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Nephrology > Volume 2 > Flashcards

Volume 2 Flashcards

0
Q

How do you diagnose nephrotic syndrome?

A
  1. protein/creat ratio >200 mg/mmol

2. 24 hr protein > 40mg/m2/hr

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1
Q

What is Liddle syndrome?

A
  1. pseudoaldosteronism
  2. autosomal dominant disorder
  3. Early, and frequently severe HTN- low plasma renin activity
  4. metabolic alkalosis
  5. hypokalemia
  6. normal to low levels of aldosterone
  7. abnormal kidney function, with excess reabsorption of Na +loss of K from the renal tubule
  8. combination of low sodium diet and potassium-sparing diuretic drugs (
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2
Q

what is pre-HTN and how do you manage it?

A

> 90th - < 95th

need lifestyle changes, wgt mgnt, diet/exercise
recheck in 6 mon

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3
Q

what is stage 1 HTN and how do you manage it?

A

> 95 th + 5 mmHg

Lifestyle changes
recheck in 1-2 weeks
start therapy
refer to nephro

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4
Q

what is stage 2 HTN and how do you manage it?

A

> 99th + 5 mmHg

lifestyle changes
recheck in < 1 week
start therapy
refer to nephro

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5
Q

what is hypertensive crisis

A

> than stage 2 HTN

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6
Q

What is hypertensive urgency

A

high BP and mild signs but no end organ damage

can ahve mild HA and vomiting

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7
Q

what is a hypertensive emergency

A

severe HTN and life threatening symptoms of end organ damage

encephalopathy
Sz
Heart failure = LVH
facial palsy/ hemiplegia
visual symptoms
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8
Q

what is the etiology of HTN in a < month

A

renal artery thrombosis
coarctation
renal parenchymal disease
BPD

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9
Q

what is the etiology of HTN for > 1 month to 10 yrs

A 
renal parenchymal
coarctation
renovascular disease
essential
endocrine
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10
Q

what is the etiology of HTN in a > 10 yrs

A

essential
white coat
renal

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11
Q

what are possible endocrine causes of HTN

A 
hyperthyroid
hyperparathyroid
CAH
cushings
pheo
neuroblastoma
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12
Q

what are drugs that cause HTN

A 
stimulant meds
OCP
steroids
smoking
cocaine
tacrolimus
cyclosporine
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13
Q

what are screening investigations for confirmed HTN?

A 
Cr, urea, lytes, CBC, 
TSH, FT4
uric acid
plasma renin
fasting lipid profile, 
fasting glucose
Urinalysis and culture
Renal ultrasound
Cardiac echo/ECG
optho to assess damage
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14
Q

who should start anti-hypertensive Rx?

A
  1. if symptomatic
  2. if secondary HTN
  3. If has DM
  4. If no change despite nonpharm measures
  5. if Hypertensive target-organ damage
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15
Q

how do you manage a HTN emergency

A
  1. Admit to PICU
  2. Goal is to decrease BP to < 95th by ↓ by 25% in the first 8 hours +
  3. Gradually normalizing over 26 to 28 hours
  4. IV sodium nitroprusside - monitor Inc HR & cyanide
  5. IV Labetelol – combined α and β blocking agent. Acts quickly (within 2-5 min) but lasts up to 2-4 hours. May lead to bradycardia and bronchospasm.
  6. IV Esmolol – ultrashort acting cardioselective β blocking agent. Onset of action is 60s with an offset of 10-20 min.
  7. IV Hydralazine – direct vasodilator of smooth muscle. Can lead to tachycardia and fluid retention. Onset of action is 5-30 min. Given as bolus q4-6 hours rather than continuous infusion.
16
Q

How do you manage HTN urgency?

A
  1. Lower BP over a course of hours to days with either IV or oral anti-hypertensives depending on the symptomology
  2. Options include;
    Hydralazine (Iv or oral)
    Clonidine (oral) Central acting & should be avoided in those with altered mental status
    Minoxidil (oral) – arteriolar vasodilation.
17
Q

what is the WU for multicystic dysplastic kidney

A

need US

if abn US - need VCUG because 30% can have VUR

18
Q

what is multicystic renal dysplasia

A

non inherited disease
abnormal nephron dev
minimal or no functioning renal tissue, LEFT > r
if BL - lethal - Potter’s
+/- VUR on other side and enlarged
most often, the effected kidney involutes
some risk of Wilms - some suggest regular monitoring

19
Q

what is the most common cause for an abdominal mass in the newborn?

A

MCDK

20
Q

what are genetic syndromes associated with renal cysts

A 
AD polycystic
AR polycystic
T 21, T18, T 13
Von-Hippel Lindau
TS
21
Q

what is true polyuria and polydipsia

A

> 2L/m2/day

22
Q

what is the WU for polyuria and polydipsia

A 
serum for osmolality, 
sodium, potassium, Ca
BUN/creatinine, 
glucose
urine for osmolality, specific gravity, and glucose determination
23
Q

what are diagnostic criteria for DI

A

serum osmolality is >300 mOsm/kg
AND
urine osmolality is <300 mOsm/kg

24
Q

what test is MOST likely to offer both diagnostic and prognostic information for PSGN

A

Persistently low C3 level is associated with an increased risk for membranoproliferative GN and possibly a poorer prognosis.

25
Q

how do you define hematuria?

A

> 5 RBCs per high-power field (HPF)

26
Q

what are 3 DDx for normocomplementemic nephritis

A
  1. IgA GN
  2. membranoproliferative glomerulonephritis (1/3)
  3. Alport syndrome.
  4. HSP
27
Q

what is Fanconi syndrome

A 
generalized dysfunction of proximal tubule
polyuria
polydipsia
FTT
loss of HCO3
loss of PO4 = rickets
28
Q

what are 4 causes of low C 3 GN

A
  1. Post infectious GN
  2. SLE
  3. Membranoproliph
  4. subacute endocarditis
29
Q

What are causes of fanconi syndrome?

A 
galactosemia
cytinosis
GSD
more metabolic stuff
drugs - VPA
31
Q

what are CF of cystinosis?

A 
fair skin
photophobia from lack of pigmentation
FTT
Fanconi syndrome: low HCO3, low PO4 = rickets
recurrent dehydration
HSM
DM
hypothyroidism
32
Q

how do we manage cystinosis

A

PO cysteamine and eye drops

may need transplant - renal

33
Q

how do you Dx cystinosis

A

leukocyte for cysteine

Nephrology (3 decks)

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