary: diuretics, ACEI, statins, high-dose steroids 4-16 wks

69
Q

Membranous Nephropathy

A

Most common nephrotic syndrome in adults (5th-6th decade)

Basement membrane thickened w/ immune complex or electron dense deposits

Primary: idiopathic, autoantibodies

Secondary: Hep B/C antigenemia, AI, CA, drugs (gold, captopril, NSAIDs)

Protein leaked despite thickening due to damage electrostatic charge

70
Q

Nephrotic Syndrome Complications

A

Infection

Edema

Hypovolemia

HTN

Acute renal failure

Protein malnutrition

Thromboembolism (hypercoagulable w/ hypovolemia)

Vitamin D/Calcium deficiency

71
Q

Nephrotic Syndrome diagnosis and treatment

A

24 hour UA

Kidney biopsy - definitive Dx

Triad: proteinuria, edema, hypoalbuminemia

Tx: ACEI/ARB for proteinuria

  • diuretics/sodium restriction (edema)
  • Statins until cured (hyperlipidemia)
  • Anticoagulate w/ DVT (hypercoagulability)
72
Q

Systemic disorders causing Nephrotic disease

A

Amyloidosis

Diabetic Nephropathy

HIV-associated nephropathy

Hepatitis C

Multiple Myeloma

Sickle-cell disease

Tuberculosis

Gout

73
Q

Amyloidosis

A

Protein deposits in organs (mesangium and capillary loops)

Dx: UA w/ amyloiduria, biopsy, CT to evaluate extent

Tx: Dialysis, progress to ESRD w/ in 2-3 years

5 year survival (w/ heart affected too) <20%

74
Q

Diabetic Nephropathy

A

Most common ESRD cause - not always diabetes-induced

-Check onset, rbc/casts, another systematic dx, or ACEI/ARB

Microalbuminuria = screen w/ dipstick, 24 hour test to confirm

Intraglomerular HTN and hyperglycemia contribute to destruction

Tx: control sugars, BP, lipids, weight loss, Na restriction, loop diuretic

75
Q

HIV-Associated Nephropathy

A

Nephrotic presentation

Need renal biopsy to confirm = FSGS pattern

HAART slows progression, consider steroids + cyclosporine and ACEI

76
Q

Systemic Lupus (SLE)

A

Nephritic presentation most common

Monitor UA and chem panel

Biopsy to confirm

Tx: steroids

Different types - membranous nephropathy is worst

77
Q

Hepatitis C

A

Mixed nephrotic/nephritic pattern

80% ESRD pts also have this

Hematuria, proteinuria, HTN, anemia, hypocomplementemia

Tx: only w/ poor renal function, nephrotic, increased HTN, or fibrosis on bx

-INF to suppress viremia and improve renal function (9month dose)

SE INF: flu-like, weight loss, fatigue, fever

78
Q

Multiple Myeloma

A

Malignant plasma cells w/ Bence-Jones protein loss

Dx: serum electrophoresis w/ Bence-Jones on UA + hypercalcemia and urea

Tx: Correct Calcium, volume

  • Chemo for underlying Ca
  • plasmapheresis doesn’t help kidney
79
Q

Sickle-cell disease

A

Nephrotic presentation

Papillary necrosis

Hematuria, isosthenuria (urine osmolality = serum), proteinuria

Tx: Hydration, control dx

80
Q

Tuberculosis

A

Microscopic pyuria w/ sterile urine - culture for Dx

-need high suspicion/positive PPD for media

Tx: treat TB

81
Q

Gout

A

Overproducers or Underexcretors of uric acid

PCT dysfunction results in uric buildup

Tx: diet, hydrate, Allopurinol/Colchicine (reduce uric acid)

82
Q

Acute Renal Failure/Acute Kidney Injury

A

Abrupt (w/in <48 hrs) decline in kidney function

-Increased SCr or decreased output or dialysis needed

Sx: N/V, malaise, HTN, pericardial effusion/rub, arrhythmias, abdominal pain, encephalopathic changes

83
Q

BUN and Creatinine increases

A

BUN: burn, tetracycline, steroids, fever, GI bleed, catabolic state

-converted from ammonia in liver

Creatinine: secretion blocked by cimetidine or Trimethoprim

84
Q

Acute Kidney Injury labs

A

Increased BUN/Creat, hyperkalemia, hyperphosphatemia

Decreased GFR, hypocalcemia, anemia

Platelet dysfunction

Anion gap metabolic acidosis

85
Q

Pre-renal AKI

A

Lack of blood flow to glomerulus

-ACEI/ARB (efferent) or NSAIDs (afferent) cause vasodilation

Urine has low sodium, high osmolality due to low perfusion-> increased Na/H2O absorption

Tx: underlying cause, maintain euvolemia and electrolytes

-Avoid nephrotoxic drugs, may need short dialysis course

86
Q

Post-renal AKI

A

Reversible, least common AKI cause (BPH usually)

Sx: olig/anuria, lower back/abdominal/flank pain, enlarged prostate/pelvic mass (rectal exam), distended bladder

Dx: US, Catheterization, CT for stones/hydronephrosis

-BUN/Creat 10-20:1

Tx: Bladder catheter, refer to Urology for stent/resection/nephrostomy

87
Q

Intrinsic AKI

A

Most common AKI

Caused by:

  • Acute Glomerulonephritis
  • Acute Interstitial Nephritis
  • Acute Tubular Necrosis
  • Contrast Nephropathy (ATN form)
88
Q

Acute Glomerulonephritis

A

Inflammation/proliferation of glomerular tissue

-damages basement membrane, mesangium, capillary endothelium

Sx: rbc casts, significant proteinuria

PSGN, Systemic (lupus, Wegeners, Goodpasures)

89
Q

Acute Interstitial Nephritis

A

Medications, bacteria/viral/fungal infection

Eosinophils on UA

Maculopapular rash, fever, arthralgias

90
Q

Acute Tubular Necrosis

A

Most common intrinsic injury

Ischemia, sepsis, nephrotoxic drugs -> tubules fail to function

UA: Deeply pigmented, coarse granular casts are hallmark

91
Q

Nephrotoxic drugs

A

Aminoglycosides

Ampho B

Chemo

Acyclovir

Ethylene glycol

Sulfa

Cephalosporins

92
Q

Contrast Nephropathy

A

Form of ATN

24-48 hours post exposure

Prevention: minimize contrast, Mucomyst, hydrate, stop Metform for 48 hrs after

93
Q

Fractional excretion of sodium and urine sodium concentration (FENa)

A

Determine if AKI cause is prerenal or ATN

100* (UNa x SCr)/(SNa x UCr)

94
Q

AKI Management and general workup

A

Maintain euvolemia, electrolytes, BP

  • stop potentially nephrotixic meds
  • may need temporary dialysis

Workup: Assess volume status, UA, CBC, BUN/Creat (BMP), FENa

95
Q

Respiratory acidosis

A

Increase ventilation to correct

Low pH with high CO2

Causes: CNS depression, hypoventilation, impaired respiratory muscle function, pulmonary disorders

96
Q

Respiratory Alkalosis

A

Increased pH with decreased CO2 - hyperventilation

Causes: Psychological response, medications, increased metabolic demand, CNS lesion

97
Q

Metabolic Acidosis

A

Lack of bicarb OR too much acid

  • GI/renal loss
  • Renal failure, DKA, ASA overdose, hypoxic tissue

Anion gap narrows down etiology

98
Q

Increased Anion Gap Metabolic Acidosis

A

MUDPILES

Methanol intoxication

Uremia

DKA/Alcoholic

Paraldehyde

Isoniazid/Iron overdose

Lactic acid

Ethylene glycol

Salicylate overdose

99
Q

Anion Gap

A

Na - (HCO3+Cl)

Normal = 12 +/-4

>20 = High serum AG => metabolic problem always

100
Q

Non-Anion Gap Metabolic Acidosis

A

USED CAR

Ureteral-sigmoid diversion (pee into intestine)

Small bowel fistula/Saline administration

Endocrinopathies (Addisons, HyperPTH)

Diarrhea

Carbonic anhydrase inhibitors

(hyper)Alimentation (supplementary/artificial nutrition)

Renal tubular acidosis

101
Q

Metabolic Alkalosis

A

Too much bicarb

Gastric suctioning, vomiting, diuretics, antacids

Check Cl here -> chloride-responsive if UCl <10

-Chloride-resistant if UCl> 10 => Mineralocorticoid problem

Contraction alkalosis with large volume loss (diuretics) but bicarb remains the same

102
Q

High serum anion gap

A

R/o DKA/alcoholic or lactic acidosis

103
Q

Delta Gap

A

Used for Metabolic acidosis

Calculate how abnormal AG is

measuredAG - 12 = change anion gap

24-HCO3 = changed bicarb

AG>BC = metabolic acidosis also present (mixed disorder)

AG<bc></bc>

<p>AG = BC +/-2 = no additional issue</p>

</bc>

104
Q

Winter’s Formula

A

Metabolic acidosis

Determine if underlying concomitant respiratory disorder

PaCO2 = 1.5(HCO3)+8 +/-2

OR PCO2 = digits of pH

PCO2>PaCO2 = concomitant respiratory acidosis

PCO2<paco2></paco2>

<p>+/-2 = each other =&gt; no underlying disorder</p>

</paco2>

105
Q

Summer’s formula

A

Metabolic Alkalosis

Calculate respiratory compensation

PaCO2 = 0.7(HCO3 +21) +/-2

PCO2>PaCO2 = respiratory acidosis

PCO2

Nephrology (2 decks)

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