Renal Flashcards

1
Q

Prerenal AKI versus Intrinsic AKI:

urine sodium

A

Prerenal: low <20
Intrinsic: high >40

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2
Q

Prerenal AKI versus Intrinsic AKI:

FENa

A

Prerenal: FENa <1%
Intrinsic: FENa >1-2%

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3
Q

Prerenal AKI versus Intrinsic AKI:

Urine osmolality

A

Prerenal: high >500
Intrinsic: low <500

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4
Q

Prerenal AKI versus Intrinsic AKI:

BUN:Cr ratio

A

Prerenal: high >20:1
Intrinsic: low

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5
Q

Prerenal AKI versus Intrinsic AKI:

specific gravity of urine

A

Prerenal: low (dilute)
Intrinsic: high (concentrated)

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6
Q

5 stages of CKD

A

1: GFR >90 with evidence of kidney damage
2: GFR 60-89
3. GFR 30-59
4. GFR 15-29
5. GFR <15

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7
Q

when do symptoms of uremia show up in CKD

A

Stage 3-5

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8
Q

when do lab values show disease (BUN/Cr) in CKD

A

Stage 3

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9
Q

when do signs of anemia, acidosis, hyperkalemia, hypocalcemia, hyperphosphatemia show up in CKD

A

Stage 4

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10
Q

what is the best predictor of disease progression in CKD

A

proteinuria

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11
Q

what is the best way to test for proteinuria in CKD

A

Spot albumin:cr ratio

preferred over 24h urine

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12
Q

what factors are taken into account in Cockcroft Gault GFR equation

A

age
weight
creatinine
gender

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13
Q

how to instruct a patient on CKD diet??

A

low protein
adequate calories, Ca, and Vit D
limit H2O, Na, K and Phos

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14
Q

what should you suspect if someone with CKD has a skull X-ray showing salt and pepper skull, bony cysts, periosteal erosions?

A

renal osteodystrophy

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15
Q

what is treatment for renal osteodystrophy

A

Vit D + Ca

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16
Q

Pt with PKD: what is the test of choice

A

US

fluid-filled cysts will be seen

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17
Q

name some extrarenal manifestations of PKD

A

berry aneurysms
hepatic, pancreatic, spleen cysts
MVP
diverticula

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18
Q

MC cause of nephrolithiasis

A

Ca stone

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19
Q

imaging of choice for nephrolithiasis

A

helical spiral ct scan

20
Q

treatment for stone <5mm

A

fluid, strain urine, pain meds, alpha or ca channel blocker

21
Q

treatment for stone 5-10mm

A

fluid, pain meds

lithotripsy or ureteroscopy

22
Q

treatment for stone >10mm

A

FLUIDS

if renal function impaired - ureteral stent or percutaneous nephrostomy

23
Q

what drug can you give for a Ca stone to help

A

HCTZ

24
Q

what drug can you give for a uric acid stone to help

A

allopurinol

25
Q

DIABETES INSIPIDUS

  • urine sodium
  • urine output
  • urine sp gravity
  • serum sodium
A
DI:
urine sodium: LOW
urine output: high
urine sp gravity: low, dilute
serum sodium: HIGH

causes a hypernatremia (which is why patients feel thirsty)

26
Q

SIADH

  • urine sodium
  • urine output
  • urine sp gravity
  • serum sodium
A

SIADH:

  • urine sodium: high
  • urine output: low
  • urine sp gravity: high, concentrated
  • serum sodium: low
27
Q

describe the mechanism of DI: central and/or nephrogenic

A

Decreased ADH
(central: can’t produce, nephrogenic: not sensitive)
Leads to kidneys not being able to concentrate urine –> large amounts of dilute urine

28
Q

describe the mechanism of SIADH

A

increased ADH –> increased water retention –> dilutional hyponatremia
AND
–> kidneys not being able to dilute urine –> concentrated urine

29
Q

how to differentiate DI: central from nephrogenic

A

DDAVP test

Give DDAVP. If central - will have effect and urine will concentrate

30
Q

how to dx DI

A

fluid deprivation test

take fluid away - normal urine will concentrate but in DI it won’t

31
Q

how to treat SIADH (mild vs severe)

A

water restriction is the mainstay

can give hypertonic IV saline with furosemide if severe or brain bleed

32
Q

how to treat DI (nephrogenic vs. central)

A

Central: DDAVP
Nephrogenic: Na + protein restriction, hctz

33
Q

what happens if you replace volume too fast in HYPOnatremia

A

central pontine myelinolysis

34
Q

what happens if you replace volume too fast in HYPERnatremia

A

pulmonary or cerebral edema

35
Q

Tx for hyperkalemia

A

calcium gluconate IV*

also sodium bicarb, D50, Insulin 10u, sodium polystyrene sulfonate

36
Q

Tx for hypokalemia

A

Oral K replacement, spironolactone

IV if cardiac abnormalities

37
Q

Tx for hypercalcemia

A

Fluids and bisphosphonates

38
Q

tx for hypocalcemia

A

IV calcium gluconate or calcium chloride (severe)

oral Ca and Vit D (mild)

39
Q

Tx for hypermagnesemia

A

mild IV fluids and furosemide

severe calcium gluconate

40
Q

Tx for hypomagnesemia

A

Oral mag oxide at 2x the estimated deficit

IV mag sulfate if severe

41
Q

Tx for isovolemic hyponatremia

A

water restriction

42
Q

tx for hypervolemic hyponatremia

A

water and salt restriction

43
Q

tx for hypovolemic hyponatremia

A

NS

44
Q

tx for severe isovolemic or hypervolemic hyponatremia

A

hypertonic saline and lasix

45
Q

treatment for hypernatremia

A

PO preferred with hypotonic fluids

pure water, D5W, 1/2NS, 0.2% saline.