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**Old DOOS > Kidney 2 > Flashcards

Kidney 2 Flashcards

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1
Q

what typically causes hypernatremia?

A

free water loss (not sodium gain)

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2
Q

what can cause hypervolemic hypernatremia?

A

administration of hypertonic saline, or hypertonic bicarb
hypertonic dialysis, feedings
cushing’s syndrome
primary hyperaldosteronism

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3
Q

what can cause euvolemic hypernatremia (most common cause)

A

diabetes insipidus
hypodipsia
insensiible dermal and skin losses

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4
Q

what typically causes hyponatremia?

A

reduced ability to excrete free water due to
reduced GFR
reduced ECV

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5
Q

what can cause hyperosmolar hypernatremia?

A

hyperglycemia

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6
Q

what can cause euvolemic hyponatremia?

A 
SIADH
glucocorticoid deficiency 
hypothyroidism
primary polydipsia
poor osmolar intake (ex- beer drinkers) 
positive pressure ventilation
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7
Q

what can cause hypovolemic hypo-osmolar hyponatremia

A

reduced total ECF
reduced effective circulating volume
severe hypokalemia

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8
Q

To dx SIADH what needs to be normal?

A

kidney function
adrenal function
thyroid function
volume status

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9
Q

what conditions cause secondary renal sodium retention?

A

heart failure
liver dz
pregnancy

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10
Q

what conditions cause primary renal sodium retention?

A

Acute and chronic renal failure
Effective mineralocortical excess
Decreased oncotic pressure
Tubular syndromes

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11
Q

what can cause pseudohyperkalemia?

A

hemolysis
thrombocytosis
leukocytosis

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12
Q

what can cause redistribution hyperkalemia?

A

acidosis
decrease in insulin
beta-adrenergic blockage

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13
Q

what can cause hyperkalemia w/ GFR >20 and low aldosterone?

A

addison’s dz
hyporeninemic hypoaldosteronism
Drugs (PG syntheses inhibition, captopril)

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14
Q

where are the afferent sensors for circulating volume circulation?

A

lungs

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15
Q

what do catecholamines cause

A

sodium retention

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16
Q

what does ANP do?

A

causes excretion of Na

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17
Q

if a person is hyponatermic, what will their urine osmols usually be?

A

increased form serum

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18
Q

what can severe hyperlipidemia cause?

A

pseudohyponatremia

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19
Q

what are causes of SIADH?

A

CNS pathology
pulmonary
drug related

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20
Q

what are renal causes of volume depletion?

A 
diuretics
post-obstruction diuresis
ATN (recovery)
Rental tubular acidosis)
salt-losing nephropathy
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21
Q

inability of kidney to handle a bicarbonate load?

A

renal tubular acidosis

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22
Q

what are extravascular sequestration causes of volume depletion?

A

intestinal obstruction
peritonitis
pancreatitis
rhabdomyolysis

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23
Q

What drugs can cause decreased renal excretion of K+ leading to hyperkalemia?

A

aldosterone antagonists (spironolactone)
ACEI, ARB
NSAIDs (prostaglandin inhibitors)

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24
Q

can you put someone who is experiencing hyperkalemia on an ACEI to an ARB?

A

No, will still have the same problem

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25
What drugs can lead to hyperkalemia?
``` spironolactone triamterene amiloride captopril ACEIs and ARBs ```
26
if a patient is hypokalemic what must you assess?
metabolic status | renal excretion
27
what is one of the most common causes of a hypokalemic metabolic alkalosis
diuretics (thiazides)
28
if potassium urine is >20 mEq/L w/ hypokalemia where are is the likely problem?
kidney
29
what can cause metabolic acidosis w/ an increased anion gap?
``` renal failure acid overproduction meds (salicylates) DKA toxins (alcohol, ethylene glycol) ```
30
how do you determine the anion gap?
(Na+)- (Cl- + HCO3-)
31
what conditions are associated w/ a normal anion gap metabolic acidosis
``` extrarenal bicarb loss RTA (renal tubular acidosis) meds supplements aldosterone deficiency ```
32
what are common causes of metabolic alkalosis
``` gastric loss diuretics antacids (Tums) volume depletion Gitelman syndrome Bartter syndrome ```
33
a Na below what or above what is a medical emergency?
155
34
A potassium above what and below what is an emergency?
6.5
35
a pH below what and above what is a medical emergency?
7.55
36
Bicarb levels above what and below what are a medical emergency?
bicarb 40
37
are cultures usually done in females w/ their first UTI
no
38
what are features of cystitis?
``` Frequency Dysuria Urgency Suprapubic pain/discomfort Hematuria ```
39
what are the 2 important labs on dipstick for cystitis?
LCE and n itrite | LCE is more sensitive
40
what should you see on the microscope analysis of urine w/ cystitis?
WBCs | RBCs
41
what are cultures used for in cystitis?
to ID organism | use after failure of response
42
what are common causes of hematuria?
UTI stones cancer BPH
43
what is the highest hazard ratio w/ cystitis for premenopausal women?
frequency of intercourse
44
what is the highest risk for cystitis in postmenopausal women?
h/o of 6 or more UTIs | insulin treated DM
45
who can experience complicated cystitis?
``` pregnant very young or old diabetic immunocomprimised GU abnormalities recent abx therapy obstruction ```
46
what are the 5 main features of pyelonephritis?
``` fever >38 degrees Celcius flank pain CVA tenderness Naseau Vomiting ```
47
what commonly causes pyelonephritis?
E. Coli (will be nitrite positive)
48
on US what can you see w/ pyelonephritis
focal bacterial infection on a pole of the kidney
49
what do clotting red blood cells indicate?
urological problem, occurring in the lower urinary tract | stones, tumor
50
if bleeding is occurring in the upper urinary tract will there be clotting?
No, most of those enzymes are removed
51
red cell casts are associated with what?
glomerulonephritis
52
what is the most effective tx for cystitis?
bactrim for 3 days (160-800 mg BID)
53
what are other treatment for cystitis?
ciprofloxacin levofloxain nitrofurantoin trimethoprim by itself (recurrent)
54
why is increasing fluids w/ cystitis controversial
too much fluid may dilute the abx
55
what is the benefit of cranberry juice w/ cystitis?
appear to prevent bacterial adherence to urinary tract epithelium have no abx activity
56
what changes the pH of urine and can help prevent UTIs
vitamin C 500 mg at bedtime
57
what is a recurrent UTI?
3 infections per year of >2 within 6 months | culture negative at 2 wk post treatment
58
what do you use for tx of pyelonephritis?
ceftriaxone IV ciprofloxacin PO or IV levofloxacin PO TMP-SMX PO
59
Does urine production exclude urinary obstruction w/ pyelonephritis?
No
60
what should you get if you think a patient has an obstruction or stone w/ pyelonephritis?
Renal US
61
when can you convert a person w/ pyelonephritis to an oral regimen?
If afebrile for 12-24 hours
62
what are some risk factors for stones?
``` hypercalciuria low urine output high protein diet high salt diet high oxalate diet ```
63
what is the most frequent cause of renal stones?
calcium oxalate/ phos | opaque, can see on x-ray
64
what causes staghorn calculus?
magnesium NH4/ PO4 | can see on x-ray, opaque
65
which of the stones may be loosened and you can't see on an x-ray
uric acid
66
what crystals look like coffin-lids?
phosphate crystals
67
what is a KUB
kidney, ureters, and bladder x-ray (flat plate)
68
how do you get rid of staghorn calculi?
surgery
69
what are the main features of renal cell carcinoma (from most to least common)
hematuria abdominal mass pain
70
what other symptoms are associated w/ renal cell carcinoma?
weight loss anemia (but may see polycythemia because some can produce EPO) fever
71
what are causes of urinary tract obstructions?
Congenital urinary tact malformation Intraluminal obstruction Extrinsic compression Acquired anomalies
72
if urine osmols are higher than serum osmols then what is there?
increased circulating levels of ADH

**Old DOOS (11 decks)

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