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Flashcards in MTB Nephro Deck (31):
1

The "best initial test" in nephrology is

a urinalysis and the blood urea nitrogen (BUN) and creatinine.

2

Severe proteinuria means

glomerular damage.

3

White blood cells in UA

inflammation, infection, or allergic interstitial nephritis. You cannot distinguish neutrophils from eosinophils on a UA. Neutrophils indicate infection. Eosinophils indicate allergic or acute inter- stitial nephritis.

4

Hematuria is indicative of:

• Stonesinbladder,ureter,orkidney
• Hematologic disorders that cause bleeding (coagulopathy) • Infection (cystitis, pyelonephritis)
• Cancerofbladder,ureters,orkidney
• Treatments (cyclophosphamide gives hemorrhagic cystitis)
•Trauma; simply "banging" the kidney or bladder makes them shedred cells
• Glomerulonephritis

5

When "dysmorphic" red cells are described, the correct answer is

glomerulonephritis.

6

The answer is cystoscopy when there is

hematuria without infection or prior trauma and:
• The renal ultrasound or CT does not show anetiology.
• Bladder sonography shows a mass for possible biopsy.

7

White cell cast

pylonephritis

8

red cell cast

Glomerulonephritis

9

AKI is categorized into 3 types:

• Prerenal azotemia (decreasedperfusion)
• Postrenal azotemia (obstruction)
• Intrinsic renal disease (ischemia and toxins)

10

prerenal azotemia

BUN rising more than the creatinine.

11

AKI presentation

AKI may present with only an asymptomatic rise in BUN and creatinine. When symptomatic, the patient feels:
• Nauseated and vomiting
• Tired/malaise
• Weak
• Shortofbreathandedemafromfluidoverload

Very severe disease presents with:
• Confusion
• Arrhythmia from hyperkalemia and acidosis
• Sharp, pleuritic chest pain from pericarditis

12

Urine osmolality in ATN is inappropriately .

low

13

nephrotoxic antibiotics

Vancomycin, gentamicin, and amphotericin

14

Urine dipstick cannot tell the difference between:

• Hemoglobin
• Myoglobin
• Red blood cells

15

Acute (allergic) interstitial nephritis (AIN) is

a form of acute renal failure that damages the tubules occurring on an idiosyncratic (idiopathic) basis. Antibodies and eosinophils attack the cells lining the tubules as a reaction to drugs (70%), infection, and autoimmune disorders.

16

Tubular disease doesnt cause

nephrotic syndrome ie no proteinuria

17

Tubular Diseases

• Acute
• Toxins
• None nephrotic
• No biopsy usually
• No steroids
• Never additional immunosuppressive agents

18

Glomerular Diseases

• Chronic
• Not from toxins/drugs
• All potentially nephrotic
• Biopsy sample
• Steroids often

• UA with hematuria
• "Dysmorphic" red cells (deformed as they "squeeze" through an abnormal
glomerulus)
• Red cell casts
• Urine sodium and FENa are low • Proteinuria

19

Cancer (solid organ):
Children:
Injection
NSAIDs:
SLE:

Cancer (solid organ): membranous
Children: minimal change disease
Injection drug use and AIDS: focal-segmental NSAIDs: minimal change disease and membranous SLE: Any of them

20

Both TTP and HUS are associated with:

• Intravascularhemolysis • Renalinsufficiency
• Thrombocytopenia

21

Polycystic kidney disease (PCKD) presents with:

Pain Hematuria Stones Infection Hypertension

22

The most common causes of hyponatremia with a hypervolemic state are:

• CHF
• Nephroticsyndrome
• Cirrhosis

23

The most common causes of hyponatremia with euvolemia (normal volume status) are:

• Pseudohyponatremia (hyperglycemia)
• Psychogenic polydipsia
• Hypothyroidism
• Syndrome of inappropriate ADH release (SIADH)

24

The EKG in severe hyperkalemia shows:

• Peaked T waves
• Wide QRS
• PR interval prolongation

25

Distal RTA (Type I)

The distal tubule is responsible for generating new bicarbonate under the influence of aldosterone.

26

Proximal RTA (Type II)

Normally 85% to 90% of filtered bicarbonate is reabsorbed at the proximal tubule.

27

The most common cause of kidney stones (nephrolithiasis) is calcium

oxalate, which forms more frequently in an alkaline urine. The most common risk factor is the overexcretion of calcium in the urine.

28

Crohn disease causes kidney stones because of

increased oxalate absorption.

29

Uric acid stones are not detectable on

x-ray but are visualized on CT.

30

NSAID-induced renal disease does not show

eosinophils.

31

Furosemide causes

ototoxicity by damaging the hair cells of the cochlea, resulting in sensorineural hearing loss