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Renal > Tubules- Clinical > Flashcards

Tubules- Clinical Flashcards

1
Q

What is cause of the diarrheal form of HUS?

A

ingesting meat with EHEC (O157:H7) with shiga-like toxin

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2
Q

What is the nondiarrheal form of HUS associated with?

A

Oral contraceptive, cyclosporine, tacolimus, mitomycin C, bleomycin, ticlopridine or quinine, underlying malignancy, radiotherapy or familial recurrence

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3
Q

What are the 3 characteristics of all HUS syndromes?

A

microangiopathic hemolytic anemia and thrombocytopenia

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4
Q

Case: adult presents with acute sx of oliguria, flank pain, renal importment and arthralgia. Labs show eosinophilia. What has this pt taken to cause this?

A

Antibiotics or NSAIDs

Acute interstitial nephritis

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5
Q

What are the 2 most common causes of AIN?

A

Methicillin and NSAIDs

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6
Q

Case: pt presents with headaches, arthritis, msuclar aches, and a recent history of a peptic ulcer. Hx shows fibromyalgia. Biopsy shows chronic interstitial nephritis with papillary necrosis. What has this pt been taking to cause the problem?

A

Analgesics

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7
Q

Case: pt presents with pain, hematuria, HTN, and renal insufficiency. Imaging shows multiple bilateral renal cysts and cysts on the liver, spleen, and pancreas. What is the mutated gene to cause this disorder?

A

PKD1 on q16 –> can’t encode polycystin 1

polycystic kidney disease

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8
Q

Rhabdomyolysis, vigerous exercise, and ingesting of cooked meat can do what to serum creatinine level?

A

↑

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9
Q

What are the 3 causes of increased serum BUN independent of GFR?

A

GI bleed
Tissue trauma
Glucocorticoids

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10
Q

Case: pt presents with ↓ GFR, azotemia, and oliguria. You suspect prerenal azotemia. What happens to the serum BUN:Cr and FENa?

A

BUN:Cr > 15

RAAS activated –> ↑ reabsorption of urea

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11
Q

What causes prerenal ARF?

A

↓ blood flow

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12
Q

What is the main cause of POSTrenal ARF?

A

bladder outlet obstruction

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13
Q

If I say: “urine osmolality is increased early and the sediment is usually benign, with only hyaline and occasional granular casts” what is the Dx?

A

Prerenal azotemia

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14
Q

If I say: “urine that is isosmotic with the serum and urinary sediment that may contain tubular epithelial cells, granular cells, and amorphous material” what is the Dx?

A

Acute tubular necrosis

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15
Q

if I say: “urinary eosinophils and leukocytes” what is the Dx?

A

Acute interstitial nephritis

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16
Q

What 4 conditions give an FENa < 1%?

A
  1. Renal artery stenosis
  2. ↓ intravascular volume
  3. CHF
  4. Advanced cirrhosis

(anything with ↓ renal blood flow)

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17
Q

What is the 1 condition where the FENa is > 3%?

A

Acute tubular necrosis

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18
Q

What are the 4 electrolytes that msut be limited in pts with ARF?

A

K, Na, Mg, and phosphorus

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19
Q

This is the syndrome characterized by advanced liver disease and portal HTN associated with ARF.

A

Hepatorenal syndrome

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20
Q

Urinary Na < 20 mEq/L, urine osmolality > 500 mOsm/L, and a low FENa is consistant in hepatorenal syndrome and what other syndrome?

A

Prerenal disease

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21
Q

What are the 4 causes of chronic kidney disease?

A

Diabetes
HTN
Glomerulonephritis
Other/unkown

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22
Q

For those with chronic kidney disease, what is the target blood pressure?

A

<130/80

23
Q

For those with chronic kidney disease and proteinuria, what is the target blood pressure?

A

< 125/75

24
Q

What are the 2 anti-HTN meds for early renal disease?

A

ACEi’s

ARB’s

25
Q

What are the 2 Tx’s for hyperphosphatemia seen in CRF?

A

Low-phosphorous diet

Phosphate binder

26
Q

Pt’s with fluid overload, acidosis, hyperkalemia, hypernatremia, and uremic signs and Sx should get what?

A

Dialysis bitch

27
Q

What are the 2 viral diseases that dialysis pts are at an increased risk for obtaining?

A

HBV and HCV

28
Q

What is the first process in evaluating hyponetremia?

A

Measure serum osmolality

29
Q

What are the 3 causes of isosmotic hyponatremia?

A

Severe hyperTGemia
Severe hyperproteinemia
Isotonic infusion of glucose, mannitol, or Gly

30
Q

What are the 2 causes of hyperosmotic hyponatremia?

A

Severe hyprglycemia

Hypertonic infusions of glucose, mannitol, or Gly

31
Q

Severe volume depletion, thiazides, and adrenal insufficiency can cause what form of hyponatremia?

A

hypo-osmotic hypovoluemic hyponatremia?

32
Q

Edematous states and renal failure can cause what type of hyponatremia?

A

hypo-osmotic hypERvolemic hyponatremia

33
Q

Hypothyroidism, addisons, reset osmostat, psychogenic polydipsia, and SIADH can cause what form of hyponatremia?

A

Hypo-osmotic euvolemic hyponatremia

34
Q

Case: pt presents with clinical euvolemia, hypotonic plasma, urine

A

SIADH

35
Q

What are the 3 most serious causes of SIADH?

A

Small cell carcinoma of the lung
CNS disorders
Drugs

36
Q

What is the eqn to calculate total Na deficit?

A

Na deficit = TBW (lean body weight x 0.5) x (desired serum Na) - (current serum Na)

37
Q

What is 1 treatment for hypervolumertric hyponatremia?

A

Diuretics

38
Q

Case: pt presents with irritability, hyperreflexia, hypertonicity, ataxia, and recurrent seizures. What is the Dx?

A

Hypernatremia

39
Q

What is the tx for hypovolemic hypernatremia?

A

Saline followed by hypotonic sln

40
Q

What is the tx for hypervolemic hypernatremia?

A

Dialysis

41
Q

What is the tx for euvolemic hypernatremia?

A

Free water

42
Q

Li, demeclocycline or amphotericin B can induce what?

A

Nephrogenic DI

43
Q

What 2 electrolyte imbalances may induce nepohrogenic DI?

A

Hypercalcemia + Hypokalemia

44
Q

Which disorder has a high serum Na: DI or primary polydipsia?

A

DI

45
Q

What is the sign that implies volume depletion?

A

Orthostatic hypotension

46
Q

What is the sign that implies volume excess?

A

Edema

47
Q

What is the normal range for an anion gap?

A

8-12

48
Q

What are the causes of a high anion gap acidosis?

A 
MUDPILES 
Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde
Isoniazid
Iron
Lactic Acidosis
Ethanol 
Ethylene glycol
Salicylates
49
Q

What are the causes of type 4 renal tubular acidosis?

A

diabetes mellitus, interstitial nephritis, spironolactone, amiloride, triamterene, or cyclosporine

50
Q

This is the difference between measured serum osmolality and calculated serum osmolarity.

A

Osmolar gap

51
Q

What is the eqn for the calculated osmolar gap?

A

Calculated osmolar gap: (2Na) + (glucose/18 + BUN/2.8)

52
Q

Why do we use the osmolar gap?

A

Screen for toxins

53
Q

Case: pt presents to ER after attempted suicide from drinking large amounts of rubbing alcohol. Labs were being sent for osmolar and anion gaps. What would be the expected changes?

A

↑ osmolar gap

anion gap unchanged

54
Q

What is the treatment for toxic alcohol ingestion?

A

Give them vodka.

Seriously. EtOH alters competes with ingested toxic alcohol and it facilitates its removal.

Renal (7 decks)

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