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MEDI IM shelf > Nephrology > Flashcards

Nephrology Flashcards

1
Q

hypervolemic hyponatremia

A

CHF
nephrotic
cirrhotic

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2
Q

hypovolemia hyponatremia

A

diruetics
vomiting
psychogenic polydypsia

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3
Q

euvolemic hyponatremia

A

SIADH
Addisons
hypotheyroidism

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4
Q

hypovolemic hyponatremia tx

A

NS fluids

3% saline if seizures or Na < 120

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5
Q

hypervolemic or euvolemic hyponatremia tx

A

fluid restriction

diruetics

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6
Q

Don’t correct hyponatremia faster than…

A

12 - 24 mEq/day
0.5 - 1 mEq/hr

or else… central pontine myelinolysis

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7
Q

low to high…

high to low…

A

pons will die (central pontine myelinolysis)

brain will blow (cerebral edema)

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8
Q

hyponatremia means…

A

gain of water

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9
Q

hypernatremia means…

A

loss of water

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10
Q

hypernatremia tx

A

replace water with D5W or other hypotnic fluid

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11
Q

Don’t correct hypernatremia faster than…

A

12 - 24 mEq/day
0.4 - 1 mEq/hr

or else… cerebral edema

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12
Q

numbness + Chvostek or Trousseau + prolonged QT interval

A

hypocalcemia

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13
Q

bones + stones + groans + psychiatric overtones + short QT interval

A

hypercalcemia

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14
Q

paralysis + ileus + ST depression + u waves

A

hypokalemia

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15
Q

Tx hypokalemia

A

K+ (make sure pt can pee)

max 40 mEq/hr

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16
Q

peaked T waves + prolonged PR + wide QRS + sine waves

A

hyperkalemia

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17
Q

hyperkalemia tx

A 
Ca+ gluconate
insuline
D50
kayexalate
albuterol
sodium bicarb

last resort…hemodialysis

C my big k drop

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18
Q

Check pH, if acidotic or alkalotic…check

A

HCO3 and pCO2

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19
Q

If HCO3 is high and pCO2 is high…

A

metabolic alkalosis

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20
Q

metabolic alkalosis, check…

A

urine chloride
- if Cl > 20 + HTN –> hyperaldosterone (Conn’s)

  • if normotensive think Barter’s or Gittlemans
  • if Cl < 20 –> think vomiting/NG sucktion, antacids, diuretics
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21
Q

If HCO3 is low and pCO2 is low…

A

respiratory alkalosis

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22
Q

respiratory alkalosis from…

A 
hyperventilation:
anxiety
increased ICP
fever
pain 
ASA
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23
Q

respiratory acidosis from…

A

hypoventilation:
opioid OD
brainstem injury
ventilation probs

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24
Q

nL anion gap metabolic acidosis from…

A

diarrhea
diuretic
RTAs (I, II and IV)

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25
Q

renal tubular acidosis (RTA) cause…

A

NAGMA

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26
Q

Type I RTA

A 
distal
Lithium/amoph B
SLE
analgesics
Sjogrens
sickle
hepatitis
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27
Q

Type I RTA sx

A

urine pH >5.4
hypokalemia
cannot excrete H+

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28
Q

Type I RTA tx

A

replete K

orla bicarb

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29
Q

Type II RTA

A 
proximal
Fanconi's syndrome
myeloma
amyloid
vit D deficiency
ai dz
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30
Q

Type II RTA dx

A

hypokalemia
osteomalacia
cannot reabsorb HCO3

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31
Q

Type II RTA tx

A

replete K
mild diuretic
bicarb won’t help

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32
Q

Type IV RTA

A 
hyper-renin
hypoaldo
>50% caused by T2DM
Addisons
sickle cell
any cause of aldo def
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33
Q

Type IV RTA sx

A

HYPERkalemia
hypercholemia
high urine Na conc even with salt restriction

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34
Q

Type IV RTA tx

A

fludrocortisone

35
Q

Fanconi’s anemia

A

hereditary or acquired proximal tubule dysfunction

defective transport of gluc, AA, Na, K, PO4, uric acid, and bicarb

36
Q

ARF

A

> 25% or 0.5 rise in Cr over baseline

37
Q

ARF/AKI workup

A 
BUN
Cr
UA
urine Na
urine Cr
measure FENa
38
Q

Prerenal AKI workup

A

BUN/Cr > 20
FENa < 1%
if on diruetic, measure FENurea < 35%

39
Q

ARF/AKI tx

A

prerenal: fluids to perfuse kidney

40
Q

Causes prerenal AKI

A 
HYPOPERFUSION
CHF
GN
cirrhosis
RAS
hypovolemia
41
Q

Muddy brown casts in pt w/ ampho, AG, cisplatin or prolonged ischemia

A

ATN

fluids, avoid nephrotox
maybe HD

42
Q

protein, blood, and eos in urine + fever + rash + recent bactrim

A

AIN

stop offending agent
add steroids if no improvement

43
Q

army recruit or crush victim w/ CPK > 50K + blood on dipstick + no RBCs

A

rhabdomyolysis

check k+ and EKG

bicarb to alkalinize urine to prevent precipitation

44
Q

enveloped shaped crystals on UA

A

ethylene glycol intox

HD
if pH < 7.2, NaHCO3

45
Q

bump in cr 48-72 h s/p cardiac cath or CT scan

A

contrast nephropathy

hydrate before
OR
give bicarb or NAC

46
Q

Indications for acute hemodialysis

A

AEIOU

A: acidosis
E: electrolyte imbalance, esp. K+ > 6.5
I: intoxication, esp. antifreeze, Li+
O: overload of volume, hypoxic pulmonary edema
U: uremia, esp. pericarditis, AMS

NOT high cr or oliguria

47
Q

1 cause CKD

A
  1. DM

2. HTN

48
Q

1 COD in CKD

A

cardiovascular dz

so, want LDL < 100

49
Q

CKD complications

A

HTN 2/2 aldo, fluid retention –> CHF

normochromic normocytic anemia –> loss of EPO

hyperk, hyperPHOS, hypoCA –> 2* HTN

hyperPHOS –> precip Ca2+ in tissues –> renal osteodystrophy and calciphylaxis (skin necrosis)

uremia –> confusion, pericarditis, itchiness, incr bleeding bc PLT dysfxn

50
Q

So you patient is peeing blood… 1st test?

A

urinalysis

51
Q

So you patient is peeing blood… painless…think

A

bladder or kidney cancer until proven otherwise

52
Q

So you patient is peeing blood… “terminal hematuria” + tiny clots…

A

bladder cancer or hemorrhagic cystitis (cyclophosphamide)

53
Q

So you patient is peeing blood… dysmorphic RBCs or RBC casts?

A

glomerular

54
Q

definition of nephitic syndrome

A

proteinuria (but < 2 g/24h)
hematuria
edema
azotemia

55
Q

So you patient is peeing blood…1-2 days after runny nose, sore throat, and cough

A

Berger’s dz

Iga nephropathy

56
Q

So you patient is peeing blood…1-2 weeks after sore throat of skin infection

A

PSGN

smokey/cola urine
subepithelial IgG humps

57
Q

Suspect PSGN…best test

A

ASO titer

58
Q

So you patient is peeing blood…and hemoptysis

A

Goodpasture’s syndrome
Abs to collagen IV

OR
Wegeners

59
Q

So you patient is peeing blood…and deaf

A

Alport syndrome

XLR mutation in collagen IV

60
Q

Kid s/p viral URI with renal railure + abd pain + arthralgia + purpura

A

HSP

supportive tx +/- steroids

61
Q

kid s/p hamburger + diarrhea + renal failure + MAHA + petechiae

A

HUS, e. coli O157H7 OR shigella

DON’T TREAT WITH ABX (releases more toxin)

62
Q

cardiac pt s/p ticlopidine + renal failure + MAHA + thrombocytopenia + fever + AMS

A

TTP

plasmapheresis
DON”T GIVE PLTs

63
Q

How tell DIC from TTP?

A

PT and PTT are normal in HUS/TTP

64
Q

c-ANCA + kidney + lung + sins involvement

A

Wegener’s grnaulomatosis

Bx

steroids OR cyclophosphamide

65
Q

p-ANCA + renal fialure + asthma + eosinophilia

A

Churg Strauss

lung bx

cyclophosphamide

66
Q

p-ANCA + NO lung involvement + hep B

A

polyarteritis nodosa

affects small/med arteries of every organ except lung!

cyclophosphamide

67
Q

flank pain radiating to groin + hematuria…get

A

CT

kidney stones

68
Q

MC type kidney stone

A

calcium oxalate

tx HCTZ

69
Q

kid with fhx stones type

A

cysteine

can’t resorb certain AA

70
Q

chronic indwelling foley and alkaline pee stones

A

Mg/Al/PO4 = struvite

proteus, staph, pseudomonas, klebsiella

71
Q

leukemia being treated w/ chemo and stones?

A

uric acid

alkalinize urine
hydrate

72
Q

s/p bowel resection for volvulus with stones?

A

pure oxylate stone

Ca2+ not reabsorbed by gut (pooped out)

73
Q

stones < 5 mm…tx

A

will pass spontaneously

hydrate

74
Q

stones > 2 cm…tx

A

open or endoscopic surgical removal

75
Q

stones 5 mm - 2 cm…tx

A

extracorporal shock wave lithotripsy

76
Q

So your patient is peeing protein… best test?

A

repeat etst in 2 weeks, then quantify w/ 24 hr urine

77
Q

So your patient is peeing protein… MC in kiddos

A

minimal change dz

fusion of foot processes

‘roids

78
Q

So your patient is peeing protein… MC in adults

A

membranous

thick capillary walls with SUBepi spikes

79
Q

definition nephortic syndrome

A

> 3.5 g protein/24 h
hypoalbuminemia
edema
hyperlipiedemia (fatty/waxy casts)

80
Q

So your patient is peeing protein… assoc. with heroin use and HIV

A

focal segmental GN

mesangial IgM deposits

try ‘roids

81
Q

So your patient is peeing protein… assoc with chronic hepatitis and low complement

A

membranoproliferative GN

tram-track BM with SUBendo deposits

82
Q

So your patient is peeing protein… and suddenly developes flank pain…think and get

A

suspect renal vein thrombosis!

2/2 peeing out ATIII, protein C and S

CT or US STAT!

83
Q

So your patient is peeing protein… other random causes

A 
orthostatic
bence jones (MM)
UTI
pregnant
fever
CHF

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