onlinemeded-nephrology

Question 1

tests to r/o AKI etiologies: pre-renal vs post-renal vs intrarenal

Answer 1

pre: Urine lytes
post: Renal U/S, CT
intra: UA, bx

Question 2

cut offs for CKD stages

Answer 2

1: >90
2: 60-89
3: 30-59
4: 15-29
5: <15

Question 3

at what stage of CKD do you start to have sxs?

Answer 3

stage III

Question 4

at what stage do you start preparing for HD with AV fistula/vein mapping

Answer 4

stage IV to have HD by V

Question 5

HD vs PD

Answer 5

HD: 3x/week, 4 hours, need prep

PD: qnightly when sleeping, 6-8 hours, cheaper

Question 6

complications of CKD

Answer 6

anemia

secondary hyperparathyroidism/ mineral bone dz

volume overload

metabolic acidosis

Question 7

what can you take to prevent secondary hyperparathyroidism in CKD?

Answer 7

sevelamer- phos binder- dec P –> dec PTH

cinacelet- calcimimetic- inc C –> dec PTH

Question 8

treatment for mild, mod, severe hypernatremia

Answer 8

mild: po H20
mod: NS
severe: D5W

Question 9

treatment of mild, mod, severe hyponatremia

Answer 9

mild: dz specific (depends on vol status)
mod: NS
severe: 3% saline

Question 10

hypertonic hyponatremia- think..

Answer 10

DM

Question 11

causes of euvolemic hyponatremia

Answer 11

RTA
Addison’s
Thyroid
SIADH

Question 12

causes of hyperkalemia

Answer 12

Low aldosterone- ACEI/ARB

Ingestion and CKD

ESRD

Iatrogenic

Artifact in lab- hemolysis

Question 13

hyperkalemia on EKG

Answer 13

peak T waves

wide QRS

Question 14

manage hyperkalemia

Answer 14

calcium gluconate- if EKG changes

Shift K into cells: Insulin + D50; Na bicarb; beta agonists

Reduce body K: loop diuretics, kayexelate, dialysis

Question 15

hypokalemia etiologies

Answer 15

GI losses (diarrhea, vomiting)

Renal losses ( hyperaldosterinism, diuretics, barter/gitelman)

Question 16

best way to replete K

Answer 16

po>IV

peripheral IV<10mEq/hr
Central IV<20 mEq/hr

give 10 mEq for every 0.1 increase

if refractory –> check Mg

Question 17

best imaging for kidney stones

Answer 17

non contrast CT

• unless pregnant- US

Question 18

treatment of kidney stones based on size

Answer 18

<5 mm: IVF, pain meds

in between: lithotripsy

> 3 cm: surgery (proximal LAP vs distal PAN)

Question 19

which kidney stones opaque and which lucent

Answer 19

opaque: calcium ox, struvite
lucent: cystine, uric acid

Question 20

complex cysts dx

Answer 20

UA, CT

Question 21

complex cyst vs RCC- which has biopsy?

Answer 21

complex cyst- NOT RCC

Question 22

extra-renal of ADPKD

Answer 22

berry aneurysm

pancreatitis

liver dz

Question 23

for metabolic alkalosis, what to order and how to interpret

Answer 23

urine chloride

if <10: volume responsive (etiologies: diuretic, dehdyration, emesis)

>10: not vol responsive - 
measure HTN (if hypertensive- hyperaldo; if not barters, gitelmans)

Question 24

if labs show low Ca and low albumin, what should you do?

Answer 24

Calcium can correct itself to normal ranges? come backt o this

Question 25

hypercalcemia of malignancy: labs differentiating mets vs PTH-rp

Answer 25

both: high Ca, low PTH

mets: high P
rp: low P

Question 26

when to order 1,25 vit D in hypercalcemia work up

Answer 26

when you suspect granulmotous dz (TB, sarcoid)

high Ca and P, low PTH

Question 27

treatment for hypoparathyroidism

Answer 27

IV ca

Question 28

what to suspect with high PTH but low Ca and low P

Answer 28

pseudohypoparathyroidism (organ resistance to PTH)

Question 29

when to order 25 vit D lab?

Answer 29

suspect vit D deficiency, osteopenia DEXA<20

Question 30

etiologies of low Calcium

Answer 30

• hypoparathyroidism
• pseudohypoparathyroidism
• vit D def
• early CKD
• pancreatits (sequestration)

Question 31

etiologies of high Ca

Answer 31

• hyperparathyrodism (1,2,3)
• hypercalcemia of malignancy
• hypervitaminosis D
• hypercalcemia of immobilization
• familial hypercacemic hypocalcuria