From Flashcardlet > MKSAP: Nephrology > Flashcards

MKSAP: Nephrology Flashcards

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0
Q

What are dysmorphic erythrocytes associated with when they are found in urine sediments?

A

-glomerular hematuria

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1
Q

What are monomorphic or intact erythrocytes characteristic of when found in urine sediments?

A

-nonglomerular hematuria

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2
Q

What classifies as ACEi-induced prerenal acute renal failure? Tx?

A
  • increase of creatinine >30% after the initiation of an ACEi or ARB (less than 30% is tolerable, an increase in creatinine is expected with these drugs)
  • tx: stop the ACEi or ARB
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3
Q

In what kidney disease are ACEi contraindicated? Why?

A
  • bilateral renal artery stenosis bc in these pts the GFR is maintained by an angII-induced vasoconstriction at the efferent arterioles
  • *switching to an ARB will NOT solve this problem!
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4
Q

What rash is characteristic of atheroembolic acute renal failure?

A
  • fine reticular rash, livedo reticularis

- red, lacy rash

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5
Q

How long after an arterial catheter can atheroembolic acute renal failure occur?

A

-1-4 weeks afterwards

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6
Q

Tx and prognosis of atheroembolic acute renal failure?

A

-no tx and the renal function does not usually return

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7
Q

Mechanism for how NSAIDs can cause prerenal acute renal failure?

A

-inhibition of prostaglandin synthesis causes vasoconstriction –> decreased glomerular capillary pressure –> acute renal failure

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8
Q

Abdominal pain and an increasing creatinine level in an elderly man?

A

-consider acute renal failure caused by urinary tract obstruction

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9
Q

4 Characteristics of hypertensive nephrosclerosis?

A
  1. HTN
  2. Non-nephrotic proteinuria
  3. Bland urine sediments
  4. Slowly progressive loss of kidney function
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10
Q

Classic triad of sx for acute interstitial nephritis?

A
  1. Fever
  2. Rash
  3. Arthralgias
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11
Q

Dipstick-positive hematuria, but no intact eyrthrocytes on microscopic analysis of urine sediments?

A

-think: rhabdomyolysis-associated acute renal failure

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12
Q

Muddy brown casts?

A

-acute tubular necrosis

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13
Q

5 Characteristics of acute glomerulonephritis?

A
  1. HTN
  2. Edema
  3. Proteinuria
  4. Glomerular hematuria
  5. Erythrocyte casts in urine
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14
Q

What type of casts are seen in acute interstitial nephritis?

A

-leukocyte casts

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15
Q

4 Characteristics of nephrotic syndrome?

A
  1. Urine protein excretion > 3.5 g/day
  2. Hyperlipidemia
  3. Hypoalbuminemia
  4. Edema
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16
Q

Which comes first diabetic retinopathy or nephropathy?

A

-retinopathy!

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17
Q

C3 and C4 levels in postinfectious glomerulonephritis?

A
  • low C3

- normal C4

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18
Q

C3 and C4 levels in SLE nephritis?

A

-C3 and C4 will be really low!

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19
Q

Glomerular nephritis + alveolar hemorrhage?

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A

-Goodpasture’s syndrome

20
Q

Which pathogen is associated with HUS?

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A

-E. Coli O157:H7 shiga toxin

21
Q

4 Characteristics of multiple myelomma?

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A
  1. Calcium is elevated
  2. Anemia
  3. Renal failure
  4. Bone lesions
    * *“CRAB”
22
Q

Common cause of nephrotic syndrome in children and adults?

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A

-minimal change disease

23
Q

5 Characteristics of minimal change disease?

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A
  1. Edema
  2. Hypoalbuminemia
  3. Hyoercholesterolemia
  4. Urine protein excretion of >3.5 g/24hrs
  5. Numerous oval fat bodies in urine –> “ maltese cross”
24
Oval fat bodies in urine?
-hallmark of proteinuria
25
4 Characteristics if Wegener's granulomatosis?
1. Upper respiratory dz 2. Lower respiratory dz 3. Glomerulonephritis 4. C-ANCA
26
Best screening test for diabetic nephropathy?
-measurement of microalbumin
27
Winter's formula?
-Expected PCO2 = 1.5*[HCO3-]+ 8 | +/-2
28
Anion Gap formula?
= [Na+] - ([Cl-] + [HCO3-])
29
Normal anion gap
- = 6-11
30
Low anion gap? Common cause?
- less than 6 | - hypoalbuminemia
31
Decreased pH and bicarb?
-metabolic acidosis!
32
Primary metabolic acidosis plus a PCO2 higher than expected?
-mixed metabolic and respiratory acidosis
33
Formula to calculate osmolality?
2*[Na]+[glucose]/18+[BUN]/2.8 | -normal gap < 10
34
Osmolar gap?
- difference btwn the calculated and measured osmolality | - normal < 10
35
What does an elevated osmolar gal mean? Common causes?
- means there is a presence of an unmeasured osmole | - causes: ethylene glycol or methanol
36
3 features of ethylene glycol poisoning?
1. Elevated Anion gap metabolic acidosis 2. Elevated osmolar gap 3. Calcium oxalate crystals in urine
37
Acetazolamide: what is it? What acid/base disturbance can it cause? Why?
- carbonic anhydrase inhibitor | - can cause a non-ion gap metabolic acidosis --> prevents the reabsorption of bicarb in the proximal tubule
38
What acid/base disturbance often develops in a pt with ESLD? Why?
- respiratory alkalosis - the liver normally metabolizes steroid hormones, the elevated prostaglandin levels in ESLD cause a stimulation of the respiratory drive --> primary resp alkalosis
39
Common cause of mixed anion gap metabolic acidosis and respiratory alkalosis?
-salicylate toxicity
40
What is the normal response to a fluid deprivation test?
-increasing urine osmolarity
41
What electrolyte abnormality can be caused by ACEi? What drug should be used instead in these pts?
- hyperkalemia | - instead use: hydralazine/nitrate combo to control the BP
42
What electrolyte imbalance can occur in a pt taking hydrochlorothiazide
-hyponatremia
43
General characteristic of SIADH?
-patient is unable to make dilute urine
44
What electrolyte imbalance does sarcoidosis cause? Why?
- hypercalciuria and hypercalcemia - the granulomatous tissue can produce 1-alpha-hydroxylase --> converts 25-hydroxyvitamin D to the active form, 1-25-dihydroxyvitamin D3 --> more absorption of calcium via vit D toxicity
45
Electrolytes in primary hyperparathyroidism?
- elevated serum calcium - low phosphorus - elevated hypercalcemia
46
What can hypomagnesium in pts with alcoholism mimic? Why?
- can mimic hypoparathyroidism with hypocalcemia - hypomagnesium can cause suppression of parathyroid hormone secretion and resistance to PTH action - so magnesium needs to be corrected in order to correct the calcium
47
Why does hypomagensium occur in alcoholics?
-acute alcohol ingestion induces magnesium loss via urine
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