MKSAP-1 Flashcards
(25 cards)
Contrast-associated nephropathy prophylaxis is not indicated for patients with a stable estimated glomerular filtration rate___
> 45
(give if GFR 30-44 if high risk like nephrotoxic med exposure, hypotn/HTN active, MM)
give if <30
NS pre and post procedure
ACE/ARB indicated in CKD stage ___ or higher or stage ____ with proteinuria
re-assess Cr, K in __ time period
III or higher
I or II with proteinuria
2-4wks after initiation
patients with acquired cystic kidney disease are at risk of ___ and should therefore be surveilled by ___
how do you get these acquired cystic kidneys?
RCC
annual renal u/s
very common in CKD/ESkidney disease
tolvaptan for renal cysts? who should get it?
Autosomal dominaant polycystic kidneys
NOT acquired kidney cysts
immediate treatment for symptomatic hypermagnesemia is ___
what is moa?
immediate treatment for symptomatic hypermagnesemia is intravenous calcium gluconate.
Calcium rapidly antagonizes the cardiovascular and neuromuscular effects of hypermagnesemia
Hypermagnesemia also blocks ___ resulting in ____These effects become apparent when the serum magnesium level is ___
calcium and potassium channels, resulting in hypotension and bradycardia.
Hypermagnesemia decreases neural transmission, resulting in weakness, as seen in this patient, which can progress to paralysi
> 4.8 mg/dL
Rhabdo Induced ATN is likely to occur with the CK level___
> 5000
Electrolyte disturbances and rhabdomyolysis
Calcium__
K___
PE___
Uric acid___
LFTs___
Hypocalcemia
Hyperkalemia
Hypophosphatemia
Hyperuricemia increased AST ALT
Medication that is first-line treatment for IgA nephropathy
And what is the reason
ACE ARB
Decreased protein excretion, proteinuria, slows rate of renal decline
What is a common cause of type IV renal tubular acidosis?
Diabetes mellitus
Drug-induced like ACE inhibitor, ARB, heparin, NSAID
In CKD, and what GFR does acidosis typically develop
Add what GFR does hyperkalemia usually develop
<40
<30
Medication like___can cause resistance to ADH which in turn leads to nephrogenic diabetes insipidus
Lithium
Central diabetes insipidus can occur as a result of___Like diseases
Tumor that invades the hypothalamus
Infiltrating disease like sarcoidosis
Surgical destruction
___medication blocks the epithelial sodium channel in the collecting tube and prevents the uptake of lithium in nephrogenic diabetes insipidus
Amiloride
Urea splitting organisms seen in the urine___
Pathophysiology___
Will cause___renal stones which will look like___under the microscope
Proteus, Klebsiella, Pseudomonas
Secretory urease, Hydro lysis urea into carbon dioxide and ammonium,Precipitation of magnesium ammonium phosphate AKA struvite
Very high pH
Cough and lid appearance, struvite crystals
Struvite crystals, what is the treatment?
What is not the definitive treatment?
Percutaneous nephrolithotomy is first-line treatment
Will continue to persist despite antibiotic therapy therefore it is not the definitive treatment
The struvite stones are large and rapidly growing, so they will not pass into the ureter like the other smaller stones, therefore they need percutaneous nephrolithotomy
You need to start ACE/ARB for hypertension in a patient with albumin to creatinine ratio of___
> 30
Treatment of type I hepatorenal___
Stop diuretics, IV albumin for volume expansion
Vasoconstrictors
Renal transplant patients, what are they at a risk for? ___Cancer
Skin cancer, need annual skin checks
You have tried first-line medications for IgA nephropathy and it did not work, what is the second line or third line?
ACE ARB did not work, second line is mycophenolate mofetil, this treatment is only beneficial for Asian descent
Overall the use of immunosuppressive therapy including prednisone is controversial
When it is a renal biopsy indicated for CKD?
When glomerulonephritis or unexplained tubulointerstitial disease is suspected
___Medication of choice true for adults risk of progressive autosomal dominant polycystic kidney disease
Tolvaptan
What other risk factors that indicate the autosomal dominant polycystic kidney disease will progress?
For risk factors
- Hypertension before 35-year-old
- Urological events i.e. cyst infection, gross hematuria, flank pain before 35-year-old
- GFR decreased >5 within a year
- Family history of ESRD before 58 years of age
You have a patient with resistant hypertension, most common causes___
Will see these electrolyte findings:___
This is the first test you should order:___
Primary hyperaldosteronism
Hypokalemia, metabolic alkalosis
Serum aldosterone: Serum renin
