Uworld renal Flashcards
Describe the effect of nephrotic syndrome on lipids/cholesterol and thrombosis?
- low plasma oncotic pressure (due to hypoalbuminemia) increases hepatic lipoprotein synthesis
- The results is an increase in serum cholesterol and triglyceride levels, which increases the risk for atherosclerotic disease
- loss of antithrombin III in urine –> hypercoagulability
patient with severe left lower abdominal pain radiating to the groin, vomiting, and unremarkable findings on abdominal exam, has typical features of what
obstructive ureterolithiasis
what are the preferred modalities for diagnosing a ureteral stone
- US
- NONcontrast spiral CT scan of the abdomen and pelvis
TMP/SMX effect on K+
-causes HYPERkalemia by blocking the epithelial sodium channel in the collecting tubule
Describe the management of ureteral stones
- if symptomatic look for urosepsis, acute renal failure and complete obstruction . . . if yes then urology consult
- if no then look at stone size
- if <10 mm then medical management: Hydration, pain control alpha blockers, strain urine
- if >10mm and uncontrolled pain without passage in 4-6 weeks then urology consult
Alpha-1 receptor blockers such as this act on the distal ureter, lowering muscle tone and reducing reflex ureteral spasm secondary to stone impaction. These agents facilitate stone passage and reduce the need for analgesics
Tamsulosin
The advantages of renal transplantation over dialysis are what?
- Better survival and quality of life
- Anemia, bone dx, and HTN persist in spite of dialysis; these are better controlled by transplant
- Transplant pts have a return of normal endocrine, sexual, and reproductive functions, and enhanced energy levels; thus, returning to fulltime employment and more strenuous physical activity is possible
- in diabetics, autonomic neuropathy persists or worsens after dialysis; whereas, it stabilizes or improves with transplantation
- Expected survival rate after transplantation is 95% at one year and 88% at 5 years
The most common renal vascular lesions seen in HTN are what?
-arteriosclerotic lesions of afferent and efferent renal arterioles and glomerular capillary
DM nephropathy is characterized by what renal pathological features
- increased extracellular matrix
- basement membrane thickening
- mesangial expansion
- fibrosis
Acute hyponatremic encephalopathy is a medical emergency and should be treated with what?
-Hypertonic (3%) saline with close monitoring
Patient has mild asymptomatic hypercalcemia and normal renal function. In light of a high-normal PTH level and low urinary calcium excretion. this presentation is consistent with what
familial hypocalciuric hypercalcemia
-benign autosomal dominant disorder caused by a mutation of the calcium sensing receptor (CaSR)
In the evaluation of hypercalcemia, an elevated (or inappropriately normal) PTH level suggest either primary hyperparathyroidism or familial hypocalciuric hypercalcemia. How do you differentiate between the 2?
- Patients with primary hyperparathyroidism have INCREASED urinary calcium excretion due to excessive mabilization of calcium from bones
- patients with FHH usually have very low urinary calcium levels (typically <100 mg/24 hr)
The most commonly implicated medication in nephrogenic diabetes insipidus are what?
- Lithium
- Demeclocycline
- foscarnet
- cidofovir
- amphotericin
In a patient with a history of a total nephrectomy and flank pain, poor urine output, intermittent episodes of high volume urination
Unilateral obstructive uropathy due to renal calculi
Clinical associations with Focal segmental glomerulosclerosis
- African American and Hispanic
- Obese
- HIV
- Heroin use
Clinical associations with Membranous nephropathy
- Adenocarcinoma (e.g. breast, lung)
- NSAIDs
- hepatitis B
- SLE
Clinical associations with Membranoproliferative glomerulonephritis
- Hepatitis B and C
- Lipodystrophy
Clinical associations with minimal change disease
- NSAIDs
- lymphoma
Clinical associations with IgA nephropathy
URI
Describe the effect of thiazide diuretics (Chlorthalidone, HCTZ) on insulin and glucose
- impairs both insulin release from the pancreas and glucose utilization in peripheral tissues
- Thiazide-induced glucose intolerance is seen more commonly in patients with DM and metabolic syndrome
Chronic alcoholism is associated with a high incidence of several electrolye abnormalities of which hypomagnesemia is the most common (likely due to poor nurtritional intake, alcohol induced renal losses, and diarrhea). Hypomagnesemia commonly occurs together with this electrolyte abnormality and is a well-known cause of refractory cases and sometimes does not improve with repletion.
Hypokalemia
-Also common cause of hypocalcemia
Clinical presentation of interstitial cystitis (painful Bladder Syndrome)
- Bladder pain with filling, relief with voiding
- increase frequency, urgency
- Dyspareunia
Renal transplant dysfunction in the early post-op period can be explained by a variety of causes, including ureteral obstruction, acute rejection, cyclosporine toxicity, vascular obstruction, and acute tubular necrosis. Acute rejection is best treated with what?
IV steroids
What is the most common cause of abnormal hemostasis in patients with chronic renal failure
platelet dysfunction
What are the 3 possibilities when a patient has symptoms consistent with typical renal colic but no stones are identified on conventional radiographs
- Radiolucent stones (uric acid stones, xanthine stones)
- Calcium stones < 1-3 mm in diameter
- Non-stone ureteral obstruction
Treatment of uric acid stones includes what
- hydration
- Alkalinization of the urine
- low purine diet
How can you alkalinize urine in the treatment of uric acid ureteral stones
-Oral potassium citrate . . uric acid stones are highly soluble in alkaline urine
What is indicated for initial therapy in patients with HTN and renal artery stenosis?
- ACEI’s or ARBs
- Renal artery stenting or surgical revascularization is reserved for patients with resistant HTN or recurrent flash pulmonary edema and/or refractory heart failure due to severe HTN
Short term management of severe (>14) hypercalcemia
- Normal saline hydration plus calcitonin
- AVOID loop diuretics unless volume overload (heart failure) exists
What is the cornerstone of therapy for renal stone disease?
hydration
major extra renal complications of Autosomal dominant polycystic Kidney disease
- Berry aneurysms
- Hepatic cysts
- Valvular hearts disease - most often mitral valve prolapse and aortic regurgitation
- colonic diverticula
- Abdominal wall and inguinal hernia
What is the most common cause of death in dialysis patients?
- Cardiovascular disease . . it accounts for approximately 50% of all deaths in this population
- it is also the most common cause of death in renal transplant patients
Clues that lead to diagnosis of cystinuria
- personal history of recurrent stones since childhood
- positive family history
- Typical hexagonal crystals on UA
- positive urinary cyanide nitroprusside test
What is the most common form of nephrotic syndrome in patients with Hodgkin lymphoma?
Minimal change disease
The dietary recommendations for patients with renal calculi are what?
- Increased fluid intake
- Decreased sodium intake
- Normal dietary calcium intake
Metformin should not be given to acutely ill patients with acute renal failure, liver failure, or sepsis as these condition increase the risk of what?
lactic acidosis
The most common cause of HYPERnatremia is hypovolemia. What are mild cases treated with?
Severe?
- 5% dextrose in .45% saline
- .9% saline
Describe the difference in urine calcium/creatinine clearance ratio between primary hyperparathyroidism and FHH
- Primary Hyperparathyroidism >.02
- FHH less than .01
