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MKSAP Flashcards

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1
Q

What are the risk factors for development of cyst in a ESRD patient

A

Male with long standing ESRD on HD

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2
Q

Why is screening for cysts important in patients with ESRD?

A

Because of malignant transformation. Screening is based on individual risk vs life expectancy and should be performed using annual renal US.

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3
Q

Medication approved for ADPKD

A

Tolvaptan

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4
Q

Rx of myeloma kidney

A

Bortezomib based chemotherapy + high dose dexamethasone

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5
Q

Why does nephrotic syndrome increase the risk of VTE

A

Increased hepatic production of procoagulants (fibrinogen, 5, 8) and increased loss of renal Anti thrombin 3 and protein S

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6
Q

What is the surrogate marker for increased VTE risk in nephrotic syndrome and what is the cutoff

A

Albumin <2.8

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7
Q

Define BP goal for severe pre-eclampsia

A

> 160/110

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8
Q

Rx of severe pre eclampsia and HELLP

A

BO control and IV magnesium for seizure prophylaxis. Unlike TTP no role for plex and steroids

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9
Q

Preferred Rx for GERD in patients with CKD

A

H2 blockers - dose and frequency adjusted for kidney function

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10
Q

Electrolyte derangement associated with PPI use and the mechanism

A

PPI in a patient with genetic TRMP mutations in Mg channels in GI tract —> GI loss of Mg—> hypo Mag—> persistent opening of K channel in distal nephron (Mg Gaurd K channel) —> K wasting

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11
Q

How do you approach white coat HTN (screen for CV risk, progression to HTN, pharmacotherapy, lifestyle interventions)

A
  1. No evidence of CV benefit with Rx of white coat HTN
  2. Can use screening echo —> LVH warrants Rx
  3. No pharmacotherapy if BP 130-160/80-100
  4. Lifestyle modifications still recommended
  5. 1-5% progress to HTN
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12
Q

Which antacid should be avoided in CKD patients

A

Magnesium based —> increased risk of hyperMg

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13
Q

What are the effects of hyper Mg and above what level are they seen?

A

Blocks K and Ca channels —> reduced neuronal transmission leading to weakness or paralysis —> bradycardia and hypotension.

Typically above >4.8

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14
Q

What is the immidiate and definitive management of hyper Mg

A
  1. Immediate: Iv Calcium gluconate —> rapid reversal of neuronal and CV effects
  2. Definitive : HD
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15
Q

Causes and Evaluation algorithm for NAGMA

A

Causes: hyperCl-, HCO3 loss (renal or GI) and H+ retention (inability of kidney to excrete acid)

Next step: asses kidneys ability to excrete acid by measuring urinary NH3. Urinary NH3 difficult to measure due to short half life —> measure Cl instead —> calculate urinary anion gap: (Na+K) - Cl. Negative AG indicated appropriate acid generation.

If kidneys adequately excreting NH3–> look for GI loss

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16
Q

What are the causes of AIN with fever, rash, eosinophils and without and what is the timeline for development of both

A
  1. With fever, rash, peripheral eosinophilia —> antibiotics, autoimmune, and systemic illness; develops within days
  2. Without the above —> NSAID including celebrex (6-18 months) and PPI (3 months)
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17
Q

Rx of AIN

A
  1. D/C offending meds
  2. Steroids to slow progression
  3. Repeat KFT within 5-10 days after d/c meds —> should improve —> no improvement—> kidney Bx
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18
Q

Proximal RTA losses mnemonic

A

Bicarbonate GAP (glucose, amino acids, phosphorus >5%)

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19
Q

Proximal RTA also known as Fanconj syndrome drug

A

Cyclophosphamide and Ifosfamide

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20
Q

Kidney disease in a young to middle aged male who is migratory agricultural worker from Central America/Asia

A

Chronic interstitial nephritis

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21
Q

Normal osmolarity range

A

279-295

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22
Q

Normal osmolal gap

A

<10

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23
Q

Hormone that regulates osmolarity

A

ADH

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24
Q

Na correction for glucose

A

1.6-2.2 for every 100 increase in glucose

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25
What is isotonic huponatremia
Lab artifact due to increased solid phase component of the plasma - MM and hyper TG
26
Most common drugs associated with hypo Na
1. Antidepressants 2. Thiazides 3. Ecstasy
27
What are the two subdivisions of isovolumic hyponatremia
1. SIADH: kidneys inability to concentrate urine —> resultant Na wasting 2. Excess water intake/low solute intake
28
Goal correction of hyperNa
10-12
29
Rx of nephrogenic DI
Thiazide diuretics
30
Rx of lithium related nephrogenic DI
Amiloride —> reduced absorption of lithium in CT
31
EKG changes in hypoK
ST depression, decreased T wave amplitude, and increased u wave amplitude
32
Urine K/Cr ratio indications extra renal losses of K
<13
33
Barter syndrome —- diuretics
Loop
34
Gitlemans syndrome — diuretics
Thiazide
35
Middle syndrome —- excess
Aldosterone
36
EKG findings in hyper K
Peaked T and short QT —> wide QRS long PR, loss of P wave —> sone wave pattern
37
Which antibiotic and another commonly used IP med (analgesic) can cause hyper K
TMP and NSIAD
38
Distal RTA is a manifestation of this common disease
DM
39
I binder in gut
Patiomer
40
FePO4 suggesting renal PO4 wasting
>5%
41
Metabolic abnormality cause hypoPO4
Respiratory alkalosis
42
Which two electrolyte derangements can cause Carpio pedal spasm and Chvostek sign
Ca and Mg
43
Rx of hyper Mg
IV CA
44
Iron preparation that causes renal PO4 wasting
Ferric carboxymaltose
45
If you check Ca, always check — too
Mg
46
What is Mg role in PTH release
Supresses
47
GFR cutoff for CIN prophylaxis
1. <30: always 2. 30-44: based on individual risk factors
48
Therapy for nephrotic syndrome
1. Albuminuria: ACE/ARB 2. Hyperlipidemia: Statins 3. Edema: salt restriction and loop diuretics
49
Patient is on max dose of loop diuretics, initially response now failed. Explaination?
Loop diuretics —> increased Na delivery to the distal tubules —> hypertrophy of distal cella’s —> counteracting effect of loop diuretics
50
Thee most common causes of CKD
1. DM 2. HTN 3. Glomerular diseases
51
Dose of ACE/ARB in DKD
Typically to maximal tolerated dose
52
What is finerenone
Non steroidal mineralicorticoid receptor antagonist
53
3 classes of Meds used in DKD
1. ACE/ARB 2. SGLT 2 3. GLP-1 4. Finerenone
54
Recommended screening for all patients with membranous nephropathy despite PLAR2 status for ages >65
Age appropriate cancer screening
55
Expected rise in Cr after ACE/ARB
25-30%
56
4 differentials for Ig deposition in kidneys
1. Amyloid 2. Multiple myeloma 3. Waldenstrom macroglobulinemia 4. MGRS
57
What is Type 1 hypoK distal RTA
Inability to excrete H—> compensatory increase in Cl—-> NAGMA —> hypoK—> loss of urine acidification beyond Ph 6
58
What is type 4 hyperK distal RTA
Aldosterone deficiency or resistance
59
Stage 2 HTN first line drug
Combination of two drugs
60
HTN plus volume overload is a — retentive state
Na
61
GFR cutoff for PICC
<60
62
Kidney manifestation of IgG4RD
CIN
63
Composition of structure stone
Magnesium ammonium phosphate
64
How does low Na diet prevent kidney stone formation
Ca parallels the excretion of Na and therefore reducing Na will also reduce Ca excretion
65
Diamond urine crystals
Utica acid diamonds
66
Coffin shaped crystals
Struvite
67
Rhomboid urinary crystals
Cal oxalate
68
Mx of resistant HTN by huperaldosteronism without surgery
Aldosterone antagonist - spirinolactone or eplerenone
69
HCO3 compensation for chronic respiratory alkalosis
10 fall in CO2 —> 5-6 fall in HCO3
70
Urine dipstick identifies —- protein while urine protein Cr ratio identifies —-
Albumin only; all proteins
71
Discrepancy in proteinuria on UA dipstick and protein/cr ratio
Protein other than albumin —> MM?
72
BP goal in pregnancy
140/90
73
Three drugs approved for HTN in pregnant
1. Labetalol 2. Methyldopa 3. Nifedipine
74
3 meds approved for HTN in pregnant
1. Labetalol, metoprolol, and pindolol. Atenolol and propranolol cause adverse side effects 2. Methydopa 3. Nifedipine
75
Med to be taken at week 12-28 or gestation in patient with HTN
Aspirin
76
What are the two mechanisms of rise in Cr
1. Decreased GFR 2. Decreased tubular secretion with normal GFR
77
Which meds reduce tubular secretion of Cr without affecting GFR
1. HIV: bictegravir and dolutegravir 2. Trimetoprim 3. Cimetidine
78
2 criteria for resistant HTN
1. HTN despite three different antihypertensives 2. BP at goal but requiring more than 4 meds
79
Diuretic more effective in managing HTN
Chlorthalidone
80
Define abdominal compartment syndrome
Pressure >20 with at-least one organ failure
81
When to initiate HCO3 supplementation in CKD
<22
82
Define pre-eclampsia
New onset HTN after 20 weeks of pregnancy with either proteinuria (>300) or evidence of end-organ dysfunction: neurological, pulm edema, liver, kidney injury, thrombocytopenia
83
Define abdominal compartment syndrome
I yea-abdominal pressure >20 with atleast one organ dysfunction
84
Serum value that is more sensitive than Cr in estimating GRF in patients with altered muscle mass
Serum cystatin C
85
Which drug crystallizes in the tubules causing intraabdominal renal obstruction
Acyclovir —> needle shaped crystals
86
How to manage acyclovir induced kindey stone formation
Aggressive fluid resuscitation during acyclovir therapy
87
Immunosupression for lupus nephritis safe during pregnancy
Tacrolimus and cyclosporine
88
Gingival Side effect of cyclosporine
Gingival hyperplasia
89
Initial therapy for African Americans with HTN
CCB or thiazides
90
In addition to ACE/ABR and NSAIDs, which other medication impairs renal blood flow causing pre-renal AKI
Calcineurin inhibitors
91
Definitive Rx of HRS
Transplant
92
Conditions associated with isosthenuria
1. Sickle cell disease 2. Iron overload
93
Lab required to make a diagnosis of iron deficiency in presence of CKD
Transferrin saturation. Ferretin alone not diagnostic
94
Fistula associated heart failure characteristic diagnostic feature
Elevated right heart pressure with preserved EF
95
Bowel regimen in CKD patient
Don’t give phosphate based enema
96
Up trending Cr with Bactrim use
Proximal tubular secretion increased
97
Which laxatives to avoid in CLD
Magnesium based

Nephrology (1 decks)

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