Nephrology Flashcards
Which malignancy is associated with which renal disorder?
Hodgkin Lymphoma and Minimal Change Disease
What is the work-up for new onset hypertension (5)?
- EKG
- UA
- CBC for Hct
- BMR for glucose, K, Ca++ and Cr
- Lipids
What are clinical features of primary aldosteronism (4)?
- Hypernatremia
- Hypokalemia
- Metabolic Alkalosis (mild)
- Suppressed plasma renin
If a patient with renal artery stenosis is given an ACEI for blood pressure, what happens to the BMR?
Increased creatinine without improvement in blood pressure
List features of nephrotic syndrome (5)
- Proteinuria > 3.5g / 24h
- Hypoalbuminemia < 3g / 24
- Edema
Lesser extent:
- Hyperlipidemia
- Lipiduria (oval fat bodies in urine, Maltese cross)
- List causes of primary nephrotic syndrome (4)
2. List causes of systemic nephrotic syndrome (4)
Primary:
- Minimal change - children
- Membranous nephropathy - whites
- FSGS - blacks
- Membranoproliferative GN
Systemic:
- DM
- SLE
- Amyloidosis
- Infection: HBV, HCV, HIV
Which cause of primary nephrotic syndrome is most common in:
- Children
- Caucasians
- African Americans
- Minimal change disease
- Membranous nephropathy
- Focal Segmental Glomerulosclerosis
What are complications of nephrotic syndrome (3)?
- VTE - DVT or renal vein, loss of inherent anticoags
- Hyperlipidemia
- Infection - loss of IgG
For IgA Nephropathy:
- What is the pathophysiology?
- Who is most commonly affected?
- What is a common outcome?
IgA Nephropathy
- Accelerated by mucosal IgA stimulation from URI or acute gastroenteritis leads to nephropathy with hematuria
- Asians
- 20% progress to dialysis in 20 years
What are secondary causes of IgA Nephropathy (7)?
- Henoch Schonlein Purpura - IgA vasculitis
- Cirrhosis
- Celiac Disease - mucosal surfaces
- Dermatitis Herpetiformis
- IBD
- Seronegative Arthritis
- HIV
Compare IgA Nephropathy with Post-Infxn GN:
- Onset
- Urine features
- Complement
- ASO
- Biopsy
- Frequency
Contrast IgA Nephropathy with Post-Infxn GN:
- 2-3 days after……….2-4 weeks after
- gross hematuria……….coca-cola urine
- C3 normal……….C3 low
- ASO - - ………. ASO ++
- IgA deposits……….Subepithelial humps
- Recurrent……….Not usually recurrent
What is the differential for low complement (6)?
- Cryoglobulinemia
- Post-infxn GN
- SLE
- Bacterial endocarditis
- Membranoproliferative Glomerulonephritis
- Renal atheroemboli
List features of nephritic syndrome (5)
- Hematuria/RBC casts
- Proteinuria < 3g / 24h
- Edema
- HTN
- Reduced GFR
- List causes of primary nephritic syndrome (3)
2. List causes of systemic nephritic syndrome (5)
Primary
- IgA Nephropathy
- Post-Strep GN
- Anti-GBM disease
Systemic
- SLE
- Cryoglobulinemia
- HSP
- ANCA-mediated
- Goodpasture’s
Which diseases overlap nephrotic and nephritic syndromes (4)?
- IgA Nephropathy
- SLE
- MPGN
- RPGN
If immune staining is positive then…
…not ANCA associated
What is the pathophysiology for anti-GBM?
Antibodies to glomerular basement membrane lead to COMPLEMENT activation with subsequent leukocyte infiltration
What is treatment for anti-GBM (3)?
- Plasmapheresis to remove antibodies to glomerular basement membrane
- Corticosteroids
- Cyclophosphamide
What is the microscopic renal feature of RPGN?
Crescent
What appears in urine microscopy in patients with rhabdomyolysis?
Hemoglobin but no RBC
What are three categories of ATN (3, 2, 7)?
- Ischemic
- Hemorrhage
- Sepsis
- CHF
- Pigment Induced
- Myoglobin
- Hemoglobin
- Nephrotoxic
- Contrast
- Aminoglycosides
- Amphotericin
- Tenofovir****
- Cisplatin
- Iphosphamide
- Ethylene glycol
What are causes of AIN (3)?
- Drugs
- Beta-lactam
- Ciprofloxacin
- NSAIDS
- Sulfa
- PPI
- Rifampin
- Allopurinol
- Infections
- Leptospirosis
- Legionella
- Viruses
- Autoimmune Disease
- SLE
- Sjogren
- Sarcoidosis
Other than AKI, what other lab abnormality occurs with AIN?
Eosinphilia (although not specific)
List non-renal manifestations of Polycystic Kidney Disease (6)
- Cerebral berry aneurysm
- Aortic and Mitral Valve Prolapse
- Thoracic and Abdominal Aortic Aneurysms
- Liver and Pancreatic Cysts
- Diverticular Disease
- Polycythemia - from excess Epo
What increase in creatinine correlates to a decrease in GFR by 50%?
Creatinine 1 –> 2
Which populations may have an artificially low creatinine (3)?
Those with very low muscle mass:
- Liver disease
- Malnutrition
- Advanced age
Which populations may have an artificially high BUN (3)?
- High-protein diets
- Catabolic states
- GI bleeding
What is seen on urine microscopy with glomerulonephritic causes of hematuria?
Acanthocytes or “Mickey Mouse cells”
- What renal cystic/mass features on CT would warrant a nephrectomy (4)?
- What test would be contraindicated?
- Enhancement after contrast
- Diameter > 3 cm
- Areas of necrosis
- Marginal irregularities
***Biopsy is contraindicated!!
- What are contraindications to kidney biopsy (8)?
2. What is an alternative to biopsy when tissue is imperative?
- Solitary kidney
- Uncooperative patient
- Bleeding history
- Uncontrolled severe HTN
- Cystic kidneys
- Hydronephrosis
- Multiple renal artery aneurysms
- Renal abscesses
***Alternative = open-wedge kidney biopsy
Name three causes of pseudohyponatremia
- Hyperglycemia (100 Glu : 1.6 Na)
- Hypertriglyercidemia
- Elevated proteins (Waldenstrom’s)
What are risk factors for hyponatremia with concurrent use of SSRI (4)?
- Older age
- Gender: women
- Diuretic use
- Low body weight
- What drug is off-label for treatment of chronic SIADH, and how does it work?
- What drug is used for Central Diabetes Insipidus, and how does it work?
- Demeclocycline - tetracycline antibiotic which reduces renal responsiveness to ADH
- Desmopressin (dDAVP) - ADH (vasopressin) receptor agonist
- What is the formula for Anion Gap?
- What is a normal AG?
- What does an AG mean (2)?
- Na - (Cl + HCO3)
- 3-11
- a. Loss of HCO3
b. Gain of acid from an unmeasured anion
What is the differential for an AG metabolic acidosis?
CUTE DIMPLES Cyanide Uremia Toluene Ethanol Diabetic ketoacidosis **SERUM KETONES Isoniazid Methanol **OSMOL GAP Propylene glycol Lactic acidosis **HIGH LACTATE Ethylene glycol **OSMOL GAP Salicylates
When comparing pH with PaCO2, how can you determine if it is a metabolic or respiratory process?
pH and PaCO2:
Same direction = METABOLIC
Opposite directions = RESPIRATORY
What is a delta-delta, and how is it used?
Delta delta = Delta-AG / Delta-HCO3
*(calculated AG -12) / (24 - HCO3)
If less 1, metabolic acidosis + nonAG acidosis
If 1-2, metabolic acidosis
If >2, metabolic acidosis + metabolic alkalosis