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MTB 2 Flashcards

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1
Q

Alport Syndrome
Defect in?
Presentation?
Tx?

A

Collagen - Type IV
Sensorineural hearing loss
Visual disturbance - collagen loss for lens of eye
No therapy

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2
Q

Polyarteritis Nodosa
Pathophys
Ass’d with

A

Systemic vasculitis - small and medium arteries
MC affect kidney
Spare the lung
Ass’d with Hep B

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3
Q

PAN Presentation

Organ systems involved

A

GN +
Nonspecific sx’s = fever, malaise, weight loss, myalgias, arthralgia over wks to months
GI = Abd pain, bleeding, N/V. Pain worse w eating
Neuro: Vasc damage around big peripheral nerves = neuropathy of peroneal, ulnar, radial, brachial
Mononeuritis multiplex
Stroke in young person
Skin: Purpura and petechiae; digital gangrene, livedo reticularis
Cardiac Dz = 1/3 of pts

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4
Q

Livedo Reticularis seen in

A

Atheroemboli of kidney

PAN

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5
Q

Tests for PAN

A

Anemia, leukocytosis
High ESR and CRP
ANA and RF sometimes

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6
Q

Most accurate diagnostic test PAN

A

BX of symptomatic site

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7
Q

TX for PAN

A

Cyclophosphamide + Prednisone

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8
Q

Best initial test for PAN

A

Angiograpy shows aneurysmal dilation

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9
Q

Presentation of Lupus Nephritis

A

Any degree of renal involvement
Kidneys - normal or mild, asymptomatic proteinuria
Severe = Membranous GN
Long standing scars = Glomerulosclerosis

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10
Q

Most accurate test for Lupus nephritis

A

Kidney Bx

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11
Q

TX for Lupus nephritis
Mild
Severe, proliferative

A

Mild - glucocorticoids

Severe - Glucocorticoids + Cyclophosphamide or Mycophenolate

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12
Q

MOA of Mycophenolate

A

Inhibits enyzme needed for T and B cells to grow
Immunosuppresant
Used in RA

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13
Q

DDX for large kidneys seen on sonogram and CT scan

A

PKD
Amyloid
HIV nephropathy
Diabetes

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14
Q

Amyloidosis ass’d with

A 
Abnormal protein production
Myeloma
Chronic Inflammatory Dz
Rheumatoid Arthritis 
IBD
Chronic Infxn
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15
Q

Most accurate test for Amyloidosis

A

Bx shows green birefringence with Congo Red stain

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16
Q

TX for Amyloidosis

A

Tx underlying dz

Melphalan + Prednisone

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17
Q

Massive proteinuria leads to

A

Nephrotic syndrome

  • Edema
  • Hyperlipidemia
  • Thrombosis = urinary loss of Protein C, protein S, antithrombin
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18
Q

Nephrotic syndrome ass’d with Cancer of solid organ

A

Membranous

- Breast, Lung, Colon, Prostate

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19
Q

Nephrotic syndrome ass’d with Hep B

A

Membranous

Membranoproliferative

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20
Q

Nephrotic syndrome ass’d with SLE

A

Membranous

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21
Q

Nephrotic syndrome ass’d with Hodgkins Lymphoma

A

Minimal Change

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22
Q

Nephrotic syndrome ass’d with Children

A

Minimal Change

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23
Q

Nephrotic syndrome ass’d with IVDA and AIDS

Study These Flashcards
A

Focal Segmental

24
Q

Nephrotic syndrome ass’d with African Americans and Hispanics

Study These Flashcards
A

Focal Segmental

25
Best initial test for Nephrotic syndrome
UA - Good for amt of protein over 24 hrs - Albumin/Creatinine = average protein produced over 24 hrs
26
Most accurate test for Nephrotic syndrome
Renal BX
27
What are maltese crosses and when do we see them
Lipid deposits in sloughed off tubular cells Fatty cast Nephrotic syndrome
28
Labs of Nephrotic syndrome
Hyperproteinuria Hypoproteinemia Hyperlipidemia = loss of lipoproteins Edema
29
Best initial TX for Nephrotic syndrome
``` Glucocorticoids No response after weeks = cyclophosphamide ACE/ARBs Edema = salt restriction + diuretics HyperLipidemia = statins ```
30
Presentation of Uremia
``` Metabolic Acidosis Fluid overload Encephalopathy Hyperkalemia Pericarditis ```
31
Manifestations of renal failure
Anemia = loss of EPO Hypocalcemia = no 1,25-OH Vit D to absorb calcium from gut Osteodystrophy = secondary hypoPTH from low Calcium Bleeding = platelets do not work in uremic environment b/c can't degranulate Infxn = neutrophils don't work well - can't degranulate Pruritis Hyperphosphatemia Hypermagnesemia Atherosclerosis and HTN Endocrinopathy - Men have low testosterone, ED. women are anovulatory
32
When do we use EPO as TX
Anemia from ESRD is the ONLY time
33
What is winter's formula
pCO2 = 1.5 (HCO3) + 8
34
TX for hyperphosphatemia
``` Oral Phosphate Binders Calcium acetate Calcium carbonate Sevalamer Lanthanum ```
35
Which phosphate binders do we never use? Why?
Aluminum containing | Cause dementia
36
Assn's with TTP
HIV Cancer Drugs = cyclosporine, ticlopidine, clopidogrel
37
HUS ass'd with
Children E.Coli 0157:H7 Shigella
38
TTP/HUS Presentation
Intravascular hemolysis Renal insufficiency Thrombocytopenia
39
What does TTP/HUS look like on smear?
Schistocytes Helmet cells Fragmented RBCs
40
TTP ass'd with
Neuro sx's | Fever
41
TX for TTP/HUS
``` HUS = resolves on own TTP = emergent Plasmapheresis or infusion of FFP ```
42
When do we use steroids in TTP/HUS
Never.
43
MCC of death in PCKD
Renal Failure from recurrent pyelonephritis and nephrolithiasis episodes = scarring, loss of renal function
44
Assn's with PCKD
Liver cysts Ovarian cysts MVP Diverticulosis
45
Causes of hypernatremia
``` From loss of free water Sweating Burns Fever Pneumonia Diarrhea Diuretics ```
46
Pathophys of DI
High volume water loss | Insufficient/ineffective ADH
47
Central v Nephrogenic DI
Central - production problem | Nephrogenic - Loss of ADH effect on collecting duct
48
Causes of Nephrogenic DI
``` Lithium Demeclocycline Chronic Kidney Dz Hypokalemia Hypercalcemia ```
49
What is Urine osmolality and sodium in NDI
Low
50
What is Urine osmolality and sodium in CDI
Low
51
Best initial test for DI
Water Deprivation Test - Urine volume stays High - Urine osmolality stays Low
52
Response to ADH admin
``` CDI = sharp decrease in urine volume, increase osmolality NDI = No change ```
53
Most accurate test for CDI v NDI
ADH Level - Low in CDI - High in NDI
54
TX for DI
``` Correct underlying cause CDI = replace ADH NDI = Correct K+ and Ca+ Stop offending drugs HCTZ or NSAIDs ```
55
What complication occurs when sodium levels are brought down too rapidly
Cerebral Edema from shift of fluids from vascular space into cells of the brain - Worsening confusion and seizures

Nephro (6 decks)

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