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MKSAP - Internal > Nephrology > Flashcards

Nephrology Flashcards

1
Q

orthostatic proteinuria - definition

A

increase in urinary protein excretion in upright position; in supine position, urinary protein excretion < 50 mg/8 hr; total urine protein excretion is usually still less than 1 g/24 hr

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2
Q

what type of casts are associated with acute intersitital nephritis?

A

leukocyte (WBC) casts

sterile pyuria - no culture

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3
Q

MC etiology of AIN

A

drugs - particularly, B-lactam antibiotics

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4
Q

characteristic triad of AIN

A

rash, fever, eosinophillia in a setting of renal insufficiency

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5
Q

types of cases seen in ATN?

A

muddy brown casts

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6
Q

what is persistent hematuria?

A

presence of > 3 RBCs/hpf on two or more samples

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7
Q

next step in diagnosing persistent hematuria?

A

cystoscopy or kidney USG - to evaluate for genitourinary malignancy

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8
Q

characteristics of nonglomerular hematuria

A

normal appearing RBCs on urine microscopy and absence of erythrocyte casts and protein

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9
Q

RF for genitourinary malignancy

A

male sex
age > 50
tobacco use
drugs - cyclophosphamide, benzene, radiation

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10
Q

what is first step in diagnosis of urinary obstruction?

A

kidney ultrasound

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11
Q

first step in management of urinary obstruction?

A

insertion of foley catheter

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12
Q

triad of hemolytic uremic syndrome

A

acute kidney injury
thrombocytopenia
microangiopathic hemolytic anemia - schistocytes

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13
Q

MCC of HUS

A

infection by shiga-toxin producing E.coli

familial deficiency of factor H

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14
Q

what should you consider if a patient presents with hypotension, hyponatremia, decreased urine sodium excretion and bland urine sediment

A

pre-renal azotemia

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15
Q

therapy for hepatorenal syndrome (ascites, portal HTN)

A

midodrine and octreotide

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16
Q

characteristic findings in tumor lysis syndrome

A

hyperkalemia
hyperphosphatemia
hyperuricemia

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17
Q

Tx. of tumor lysis syndrome

A

rasburicase

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18
Q

what is the Tx. strategy in pts with diabetic nephropathy

A

angiotenson receptor blocker or ACE inhibitor to reduce blood pressure < 130/80 or < 125/75 if significant proteinuria is present

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19
Q

what change in lab findings can you expect in a pt taking ACEi/ARBs

A

increase in creatinine - up to 30% is acceptable

20
Q

should you combine ACEi and ARBs in the tx. of diabetic nephropathy?

A

no - recent trials showed no benefit in morbidity or mortality and it increased the adverse effects compared to ACEi alone

21
Q

absolute indications for dialysis

A 
uncontrollable hyperkalemia
uncontrollable hypervolemia
altered mental status/somnolence
pericarditis
bleeding diathesis
22
Q

relative indications for dialysis

A 
NV, decreased appetite
severe metabolic acidosis
mild changes in mental status - lethargy
asterixis
worsened kidney function with GFR < 15
23
Q

what is recommended in pts with DM who have features of non-diabetic kidney disease?

A

kidney biopsy

24
Q

what type of bone disease is associated with chronic kidney disease

A

secondary hyperparathyroidism

  • hyperphosphatemia
  • hypocalcemia
  • elevated serum PTH and ALP
25
Q

what kind of bone disease is associated with hypoparathyroidism caused by excess vit D intake and/or oral calcium loading; manifests as bone pain with serum PTH < 100

A

adynamic bone disease

26
Q

urine anion gap

A

(U-Na + U-K) - U-Cl

- normally between 30-50 mmol/L

27
Q

metabolic acidosis of extrarenal origin is suggested by..

A

large, negative urine anion gap

28
Q

metabolic acidosis of kidney origin is suggested by..

A

positive urine anion gap

29
Q

how do you predict the increase in serum HCO3- that should occur with respiratory acidosis?

A
  • 1 mmol/L HCO3- for every 10 mmHg increase in PCO2 (in acute situations)
  • 4 mmol/L for every 10 mmHg PaCO2 (chronic)
30
Q

how can you calculate the expected decline in HCO3- to compensate for respiratory alkalosis ?

A

for every 10 mmHg decline in PaCO2, the expected decline in HCO3- is 2 mmol/L

31
Q

causes of respiratory alkalosis

A 
psychogenic - hyperventilation
normal pregnancy
pulmonary vascular dz - HTN, PE
pulmonary parenchymal dz - pneumonia, fibrosis
cirrhosis
heart failure
sepsis
32
Q

how do you distinguish metabolic acidosis due to ethylene glycol poisoning vs. DKA, alcoholic ketoacidosis or lactic acidosis?

A

ethylene glycol (and methanol) will have an INCREASED osmolar gap - calculate!

33
Q

formula for osmolar gap

A

2(Na) + BUN/2.8 + glucose/18

34
Q

how do you calculate what the expected PaCO2 should be if compensating for a metabolic alkalosis?

A

PaCO2 should be increasing atleast 0.7 mmHg for every 1 mmol/L increase in HCO3

35
Q

normal plasma osmolarity

A

275-295 mOsm/Kg

36
Q

diuretic induced hyponatremia MC after what drugs?

A

thiazide diuretics

37
Q

Tx. of diuretic induced hyponatremia

A

stopping diuretics and infusing NS for mildly sx. pts or 3% saline for significantly sx. pts

38
Q

electrolyte abnormalities commonly associated w/ acetazolamide

A

hypokalemia

metabolic acidosis - impairs HCO3- reabsorption

39
Q

what ECG findings indicate hyperkalemic cardiotoxicity?

A

spiked T waves

widened QRS complexes

40
Q

first step in tx. urgent hyperkalemia

A

IV calcium gluconate - takes 2-3 mins to work

41
Q

second step in tx. urgent hyperkalemia

A

intracellular shift with any of the following:

  • sodium bicarbonate
  • albuterol
  • glucose + insulin
42
Q

what does a urine K+ conc. < 20 mean?

A

extra-renal losses i.e. GI tract or skin

43
Q

what two GI disorders lead to potassium loss?

A

diarrhea (laxative abuse)

villous adenoma

44
Q

how can you tell apart diuretic abuse from laxative abuse?

A

diuretic abuse = hypokalemia, metabolic alkalosis and high U-K+ conc
laxative abuse - hypokalemia with metabolic acidosis and low U-K+ conc

45
Q

effect of acute pancreatitis on calcium levels

A

acute pancreatitis can generate free fatty acids that avidly chelate insoluble calcium salts in pancreatic bed, leading to HYPOCALCEMIA

46
Q

how do you tx. hypercalcemia in the setting of sarcoidosis?

A

prednisone - decreased vit D3 production by decreasing the number of activated macrophages

47
Q

what electrolyte abnormality can present with severe muscle weakness in an alcoholic pt?

A

hypophosphatemia - initially levels may look normal, but upon administration of IV glucose, it shifts phosphate into cells resulting in severe hypophosphatemia

MKSAP - Internal (11 decks)

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