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GK PANCE > GK Nephrology > Flashcards

GK Nephrology Flashcards

1
Q

MCC of glomerulonephritis worldwide?

A

Berger’s Disease (IgA nephropathy)

affects young males within days after URI or GI infection

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2
Q

MCC of glomerulonephritis in the US?

A

Post-infectious group A strep after a skin (impetigo) or pharyngeal infection

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3
Q

UA results for acute glomerulonephritis

A

hematuria

RBC casts

proteinuria

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4
Q

acute glomerulonephritis + hemoptysis

A

goodpasture’s disease

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5
Q

Tx for glomerulonephritis

A

supportive

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6
Q

CPx of Berger’s Disease (IgA Nephropathy)

A

gross hematuria following a URI

red/smokey/coca cola colored urine

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7
Q

Berger’s Disease Tx for pts at high risk of progression to AKI (pts with HTN, low GFR, proteinuria > 1g/day)

A

ACE-I or ARB

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8
Q

cola/tea colored urine

A

glomerulonephritis

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9
Q

hypertension

coca colored urine

periorbiral edema

azotemia: ↑ BUN/Creatinine Ratio
oliguria: < 400ml

fever/abdominal/flank pain

A

glomerulonephritis

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10
Q

IgA mesangial deposits

A

Berger’s Disease

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11
Q

Tx for IgA nephropathy or proteinuria

A

ACE-I

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12
Q

normal glomerulus

A

impermeable to RBC and proteins

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13
Q

glomerulonephritis pathophys

A

immune mediated glomerular inflammation → glomerular damage →increased urinary protein + blood loss

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14
Q

crescent-shaped glomerulus on biopsy

A

rapidly progressing glomerulonephritis

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15
Q

What is the MCC of nephrotic spectrum glomerular disease in Americans?

A

Diabetes Mellitus

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16
Q

MCC of nephrotic syndrome in children

A

minimal change disease

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17
Q

periorbital edema worse in the AM in children

A

minimal change disease (nephrotic syndrome)

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18
Q

sxs of nephrotic syndrome

A

proteinuria, hypoalbuminemia, hyperlipidemia, edema, frothy urine, DVT

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19
Q

initial test for nephrotic syndrome

A

UA: proteinuria causing frothy urine

Microscopy: oval maltese cross-shaped fat bodies (fatty casts)

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20
Q

oval shaped fat bodies

A

nephrotic syndrome

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21
Q

gold standard test for nephrotic syndrome

A

24 hr urine protein > 3.5g/day

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22
Q

definitive dx for nephrotic syndrome

A

podocyte damage on electron microscope (Minimal Change disease)

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23
Q

1st line tx for minimal change diease

A

glucocorticoids

Others: Thiazides or loop diuretics for edema

fluid/Na restriction

Proteinuria reduction: ACE-I/ARBS

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24
Q

MCC of pyelonephritis

A

E. Coli

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25
Q

What will physical exam show for pyelonephritis?

A

+ CVA tenderness

fever

tachycardia

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26
Q

What will UA show for Pyelonephritis

A

Pyuria (WBC > 10)

+ nitrites

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27
Q

hallmark of pyelonephritis

A

WBC casts

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28
Q

definitive dx of pyelonephritis

A

urine culture

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29
Q

1st line Outpatient treatment for pyelonephritis

A

fluoroquinolones

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30
Q

Inpatient treatment for pyelonephritis

A

3rd or 4th gen ceph:

Third Generation: Cefotaxime, Ceftazidime, CeftriaxoneCefixime, Cefdinir

Fourth Generation: Cefepime

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31
Q

tx for pyelonephritis in pregnant patients

A

IV ceftriaxone

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32
Q

Tx for Hyperkalemia

A

calcium gluconate: administer when there are ECG changes to stabilize the cardiac membrane and reduce risk of cardiac dysrhythmias

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33
Q

hallmark of intrinsic kidney injury

A

cellular cast formation

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34
Q

What medication can cause exogenous intrinsic kidney injury?

A

aminoglycosides: gentamicin, tobramycin etc

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35
Q

epithelial cell casts & muddy brown casts

low specific gravity (unable to concentrate urine)

A

Acute tubular necrosis

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36
Q

electrolyte imbalance seen in ATN

A

hyperkalemis

increased phosphatemia

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37
Q

Tx for ATN

A

remove offending agents, IVF

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38
Q

How does acute tubulointerstitial nephritis present?

A

fever, eosinophilia, maculopapular rash, arthralgias

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39
Q

WBC casts

A

acute tubulointerstitial nephritis (AIN)

40
Q

most imp noninvasive test in acute kidney injury

A

UA

41
Q

RBC casts with hematuria, dysmorphic red cells

A

acute glomerulonephritis (AGN) or vasculitis

42
Q

waxy/granular casts: acellular with sharp edges

A

narrow waxy casts: chronic ATN

broad waxy casts: end stage renal disease

43
Q

fatty casts: “maltese crosses”, oval fat bodies

A

nephrotic syndrome due to HLD

44
Q

Hyaline casts

A

nonspecific, can be seen in normal urine

45
Q

normal or near normal UA results indicate which kind of AKI?

A

prerenal or postrenal

46
Q

hematuria and pyuria w/o casts

A

UTI

47
Q

pyuria alone

A

most likely due to infection

48
Q

GFR for stage 5 CKD

A

GFR < 15 = ESRD

49
Q

MCC of ESRD

A

DM, HTN, gomerulonephritis

50
Q

what is the best predictor for renal disease progression

A

proteinuria

51
Q

best test for CKD

A

spot Ualbumin/Ucreatinine ratio ACR

52
Q

broad waxy casts in UA

A

ESRD

53
Q

what will renal US show in CKD?

A

small kidneys

54
Q

what is a lifestyle change a pt can make when diagnosed with CKD?

A

restrict protein, sodium, water, potassium, phosphate

55
Q

what are hematologic complications of CKD?

A

anemia of chronic disease

renal osteodystrophy

56
Q

osteitis fibrosis cystica

A

periosteal erosions and bony cysts on skull X ray

57
Q

“Salt & Pepper” appearance of skull on x ray

A

renal osteodystrophy

58
Q

typical findings in labs of renal osteodystrophy

A

hypocalcemia, dec. Vit D, inc Phosphate, Inc PTH

59
Q

Tx for renal osteodystrophy

A

Vit D (calcitriol) + phosphate binders: Calcium acetate, Sevelamer (if both calcium and phosphate levels are elevated)

60
Q

When is dialysis indicated?

A

GFR ≤ 10

and/or

serum creatinine ≥8

61
Q

typical presentation for adult polycystic kidney disease

A

abdominal pain

palpable flank mass

HTN, hematuria

62
Q

resistant HTN and palpable abd pass

A

PKD

63
Q

cerebral berry aneurysms (worst HA of my life), Mitral valve prolapse, abdominal pain, abd mass and hematuria

A

PKD

64
Q

Prevalance of horseshoe kidneys is increased in females with what?

A

turner syndrome (amenorrhea, short-statured, delayed breast development, webbed skin b/w neck and shoulders)

65
Q

Dx for horseshoe kidney

A

CT urography

66
Q

Tx for horseshoe kidney

A

tx complications like UTI and kidney stones

Symphysiotomy (older tx method)

67
Q

imaging for Hydronephrosis

A

Ultrasound

68
Q

MCC of secondary HTN

A

renal vascular disease

69
Q

Initial Imaging for Renal Vascular Disease

A

Initial test = CT angio

70
Q

Gold standard for renal vascular disease

A

renal catheter arteriography

71
Q

def mgmt for renal vascular disease

A

revascularization

72
Q

signs of hypoalbuminemia

A

ascites, pitting edema

73
Q

Typical findings of Granulomatosis w/ Polyangiitis (GPA Wegener’s)

A
  • URI/Nose sxs: refractory sinusitis
  • lower resp tract sxs (hemoptysis)
  • glomerulonephritis (hematuria)
74
Q

main lab finding in granulomatosis w/polyangitis

A

+ C-ANCA

75
Q

Tx for Granulomatosis w/ polyangiitis

A

corticosteroids + cyclophosphamide (immunomodulator)

76
Q

The most common ECG abnormality associated with hypercalcemia is

A

a shortened Q-T interval

77
Q

Renal Cell Carcinoma Triad

A
  1. hematuria
  2. abdominal/flank pain
  3. palpable abdominal mass

HTN, hypercalcemia, normocytic normochromic anemia

78
Q

Renal Cell Carcinoma Tx

A

radical nephrectomy

79
Q

Aldosterone is released in response to what two electrolyte/volume changes?

A
  1. Hypovolemia: increased aldosterone promotes sodium retention
  2. Hyperkalemia: Aldosterone causes increased K+ excretion in exchange for Na+ reabsorption
80
Q

Na+ homeostasis is determined by

A

aldosterone

81
Q

hypovolemia stimulates both

A

aldosterone and ADH secretion

82
Q

Hyperkalemia Tx

A

Calcium Gluconate

83
Q

ECG changes for Hyperkalemia

A

Peaked T waves

Dropped P waves, widened QRS complex

Sine waves

84
Q

Best test to diagnose Renal Artery Stenosis

A

Magnetic Resonance Angiography (MRA)

85
Q

What is a serious complication of Polycystic Kidney DIsease?

A

cerebral aneurysm

86
Q

SIgns of Polycystic Kidney Disease

A

abd, flank, back pain

hematuria

HTN

Cerebral Aneurysms

87
Q

Mgmt for PKD

A

ACE-I or ARBs

88
Q

General causes of metabolic acidosis

A

addition of excess acids

impaired acid secretion

inapprorpiate loss of alkali

89
Q

How is the anion gap calculated

A

Na - (Cl + HCO3)

normal anion gap is 10 +/- 2

anion gap > 12 = elevated

90
Q

MUDPILES

A

Causes of Elevated Anion Gap Acidosis:

Methanol

Uremua

Diabetic Ketoacidosis

Paraldehyde

Isoniazid

Lactic acidosis

Ethylene Glycol

Salicylate Toxicity

91
Q

Typical findings for wilms tumor

A

asymptomatic abd mass

abdominal pain

92
Q

A salicylate overdose results in what acid-base disturbance?

A

Primarily respiratory alkalosis (hyperventilation)

Secondary metabolic acidosis

93
Q

What electrolyte abnormality will be present in Multiple Myeloma?

A

Hypercalcemia

94
Q

Common manifestations of hypomagnesemia

A

muscle cramping, weakness, hyperreflexia, ataxia, seizures

95
Q
A

GK PANCE (26 decks)

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