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Medicine > Renal > Flashcards

Renal Flashcards

1
Q

winter’s formula

A

hco3 x 1.5 + 6to10

= expected PaCO2 if sufficient respiratory compensation for metabolic acidosis

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2
Q

delta gap

A

anion gap - normal anion gap
add that difference to HCO3
compare that total to normal HCO3 (24)
if elevated, primary metabolic alkalosis on top of primary anion gap metabolic acidosis going on (e.g. contraction alkalosis)

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3
Q

contraction alkalosis mechanism

A

not certain, here are a few theories:

  • fluid loss w/o bicarb loss ^bicarb conc
  • volume contraction -> aldo secretion -> H+ secretion, bicarb resorption
  • chloride depletion, failure of Cl-/HCO3- exchanger in distal tubule
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4
Q

anti-___ antibodies correlate with lupus disease activity

A

anti-dsDNA

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5
Q

TF

need kidney biopsy to diagnose lupus nephritis

A

F

evidence of AKI with anti-dsDNA antibodies sufficient

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6
Q

anti-Histone antibodies are positive in ____

A

anti-Histone antibodies positive in Drug-Induced Lupus

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7
Q

drug-induced lupus does Not induce ___ ___ or ___ like non-drug induced lupus does

A

DI Lupus does NOT induce Nephritis, Serositis, or Cerebritis like non-drug induced lupus does

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8
Q

FeNa can’t be used in pt taking ___

A

FeNa useless if pt taking FUROSEMIDE

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9
Q

TF

CHF pt can be volume up but have prerenal AKI

A

T

give furosemide

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10
Q

common complication of EPO administration to ESRD patients

A

hypertension

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11
Q

TF

hypertension in ESRD pt may be due to calcium and vit D supplementation

A

F
ESRD pts chronically low in Ca and VitD

more likely due to EPO

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12
Q

TF

Meloxicam causes AKI

A

T

Meloxicam is an NSAID

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13
Q

2 meds most notorious for causing AKI

A

NSAIDS

Pip/Tazo (sulfa abx and penicillin)

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14
Q

Meloxicam drug class

A

NSAID

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15
Q

Metformin is contraindicated in AKI and CKD because

A

Metormin is Contraindicated in AKI and CKD because it can cause METABOLIC ACIDOSIS

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16
Q

TF

Metformin is contraindicated in AKI and CKD

A

T

can cause METABOLIC ACIDOSIS

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17
Q

what is the concern with Glipizide in setting of AKI?

A

HYPOGLYCEMIA, because it reduces insulin clearance

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18
Q

TF

Nifedipine and other CCBs are contraindicated in CKD

A

F

CCBs strongly indicated in CKD to control HTN

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19
Q

urine microscopy is used to…

A

assess for Casts when Intrinsic renal disease is on the ddx – ATN AIN Glomerulonephritis

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20
Q

contrast-induced kidney injury occurs how long after contrast study

A

7-10 days…?

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21
Q

contrast causes ___ of the kidney

NSAIDS cause ___ of the kidney

A

contrast - ATN

NSAIDS - AIN

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22
Q

how is EPO administered to ESRD pts

what is the goal

A

IV, during dialysis

goal is Hb of 10

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23
Q

60 pack-year smoking history, microhematuria, flank pain

2 ddx

A

urologic cancer

kidney stone

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24
Q

African American and AIDS Nephropathy means ___ on kidney biopsy

A

AA and AIDS Nephropathy means FSGS on kidney biopsy

Focal Sclerosing Glomerular Sclerosis

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25
Q

what to expect on kidney biopsy:

African American AIDS nephropathy

Post-Strep Pharyngitis or Skin Rash or URI with neprhotic range proteinuria

Diabetes

Idiopathic Nephrotic Syndrome, Autoimmune Disease, Hepatitis infection, Drug-Induced Nephrotic Syndrome

Hep C in absence of cryoglobulinemia

Peds asymptomatic other than spilling protein

A

AA AIDS - FSGS focal segmental glomerular sclerosis

Post-Strep - IgA Nephropathy

DM - Kimmelstiel-Wilson nodules

Idiopathic, AutoImmune, Hepatitis, Drug-Induced – Membranous Nephropathy

HepC without cryoglobulinemia - FSGS

Peds - MCG minimal chage disease

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26
Q

first thought with kidney biopsy:

FSGS

IgA nephropathy

Kimmelstiel-Wilson nodules

Membranous Nephropathy

Minimal Change Disease

A

FSGS - AfAm AIDS or HepC without cryoglobulinemia

IgA - Post-Strep Pharyngitis, Skin Rash, or URI

K-W nodule - DM

MN - Idiopathic, AutoImmune, Drug-Induced

MCG - Peds, asymptomatic other than spilling protein

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27
Q

treat acute severe hyponatremia, eg from water drinking contest

A

3% saline

HYPERTONIC

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28
Q

when to give 3% vs .9% saline vs fluid restriction for hyponatremia

A

3% if acute and severe volume up eg water drinking contest seizure coma

.9% if more chronic volume down eg hiking over the week or inpatient falling behind on fluids with daily lab draws

fluid restriction for SIADH – free water toxicity but more chronic less sever than chugging contest

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29
Q

HTCZ treats what kind of hyponatremia

Furosemide for what kind

A

HCTZ for Euvolemic hyponatremia

Furosemide for hypERvolemic hyponatremia

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30
Q

how does PTH affect Ca and Phos

vs how does Vit D affect Ca and Phos

A

PTH ups Ca, downs Phos

Vit D ups both Ca and Phos

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31
Q

when is the only time you measure Calcitonin

A

MEN syndromes only

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32
Q

high PTH despite high calcium levels… primary, secondary, or tertiary hyperparathyroidism?

A

primary or tertiary

secondary is caused by low calcium

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33
Q

young healthy guy with family history of calcium disorders has asymptomatic hypercalcemia – Modestly high Ca, PTH, little low Phos, asymptomatic

likely dx
inheritance
next test

A

likely Familial Hypocalcuric Hypercalcemia (benign)

Autosomal Dominant

next test Urinary Calcium (low)

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34
Q

what are you suspecting when you get 1,25-vit D level in workup of hypercalcemia

A

Granulomatous disease like TB or Sarcoid

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35
Q

when do you get serum 25-vit D level

A

working up hypOcalcemia suspecting vitD Deficiency

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36
Q

what is Hungry Bone syndrome

A

low PTH after parathyroid adenoma resection (remaining pth glands have been suppressed, need a while to turn back on)

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37
Q

difference in calcium levels between early CKD and ESRD

A

early CKD may be hypOcalcemic because not making vit D

ESRD is hypERcalcemic because not excreting it

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38
Q

treat hypercalcemia from multiple myeloma

A

vigorous Fluids and Alendronate (bisphosphonates)

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39
Q

TF

fluids fluids fluids fluids - and a little lasix is the treatment for hypercalcemia

A

Fish
not anymore
Furosemide can cause initial worsening of hypercalcemia via concentration by diuresis…

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40
Q

when is Cincacalcet used

moa

A

for secondary and tertiary HyperParathyroidism

stimulates Calcium-sensing receptor in Parathyroid glands, Reducing PTH secretion

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41
Q

how do Granulomatous diseases (Sarcoid, TB) cause hypercalcemia?

A

HyperVitaminosis D

increased 1,25-vitD

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42
Q

how could Prednisone possibly treat hypercalcemia?

A

if due to Granulomatous disease

Prednisone decrease granulomatous inflammation, decrease hypervitaminosis 1,25-D

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43
Q

when is Calcitonin administered

A

during acute, severe, and symptomatic hypercalcemia – as a temporizing measure while fluids are being given

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44
Q

calcitriol is ___

it does ___

use it for

A

calcitriol is 1,25-vitD

it increases Absorption of Ca and Phos from the gut

use it for Renal Failure when Hypocalcemia is driving Parathyroid production – to prevent secondary and tertiary hypercalcemia

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45
Q

Pamindronate is a ____

used to treat ___ and ___

A

Paindronate is a Bisphosphonate

used to treat Osteopenia in teh elderly and HyperCalcemia from Cancer

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46
Q

If symptomatic hypocalcemia (perioral and fingertip paresthesias), give _______

A

Gove IV Calcium Gluconate

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47
Q

Black woman, bilateral hilar lymphadenopathy, hypercalcemia

Dx
Pathophys of hypercalcemia
Treat hypercalcemia

A

Sarcoid

Granulomatous inflammation converts 25-vitD to 1,25vitD

treat with Prednisone

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48
Q

Hypokalemia with non-gap metabolic acidosis can be 2 things

A

Proximal Renal Tubular Acidosis
(distal would cause hyperkalemia)

Diarrhea

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49
Q

Hypertensive with hypokalemia, best first antihypertensive drug?

A

ACEI / ARB

~potassium sparing diuretics in a way and first line for HTN

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50
Q

Hydralazine dilates ____

used to treat ____

main side effect is ____

A

Hydralazine dilates Arteries

used to treat HTN

main side effect is Reflex Tachycardia

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51
Q

guy passed out found to have 3rd degree AV block and hyperkalemia to 9. Heart is paced, treat the hyperkalemia

A

same as any symptomatic hyperkalemia
3 steps

stabilize myocardial membrane with CALCIUM GLUCONATE or CALCIUM CARBONATE

temporize potassium out of the blood with INSULIN with D50

eliminate potassium from body with KAYEXYLATE (stool), FUROSEMIDE (urine) or HEMODIALYSIS (last resort)

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52
Q

TF

Calcium Carbonate can be used to stabilize myocardial membrane in hyperkalemia just like Calcium Gluconate

A

T

equivocal

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53
Q

TF

asymptomatic hyperkalemia with no EKG changes can be treated with Furosemide or Kayexylate

A

T

no need for calcium or insulin and glucose if no manifestations

54
Q

CHF exacerbation getting diuresed with furosemide now hypokalemic, what do you do?

A

give potassium

continue furosemide if still a ways to go to dry weight

55
Q

Patient had a calcium oxalate kidney stone

how to prevent more in the future?

A

Thiazide diuretic
(hypercalcemia, hypocalcuria)

also avoid vitamin C excess and animal protein excess (oxalate)

also avoid vit D excess, hyperparathyroidism, familial hypocalcemic hypercalcuria

56
Q

allipurinol is used for…

A

gout

uric acid stones – particularly to ppx in setting of tumor lysis syndrome

57
Q

alkaline urine causes ___ stones

often a byproduct of…

A

alkaline urine causes STRUVITE stones

often a byproduct of UTI with Urea-Splitting Bacteria such as Proteus

58
Q

TF

advise large water intake for large urine volumes to prevent recurrence of kidney stone

A

F
this can help pass a stone v5mm
BUT NOT A LONG TERM PPX STRATEGY… will do more harm than good

59
Q

TF

ppx against calcium oxylate stones with furosemide

A

F
loop diuretics prevent paracellular calcium absorption and WORSEN calcium oxalate stones, avoid

–ppx with THIAZIDE diuretic (hypercalcemia, hypocalcuria)

60
Q

struvite stone =

A

magnesium ammonium phosphate

61
Q

how does a struvite stone present on imaging

A

Staghorn Calculi

single large continuous stone throughout the kidney

62
Q

without any hints otherwise, assume kidney stone is made of…

hints that would make you think otherwise…

A

calcium oxalate
(most common stone)

if uti with alkaline urine - struvite

if gout or tumor lysis syndrome - uric acid

if cystinuria - cyseine

63
Q

single stone obstructing ureter suggests this makeup

A

calcium oxalate

64
Q

staghorn calculi suggests this stone makeup

A

struvite

magnesium ammonium phosphate

65
Q

Obstructing stone ^3cm with hydronephrosis

Manage

A

Nephrostomy tube to relieve obstruction then get urology involved to cut it out

66
Q

Lithotripsy can be done for kidney stone of what size

A

v3cm for Lithotripsy

67
Q

Vigorous IV Fluids is appropriate management for a kidney stone of what size

A

v5mm to try to wash it out

68
Q

manage kidney stone:

incidental finding
v5mm
v3cm
^3cm
with hydronephrosis
A 
incidental - ntd, observation
v5mm - hydration
v3cm - lithotripsy
^3cm - surgery
with hydronephrosis - nephrostomy tube then according to above
69
Q

you think there is cancer in the kidney - bopsy or resect?

A

resect (that’s your biopsy)

biopsy may bleed excessively…

70
Q

TF

a complex renal cyst can be followed

A

F

complex renal cyst is Always Abnormal and must be Worked Up

71
Q

complex renal cyst with history of flank pain, hematuria, and palpable mass is ___ until proven otherwise

A

complex renal cyst with history of flank pain, hematuria, and palpable mass is RCC until proven otherwise

72
Q

Adult Polycystic Kidney Disease starts around age __ and causes ESRD around age __

A

Adult Polycystic Kidney Disease starts around age 20 and causes ESRD around age 60

73
Q

is Polycystic Kidney Disease of the Newborn compatible with life?

Inheritance pattern?

A

Not compatible with life

Autosomal Recessive

74
Q

complex renal cyst on ultrasound, f/u?

A

con CT

to further characterize before deciding on surgery

75
Q

TF

ESRD can get contrast CT

A

T

damage to kidneys already done, end stage

76
Q

when is kideny biopsy the answer for a renal cyst

A

never

not for renal cysts

77
Q

incidental renal cyst found in pt otherwise low-risk for cancer, f/u?

A

just reassure
no need to follow up
if risk factors, can followup with imaging…

78
Q

when to get a urine anion gap

A

in a non-gap metabolic acidosis, to differentiate renal tubular acidosis from diarrhea as the cause

79
Q

pH 7.24
PCO2 32
pO2 66

Na 124
K 4
Cl 98
Bicarb 10

what acid/base derangement?

A

respiratory acidosis with gap metabolic acidosis and non-gap metabolic acidosis

pH is acidemic. but PCO2 is low so it is Metabolic Acidosis

Na-Cl-Bicarb = 16 so GAP of 4

add 4 to bicarb = 14 which is still low v24… so ANOTHER METABOLIC ACIDOSIS so GAP AND NON-GAP

expected pCO2 by Winters Formula 1.5bicarb plus 8 = 23… but real pCO2 is 32 so a RESPIRATORY ACIDOSIS ON TOP

80
Q

pH 7.52
PCO2 25
PO2 42

Na 137
K 4
Cl 110
Bicarb 21

what acid/base derangement?

A

respiratory alkalosis

pH is alkalotic

pCO2 is up 15, this should correspond to a .12 increase in pH, which it does, and a 3 point decrease in bicarb, which it does, so acute respiratory alkalosis with no metabolic derangements yet

81
Q

what kind of urine anion gap points to diarrhea

what kind points to Renal Tubular Acidosis

A

Negative urine anion gap points to diarrhea
e.g. U Na 14 K 12 Cl 60
26-60 = -34 = negative anion gap

Positive urine anion gap points to RTA

(both in a NON GAP Metabolic Acidosis)

82
Q

TF

as soon as you see no anion gap, lactic acidosis can be withdrawn from consideration

A

T

Lactic acidosis is a GAP acidosis

83
Q

how much should bicarb drop in response to elevated pCO2 in respiratory acidosis?

A

drop 2 Bicarb for every 10 pCO2

84
Q

pH 7.33
pCO2 34
pO2 80

Na 133
K 4
Cl 101
Bicarb 16

acid/base derangement?

A

anion gap metabolic acidosis with non-gap metabolic acidosis

pH is Acidic
but pCO2 is low, so Metabolic Acidosis

gap is 133-17 = 16… -12 = GAP of 4

16plus4 = 20 is less than normal 24 bicarb so ADDITIONAL NON-GAP METABOLIC ACIDOSIS

Winters 1.5bicarb plus 8 plusminus 2 = 24 plus 8 = 32 plus 2 = 34 which is what the pCO2 actually is so no respiratory derangement

85
Q

pH 7.50
pCO2 52
pO2 62

acid base derangement?
look for gap?
look for additional derangements?

A

metabolic alkalosis
-appropriate pH up with PCO2 up… you are pretty much done, just check for gap to rule out gap metabolic acidosis in addition… but don’t need to define any respiratory aspect

86
Q

suspect ureteral stone after H and P, next step?

A

US or Noncon spiral CT

US good imaging little radiation best if no real alternate diagnosis, may miss small stones and technician-dependent

NONcon spiral CT best but more expense and radiation

87
Q

suspect ureteral stone in pregnant pt, best test

A

ultrasound

avoid radiation of noncont spiral ct

88
Q

how can glucocorticoids affect BMP?

affect Cr?

A

BUN up maybe from catabolic effect

increase glucose level

NO creatinine elevation

89
Q

DKA typically accompanied by glucose levels in the ___ range

A

DKA has glucose in ^400 range

90
Q

why use diuretics but use cautiously in COPD exacerbation

A

use because increased pulmonary pressures cor pulmonale and increased right atrial pressures and peripheral edema

careful because can dehydrate and cause AKI

91
Q

why would a Crohn’s pts be predisposed to kidney stones

A

increased Oxalate resorption

Crohns, fat malabsorption, gut Ca binds to fat instead of oxalate, more oxalate absorbed, more calcium oxalate stones

92
Q

most common cause of symptomatic hyperoxaluria and oxalate stone formation is…

A

increased GI absorption of oxalate

e.g. from malabsorption of fatty acids which chelate more calcium and prevent calcium binding to oxalate which normally reduces oxalate absorption

93
Q

pt has hypokalemic hypochloremic metabolic acidosis from vomiting… is the cause of the hyochloremia and hypokalemia vomiting? volume depletion? metabolic alkalosis? intracellular shift?

treat

A

Yes, low Cl simply from GI Loss from vomiting. HCl and KCl lost from GI tract with vomiting.

Low K from GI loss, ALSO intracellular shift caused by alkalosis, and increased renal excretion caused by RAAS activation

loss of H causes increased Bicarb, Alkalosis. additionally, dehydration causes contraction alkalosis - more bicarb resorp in kidney from RAAS activation…. but this is the RESULT of chloride loss, not the cause of it

treat with IV NaCl plus K

94
Q

calcium oxalate stones are ___ shaped

A

Envelope shaped calcium oxalate stones

95
Q

calcioum phosphate stones are common in….

A

calcium phosphate stones common in Primary Hyperparathyroidism and Renal Tubular Acidosis

96
Q

small bowel disease
surgical bowel resection
or chronic diarrhea
can cause kidney stones how

A

by fat and bile acid malabsorption, which binds calcium away from oxalate and allows increased oxalate resorption

97
Q

normal sodium

A

135-145

98
Q

immigrant from Russia with probable TB has fatigue weakness hypotension and electrolyte abnormalities including low sodium high potassium low glucose and eosinophilia – what complication does this suggest?

what acid-base disturbance?

What similar diseases can cause a similar complication?

A

Adrenal Insufficiency aka Addison’s Disease
(extrapulmonary TB often goes to liver, spleen , kidney, bone, and adrenal gland)

Non-Gap Metabolic Acidosis aka Renal Tubular Acidosis

other granulomatous diseases e.g. Histoplasmosis Coccidiomycosis Cryptococcosis and Sarcoidosis may also cause adrenal insufficiency

99
Q

4 causes of primary adrenal insufficiency

A

autoimmune
infections (TB Fungal HIV)
Hemorrhagic infarct
Metastatic cancer (e.g. Lung)

100
Q

3 most common causes of metabolic alkalosis

A

vomiting
hyperaldosteronism
volume contraction

101
Q

Elderly pt with rheumatoid arthritis, enlarged kidneys and liver, and proteinuria with peripheral edema

most likely finding on renal biopsy? cause?

A

Glomerular deposits after special staining (Congo Red, Apple Green Birefringence in Polarized Light)

Amyloidosis (RA predisposes, and age, large kidneys and liver tip off)

102
Q

conditions associated with AL amyloidosis

composition of amyloid

A

Multiple Myeloma
Waldernstrom Macroglobulinemia

light chains usually lambda

103
Q

conditions associated with AA amyloidosis

composition of amyloid

A 
RA IBD (chronic inflammatory conditions)
Osteomyelitis TB (chronic infections)

abnormally folded proteins - beta2microglobulin, apoliporprotein, transthyretin

104
Q

__ is the most common cause of AA amyloidosis in the united states

A

Rheumatoid Arthritis

most common cause of AA amyloidosis in USA

105
Q

glomerular crescent formation on light microscopy classic for

A

rapidly progressive glomerulonephritis…

-crescent formation

106
Q

hyalinosis that affects both afferent and efferent glomerular arterioles is pathagnomonic for

A

Diabetic Nephropathy

-afferent and efferent hyalinosis

107
Q

normal light microscopy findings in patient with nephrotic syndrome usually suggest…

A

Minimal Change Disease

-normal light microscopy with nephrotic syndrome

108
Q

how is a pt with severe proteinuria and low total protein and albumin at risk of developing atherosclerosis?

Hy hypercoagulable? affecting veins or arteries more? any in particular?

what treatment to start? why?

A

liver increases Lipid production along with protein production

loss of Anithrombin III in urine makes hypercoagulable, Veins more than arteries, Renal Veins in particular

start aggressive Statin therapy, combo hyperlipidemia and hypercoagulablity at risk for MI and Stroke!

109
Q

how can nephrotic syndrome cause HyperParathyroidism

A

Vit D loss in urine, compensatory HyperParathyroidism

110
Q

why does hypoalbuminuria cause peripheral edema but not pulmonary edema

A

alveolar capillaries have higher permeability to albumin at baseline (so less oncotic pressure difference) and greater lymphatic flow than skeletal muscle

111
Q

TF

red blood cells or casts on UA in renal hypoperfusion

A

F
think more primary glomerular damage
-acute nephritic syndrome – post strep GN, IgA nephropathy, Lupus nephtiis, MPGN, RPGN…

112
Q

nephritic glomerulonephritis usually presents with urinary sediment containing __ and __ with occasional __ or __. Edema is due primarily to ___ and ___

A

nephtiric gn presents with urinary RBCs and Red Blood Cell Casts with occasional WBCs or Mixed Casts.

Edema due to low GFR and Salt and Water Retention

113
Q

major buffer in human blood and its pK

A

Carbon Dioxide

pK 6.1

114
Q

how can you calculate HCO3- if you know pH and PaCO2

A

henderson hasselbach

pH = 6.1 log HCO3/(.03xPaCO2)

115
Q

best two lab values for acid-base status

A

pH and PaCO2
can calculate Bicarb from henderson hasselbach

pH -= 6.1 log HCO3/(.03xPaCO2)

116
Q

recurrent kidney Stones since childhood, father too (Family History), Hexagonal crystals on UA, positive Urinary Cyanide Nitroprusside test

diagnosis
pathophys
appearance on XR

A

Cystiniuria
Inherited Defective Tansport of dibasic amino acids by the brush borters of renal tubular and interstitial epithelial cells – cysteine is poorly soluble – recurrent stones

radioOpaque

117
Q

TF

pt with recurrent kidney stones and positive Urinary Cyanide Nitroprusside test think uti’s and struvite stones

A

F

think Cystinuria and Cysteine stones

118
Q

old guy hospitalize with hip fracture gets lethargic and asterixis with high CK from rhabdo from trauma, taking NSAIDs, diuretics, and ACI, with high BUN but normal LFTs

treat with Lactulose or Hemodialysis?

how is each factor contributing to AKI

A

treat Uremic Encephalopathy with DIALYSIS… this guy

treat hepatic encephalopathy in decompensated cirrhosis with Lactulose… not this guy

rhabdo CK clogs kidneys? NSAIDS ATN. diuretics prerenal aki, lisinopril loses glomerular autoregulation

119
Q

big renal cyst with thin walls no solid components and no contrast enhancement on CT or MRI

diagnosis?
follow-up?

A

simple renal cyst (benign)
don’t get scared by bigness

no follow-up necessary

120
Q

big renal cyst multiloculated, irregular walls, thickened septae, contrast enhancing on CT or MRI

diagnosis?
follow-up?

A

malignant renal cyst

urology eval for malignancy

121
Q

normal anion gap 6-12 accounted for by what normal serum anions

A

protein citrate phosphate sulfate

122
Q

old demented guy with bph now with abdominal pain and midline abdominal fullness below umbilicus after starting amitriptyline

diagnosis?
treat

A

amitriptyline-induced urinary retention (anticholinergic sideffect)

foley

123
Q

barium enemas are used for…

A

luminal abnromalities of the colon - Colon Cancer or Diverticulosis

124
Q

why is prerenal AKI a misnomer

A

not really an injury with bland urinary sediment unless prolonged leading to ATN muddy brown casts

125
Q

normal anion gap

A

10 plus minus 2 so 8-12

126
Q

low bicarb and hyperkalemia

think

A

metabolic acidosis

127
Q

non-anion gap metabolic acidosis with preserved kidney function

diagnosis

A

RTA renal tubular acidosis

128
Q

loop diuretics cause hyp_kalemia and metabolic __osis

A

loops cause hypERkalemia and metabolic ALKALosis

129
Q

lady with kidney stone v1cm, on top of hydration, what drug can help her pass it?

furosemide?

A

alpha blocker Tamsulosin
relax ureteral smooth muscle

not furosemide, causes hypercacluria and may exacerbate stone

130
Q

name all the fucking metabolic side effects of thiazide diuretics

which thiazide is worse for these but still preferred based on cardiovascular mortility in teh ALLHAT trial

A 
HYPERGLYCEMIA
HYPERLIPIDEMIA
HYPERURICEMIA
hypONatremia
hypOKalemia
hypOMagnesemia
hypERCalcemia

chlorthalidone worse than hydrochlorothiazide but still preferred based on allhat cardiovascular mortality DAMMIT

131
Q

how do fucking Thiazide diuretics cause hypERGlycemia

A

Impair Insulin Release from pancrease and
Impair Glucose Utilization in tissues
call it Thiazide-Induced Glucose Intolerance

Medicine (13 decks)

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