Nephro Flashcards
1
Q
Best initial test in nephrology
A
U/A and BUN and Cr
2
Q
Only times U/A is used for screening
A
DM
HTN
3
Q
1+ protein on U/A, next step
A
Repeat
4
Q
What do nitrites indicate on U/A
A
G- bacteria
5
Q
What are the 2 parts of U/A
A
Dipstick
Microscopic analysis if positive
6
Q
What is bacteriuria
A
Bacteria w/o WBCs
Check for this in pregnancy
7
Q
Severe proteinuria (4+) only happens in
A
Glomerular disease
8
Q
When should a kidney Bx be performed w/ persistent proteinuria
A
When it is not associated w/ prolonged standing
9
Q
What does a urine dipstick detect
A
Albumin
10
Q
Normal protein per day in urine
A
Less than 300mg per 24hrs
11
Q
Test used for total amount of protein in a day
A
Single protein to creatinine ratio
12
Q
What determines the cause of proteinuria
A
Bx
13
Q
What is microalbuminuria
A
30-300mg/24hrs
Seen in DM
14
Q
Best initial therapy for Microalbuminuria in DM
A
ACEIs or ARBs
15
Q
What does the presence of WBCs in the urine indicate
A
Inflammation
Infection
Allergic intersitital nephritis
16
Q
Stains used to detect eosinophils in urine
A
Wright and Hansel
17
Q
What do eosinophils in the urine indicate
A
AIN
18
Q
Persistent WBCs on U/A w/ neg Cx indicates
A
TB
19
Q
Normal RBCs in urine
A
Less than 5 per HPF
20
Q
What is hematuria indicative of
A
Stones Coagulopathies Infection CA Cyclophosphamide Trauma Glomerulonephritis
21
Q
What is the different about hematuria in glomerulonephritis
A
Dysmorphic RBCs
22
Q
Best initial test for dark urine w/ blood on dipstick
A
Microscopic examination
23
Q
Hematuria w/o infection/trauma and renal U/S and CT neg but bladder CT shows mass
A
Cystoscopy
24
Q
Most accurate test for bladder
A
Cystoscopy
25
When do you find RBC casts
Glomerulonephritis
26
When do you find WBC casts
Pyelonephritis, Interstitial nephritis
27
When do you find eosinophil casts
Allergic interstitial nephritis
28
When do you find hyaline casts
Dehydration, Prerenal azotemia
29
When do you find broad, waxy casts
Chronic renal disease
30
When do you find granular casts
ATN
31
What is AKI
Decrease in Cr clearance leading to sudden rise in BUN and Cr
32
Causes of AKI if it happens in hours
Rhabdo
| Contrast
33
Causes of AKI if it happens in weeks
```
Aminoglycosides
Vanco
Genti
Amphoteracin
Post-strep
```
34
Main issue in prerenal azotemia
Inadequate perfusion
35
Causes of prerenal azotemia
```
Hypotension
Hypovolemia
Renal artery stenosis
Shock
Hypoalbuminemia
Cirrhosis
NSAIDs
ACEIs
```
36
How do ACEIs cause AKI
Dilate efferent
Decrease hydrostatic pressure in glomerulus
Decrease GFR
37
How do NSAIDs cause AKI
Constrict afferent
Decrease hydrostatic pressure in glomerulus
Decrease GFR
38
How to manage medication induced AKI
Decrease trough levels by spacing doses
39
Main cause of postrenal azotemia
Obstruction
40
Causes of postrenal azotemia
```
Prostate CA or BPH
Stone
Cervical CA
Urethral stricture
Atonic bladder
Fibrosis (bleomycin, methylsergide)
```
41
Greatest driving force for GFR
Hydrostatic pressure in glomerular capsule
42
Main management for pre and postrenal azotemia
Treat underlying cause
| Therefore it is reversible in the majority of cases
43
MCC intrinsic renal failure
ATN from toxins or prolonged ischemia
44
Other causes of intrinsic renal failure
```
AIN
Rhabdo and hemoglobinuria
Drugs
Crystal
Bence-Jones
Post-strep
```
45
MC toxins causing ATN
```
NSAIDs
Contrast
Aminoglycosides
Cisplatin
Amphotericin
Cyclosporine
```
46
Only time AKI can present w/ specific sx
Postrenal
Enlargement of bladder on U/S
Massive void after cath
47
Best initial test for AKI
BUN and Cr
20: 1 = pre/postrenal
10: 1 = Intrinsic
48
Best initial imaging test for AKI
Sonogram
49
Most accurate test for AKI
Kidney Bx
| Never done
50
Next best step if AKI etiology is unclear
U/A (first)
UNa
FENa
Uosm
51
Relationship between UNa and FENa
Low FENa means Low UNa
| And vice versa
52
Why is Uosm low in ATN
Water cannot be reabsorbed since tubules are damaged
Urine cannot be concentrated
Extra Na is also lost
53
What is the only significant manifestation of sickle cell trait
Defect in renal concentrating ability (isosthenuria)
| Therefore try not to get dehydrated
54
Lab value predictor for Urine specific gravity
Uosm
55
Best way to prevent contrast-induced nephrotoxicity
Saline hydration (best)
NAC
Bicarb
56
Lab changes in contrast-induced nephropathy
UNa very low
| FENa
57
While both prerenal azotemia and ATN can be caused by hyperperfusion, how is ATN different
BUN:Cr = 20
FENa >1
Uosm
58
Post chemo increase in creatinine is caused by
Hyperuricemia (Tumor lysis syndrome)
59
How long does cisplatin take to cause elevation in creatinine
5-10 days
60
How to prevent tumor lysis syndrome in chemo
Allopurinol, hydration and rasburicase
61
How does ethylene glycol cause renal failure
Oxalate precipitation in kidney tubules
62
Why is there hypocalcemia in ethylene glycol poisoning
Precipitates as Ca oxalate
63
Loss of kidney function w/ age
1% loss per year over 40
64
What can increase risk of aminoglycoside or cisplatin nephrotoxicity
Low Mg
65
Rx ethylene glycol nephrotoxicity
Ethanol or Fomepizole
| Remove ethylene glycol w/ dialysis
66
Management of elevated PTH w/ no renal damage or stones
No need to treat
67
Best initial test for rhabdomyolysis
U/A - blood on dipstick, no cells on microscopy
68
Most specific test for rhabdomyolysis
Urine test for myoglobin
69
Lab findings in Rhabdo
Elevated CPK
Hyperkalemia
Hyperuricemia
Hypocalcemia
70
Rx rhabdo
Saline hydration
Mannitol
Bicarb (PROTECT THE HEART)
71
Next best step in suspected rhabdo
EKG
72
Rx ATN
No proven therapy
| Diuretics increase urine output
73
When do you do dialysis in ATN
```
Fluid overload
Encephalopathy
Pericarditis
Metab acid
Hyperkalemia
```
74
AE Furosemide
Ototoxicity
75
What is hepatorenal syndrome
Renal failure 2/2 liver disease
76
What to look for in hepatorenal syndrome
Cirrhosis
New onset renal failure w/o explanation
Very low UNa
FENa 20:1
77
Rx Hepatorenal syndrome
Midodrine
Octreotide
Albumin
78
What to look for in cholesteral atheroemboli causing AKI
Blue/purplish lesions in fingers and toes
Livedo reticularis (Blue fishnet)
Normal peripheral pulses
Ocular lesions
79
Dx tests in cholesteral atheroemboli causing AKI
Eosinophilia
Low complement
Eosinophiliuria
Elevated ESR
80
Most accurate test for cholesteral atheroemboli causing AKI
Bx of a purplish lesion
| Shows cholesterol crystals
81
Rx cholesteral atheroemboli causing AKI
None
82
MCC AIN
Drugs
83
MC drugs causing AIN
```
PCN, Ceph
Sulfas
Phenytoin
Rifampin
Quinolones
Allopurinol
PPIs
```
84
Drugs causing AIN can also cause
Allergy, rash
SJS
TEN
Hemolysis
85
Drugs causing AIN affect what target organs
Skin
Kidney
Blood
86
Non-drug causes of AIN
SLE
Sjogren
Sarcoidosis
87
Acute presentation of AIN
Fever (80%)
Rash (50%)
Eosinophilia and eosinophiluria (80%)
Arthrangias
88
Dx tests in AIN
BUN:Cr =
89
Best initial test for eosinophiluria
U/A
90
Most accurate test for AIN
Hansel or Wright stain for eosinophils
91
Rx AIN
Spontaneous resolution
92
Presentation of analgesic nephropathy
```
ATN from direct toxicity to tubules
AIN
Membranous glomerulonephritis
Vascular insufficiency from PG inhibition
Papillary necrosis
```
93
How do NSAIDs cause vascular insufficiency in the kidney
Older pts w/ DM or HTN causing renal insufficiency
NSAIDs inhibit PGs which dilate afferent arteriole
Tips them over into renal failure
94
How to Dx analgesic nephropathy
Exclude other causes
95
What is papillary necrosis
Sloughing off of renal papillae
96
Cause of papillary necrosis
NSAIDs in the setting of ongoing renal damage
97
When to suspect papillary necrosis
NSAID use w/ hx of
- Sickle cell
- DM
- Urinary obstruction
- Chronic pyelo
98
Presentation of papillary necrosis
Sudden onset flank pain fever and hematuria
99
Best initial test for papillary necrosis
U/A showing necrotic material, RBCs, WBCs
100
Most accurate test for papillary necrosis
CT
101
Rx papillary necrosis
None
102
Features of papillary necrosis
```
Few hrs of sx
Necrotic material in urine
Neg UCx
Bumpt inner contour on CT
No Rx
```
103
Features of Pyelonephritis
```
Few days of sx
Dysuria
Pos UCx
Diffusely swollen kidney on CT
Ampi/Genta/quinolone for Rx
```
104
Features of all tubular diseases
```
Acute
Toxins
None nephrotic
No Bx
No Steroids
No immunosuppresives
```
105
Features of all glomerular diseases
```
Chronic
Not from toxins
All potentially nephrotic
Bx needed
Steroids often
```
106
All forms of glomerulonephritis have
```
Hematuria on UA
Dysmorphic RBCs
RBC casts
Proteinuria
Low UNa and FENa
```
107
Features of Goodpasture
Lung and Kidney involvement
No URT
No skin, joint, GI, eye or neuro
108
Best initial test for Goodpasture
Antiglomerular BM Abs
109
Most accurate test for Goodpasture
Lung or Renal Bx
110
Rx Goodpasture
Plasmapheresis and steroids
| Cyclophosphamide can help
111
What does renal bx show in goodpasture's
Linear deposits
112
MCC acute glomerulonephritis
IgA nephropathy (Berger disease)
113
Features of IgA nephropathy
Asian
| Recurrent gross hematuria 1-2 days after URI
114
Most accurate test for IgA nephropathy
Bx
| IgA elevated in 50%
115
Rx IgA nephropathy
Nothing reverses
30% spont resolve
40-50% go to ESRD
Rx proteinuria w/ ACEIs and steroids
116
MC organism leading to postinfectious glomerulonephritis
Strep
117
How long after strep infectious do you get PSGN
1-3 weeks
118
Presentation of PSGN
Dark (cola coloured) urine
Periorbital edema
HTN
Oliguria
119
UA in PSGN
Proteinuria
RBCs
RBC casts
120
Confirmation of PSGN from group A beta hemolytic strep
Antistreptolysin O titres
| Anti-DNAse Ab
121
Most accurate test for PSGN
Bx (not routine)
122
Complement levels in PSGN
Low
123
Management of PSGN
ABX
Diuretics
This doesn't reverse glomerulonephritis
124
What is Alport syndrome
Congenital defect in collagen
125
Features of Alport syndrome
```
Sensorineural hearing loss
Visual disturbances (lens doesn't stay in place)
```
126
Features of PAN
Systemic vasculitis
Spares lungs
Associated w/ Hep B
127
Presentation of PAN
```
Glomerulonephritis
Fever, wt loss, myalgias, arthralgias
GI - pain worse w/ eating
Neuro - Stroke in young person
Skin - Distal gangrene, livedo reticularis
Cardiac disease
```
128
Dx tests in PAN
Anemia and leukocytosis
Elevated ESR and CRP
ANCA not present
ANA and RF sometimes
129
Most accurate test for PAN
Bx of symptomatic area
130
How to confirm PAN when symptomatic area cannot be biopsied
Angiography (Renal, Mesenteric, Hepatic artery)
131
Rx PAN
Prednisone and Cyclophosphamide
| Treat Hep B
132
Renal disease in SLE
Normal
Mild ASx proteinuria
Membranous glomerulonephritis
Glomerulosclerosis
133
Most accurate test in lupus nephritis
Bx, not to Dx but to determine stage of disease
134
Rx mild SLE nephritis
Glucocorticoids
135
Rx severe SLE nephritis
Glucocorticoids plus cyclophosphamide/mycophenolate
136
What is amyloidosis associated with
```
Myeloma
Chronic inflammatory diseases
RA
IBD
Chronic infections
```
137
What conditions show large kidneys on CT and U/S
Amyloid
HIV
PKD
DM
138
Dx amyloidosis
Bx
| Green birefringence on congo red
139
Rx Amyloidosis
Rx underlying disease
| If fail, Melphalan and prednisone
140
What is nephrotic syndrome
Measurement of severity of proteinuria in glomerular disease
| Ie. 4+
141
Sequelae from massive proteinuria
Edema
Hyperlipidemia
Thromgosis (Loss of protein C, S, antithrombin III)
142
MCC Nephrotic syndrome
DM
| HTN
143
Other causes of nephrotic syndrome
```
Any nephritic syndrome
CA
NSAIDs
IVDU, AIDS
SLE
```
144
Nephrotic syndrome associated w/ CA
Membranous
145
Nephrotic syndrome associated w/ children
Minimal Change Disease
146
Nephrotic syndrome associated w/ IVDU/AIDS
Focal-segmental
147
Nephrotic syndrome associated w/ NSAIDS
Minimal change and membranous
148
Nephrotic syndrome associated w/ SLE
Any
149
Why are infections more common in people w/ nephrotic syndrome
Igs and Complement lost in urine
150
Difference between edema in CHF vs nephrotic
CHF - legs (dependent areas)
| Nephrotic - Everywhere
151
Why are there problems in skin healing in nephrotic syndrome
Loss of Zn
152
Best initial test in nephrotic syndrome
UA
153
What is iseen on UA in nephrotic syndrome
Maltese crosses (lipid deposits)
154
Most accurate test for nephrotic syndrome
Renal Bx
155
Nephrotic syndrome associated w/ Chronic Hep B
Membranoproliferative
Rx w/ IFN, Ribavirin
Dypiridamole, Aspirin
156
Definition of Nephrotic syndrome
Hyperproteinuria (>3.5g/24hrs)
Hypoproteinemia
Hyperlipidemia
Edema
157
Best initial therapy for nephrotic syndrome
Glucocorticoids
| Cyclophosphamide if no response after wks
158
Other therapies for nephrotic syndrome
ACEIs/ARBs to control proteinuria
Salt restriction and diurectics for edema
Statins for hyperlipidemia
159
What is ESRD
Chronic renal failure so severe that there is need for dialysis
160
MCC ESRD
DM
| HTN
161
Uremia is the presence of
```
Metabolic acidosis
Fluid overload
Encephalopathy
Hyperkalemia
Pericarditis
```
162
Uremia or it's individual components are an indication for
DIalysis
163
Complication of peritoneal dialysis
Peritonitis w/ S. aureus
164
Manifestations of renal failure
```
Anemia
Hypocalcemia
Osteodystrophy
Bleeding
Infection
Pruritis
Hyperphosphatemia
Accelerated atherosclerosis and HTN
Endocrinopathy
ED
```
165
Anemia features in ESRD
Low EPO = normocytic normochromic
166
How does osteodystrophy and hyperphosphatemia happen in ESRD
Low Ca → High PTH → High PO4 and Ca is removed from bone making it softer
167
Why does infection and bleeding occur in ESRD
Platelets and WBCs do not degranulate
168
Why does hypocalcemia occur in ESRD
Kidney can't transform 25-OH vit D to 1,25-OH vit D and so Ca cannot be absorbed in gut
169
Endocrinopathy features of ESRD
Women are anovulatory
| Men have low testosterone
170
Rx Anemia in ESRD
EPO replacement and Fe supplementation
171
Rx hypocalcemia and osteomalacia in ESRD
Replace Vit D and Ca
172
Rx Bleeding in ESRD
DDAVP
173
Rx Pruritisin ESRD
Dialysis and UV light
174
Rx Hyperphosphatemia in ESRD
Oral binders
175
Rx Hypermagnesemia in ESRD
Restriction of high Mg foods
176
Rx Atherosclerosis in ESRD
Dialysis
177
Rx Endocrinopathy in ESRD
Dialysis, estrogen and testosterone replacement
178
What oral binders are used to rx hyperphosphatemia in ESRD
Ca acetate
Ca carbonate
Sevelamer
Lanthanum
179
What do you never use to rx hyperphosphatemia in ESRD
Al containing binders
| Al can cause dementia
180
Importance of Renal transplant in ESRD
Only 50% are eligible
Live donors > Cadavers
Related > Unrelated
181
What are both HUS and TTP associated with
Intravascular hemolysis
Renal insufficiency
Thrombocytopenia
182
Peripheral smear of hemolysis in TTP/HUS
Schistocytes
Helmet cells
Fragmented RBCs
183
What is TTP associated with
Neuro sx
| Fever
184
Coagulation profile in TTP/HUS
NL PT and aPTT
185
Rx HUS from E. coli
Spontaneous resolution
186
Rx TTP
Plasmapheresis
| Also for severe HUS
187
Plasmapheresis not an option for TTP/severe HUS, now what
FFP
188
Features of simple kidney cysts
Echo free
Smooth, thin walls
Sharp demarcation
Transmission good through to back
189
Features of complex cysts (potential malignancy)
Mixed echogenicity
Irregular, thick walls
Low density on back wall
Debris in cyst
190
What to do with renal cysts
Simple - Nothing
| Complex - Aspirate
191
Presentation of PKD
```
Pain
Hematuria
Stones
Infection
HTN
```
192
MCC death from PKD
Renal failure from recurrent pyelo and stones causing scarring
193
Pts w/ PKD may also have
Liver cysts (MC)
Ovarian cysts
MVP
Diverticulosis
194
Only true treatment for PKD
Transplant
195
How is free water lost
Skin - sweat, burns
Urine - diuretics
GI - diarrhea
196
How does DI occur
High volume water loss from insufficient/ineffective ADH
197
How does CDI occur
Any damage to hypothalamus/post pit
198
How does NDI occur
Loss of ADH effect on collecting duct
- Li
- Hypokalemia
- Hypercalcemia
- Demeclocycline
199
First clue to presence of DI
High volume nocturia
200
Sx of DI and hypernatremia
Neuro sx
- Confusion
- Disorientation
- Lethargy
- Seizures
201
Best initial test for DI
Water deprivation test
| - DI urine volume stays high and osmolality stays low
202
How does DI respond to ADH
CDI - sharp decrease in urine volume, increase in osmolality
| NDI - No change in volume or osmolality
203
ADH in DI
Low in CDI
| High in NDI
204
Rx fluid loss in DI
Correct underlying cause
205
Rx CDI
Replace ADH - DDAVP
206
Rx NDI
Correct K and Ca
Stop Li or demeclocycline
Give HCTZ or NSAIDs if above fail
207
What can happen from rapid correction of hypernatremia
Cerebral edema causing confusion and seizures
208
MCC of hyponatremia w/ hypervolemia
CHF
Nephrotic syndrome
Cirrhosis
209
Causes of hypovolemic hyponatremia
Same as causes for hypernatremia
| They will lead to hyponatremia w/ chronic replacement with free water
210
How does addison's cause hyponatremia
Loss of aldosterone which normally causes Na reabsorption
211
MCC hyponatremia w/ euvolemia
Pseudohyponatremia (hyperglycemia)
Psychogenic polydipsia
Hypothyroidism
SIADH
212
How does hyperglycemia cause hyponatremia
Glucose draws water out of cells to correct increase osmolarity
This leads to a relative decrease in Na in the serum
Corrected by correcting glucose level
213
Relationship of glucose to Na
Every 100mg/dL glucose above NL drops Na by 1.6meq/L
214
Difference between psychogenic polydipsia and NDI
HypoNa in psycho
| HyperNa in NDI
215
Difference between psychogenic polydipsia and NDI if Na is NL
NDI has massive nocturia
216
What in the Hx is a clue for psychogenic polydipsia
Bipolar disorder
217
How does hypothyroidism cause euvolemic hyponatremia
TH needed for water excretion
218
What causes SIADH
Any lung or brain disease
Drugs
Cancers
Pain
219
What drugs cause SIADH
```
SSRIs
Sulfonureas
Vincristine
Cyclophosphamide
TCAs
```
220
What Pulm conditions cause SIADH
Malignancies (small cell)
TB, sarcoid
Abscess
221
What brain conditions cause SIADH
Head injury
| Stroke
222
Urine values in SIADH
UNa increased
| Uosm increased
223
Most accurate test for SIADH
High ADH level
224
Presentation of hyponatremia
Exclusively CNS sx
- Confusion
- Lethargy
- Disorientation
- Seizures
- Coma
225
Lab tests for SIADH
UNa innapropriately high
| Uric acid and BUN are low
226
Rx mild hyponatremia
Restrict fluids
227
Rx moderate hyponatremia (minimal confusion)
Saline and loop diuretics
228
Rx severe hyponatremia
Hypertonic saline, conivaptan, tolvaptan
229
Rx chronic SIADH (malignancy)
Demeclocycline
230
How fast should Na be corrected in hyponatremia
Under 0.5 to 1 meq per hr or 12-24meq per day
231
What can happen if hyponatremia is corrected too quickly
Central pontine myelinosis (osmotic demyelination)
232
What happens in SIADH is saline is given w/o diuretic
Gets worse
233
What can happen is K levels are high enough
Stops the heart
234
What causes pseudohyperkalemia
Hemolysis
Repeated fist clenching w/ tourniquet
Thrombocytosis or leukocytosis
235
What causes decreased excretion of K
Renal failure
| Aldosterone decrease
236
What causes aldosterone decrease
```
ACEIs/ARBs
Type IV RTA
Spironolactone/eplerenone
Tramterene, amiloride
Addison
```
237
What causes K release from tissues
```
Tissue destructions
Decreased insulin
Acidosis
BBs, and digoxin
Heparin
```
238
What to look for in hyperkalemia
Weakness and possible paralysis
Ileus
Cardiac rhythm disorders
239
Most urgent test in severe hyperkalemia
EKG
240
EKG in severe hyperkalemia
Peaked T waves
Wide QRS
PR prolongation
241
Rx hyperkalemia w/ abnormal EKG
Ca chloride or Ca gluconate
Insulin and glucose
Bicarb
242
What is given to remove K from body
Sodium polystyrene sulfonate (Kayexalate)
| Dialysis
243
What is given to lower K in a non-acute setting
Insulin and bicarb
Inhaled beta agonists
Loops
Dialysis
244
Hyperkalemia w/ abnormal EKG, most appropriate next step
Ca chloride or gluconate
245
What causes hypokalemia
```
Decreased intake
Shift into cells
Renal loss
Gi loss
Hypomagnesemia
RTA I, II
```
246
What causes K to shift into cells
Alkalosis
Increased insulin
Beta agonists
247
What causes renal loss of K
```
Loops
Increased aldosterone
- Addison's
- Conn
- Cushing
- Licorice
Volume depletion
Bartter
```
248
What causes GI loss of K
Vomitting
Diarrhea
Laxative abuse
B12/folate replacement
249
Presentation of hypokalemia
Weakness
Paralysis - Can cause rhabdo
Loss of reflexes
250
EKG findings in hypokalemia
U waves
PVCs
Flattened T
ST depression
251
What are U waves
Purkinje repolerization
252
Rx Hypokalemia
Replace K
- Oral replacement has no max rate
- Replace via IV too fast and risk fatal arrhythmia
253
What to check if hypokalemia isn't resolving
Mg levels
254
Most important step in life threatening hyperkalemia
EKG
255
Most important causes of metabolic acidosis with normal anion gap
RTA
| Diarrhea
256
Why is anion gap normal in RTA and diarrhea
Elevated Cl levels
257
What does the distal tubule do
Generate new bicarb due to aldosterone
258
What is affected in type I RTA
Distal tubule
259
What damages the distal tubule
Amphoteracin
SLE
Sjogren
260
What happens in Distal RTA
pH of urine increases as acid can't be excreted
| Increases formation of kidney stones
261
Best initial test for Distal RTA
UA looking for pH > 5.5
262
Most accurate test for Type I RTA
Infuse acid into blood w/ ammonium chloride
| pH will remain >5.5 rather than decreasing as it should
263
Rx Distal RTA
Replace bicarb
264
What is damaged in Type II RTA
Proxmial tubule
265
What causes proximal RTA
```
Amyloidosis
Myeloma
Fanconi
Acetazolamide
Heavy metals
```
266
What happens in proximal RTA
Bicarb is filtered but not reabsorbed in proximal so it is reabsorbed in distal to prevent body depletion of bicarb
267
Urine pH in proximal RTA
Starts basic and then becomes acidic
268
Most accurate test for proximal RTA
Give bicarb and urine pH rises
269
Common finding in both proximal and distal RTA
Hypokalemia
270
Rx proximal RTA
Thiazides to cause volume depletion which will enhance bicarb reabsorption
271
Who gets Type IV RTA
DM
272
How does Type IV RTA occur
Decreased renin leads to decreased aldosterone which causes increased K
273
What is the test for Type IV RTA
Persistently high UNa despite Na depleted diet
| Hyperkalemia
274
Which RTA has High K
4
275
Which RTA has kidney stones
1
276
Urine pH in Type IV RTA
277
Rx Type IV RTA
Fludrocortisone
278
Differentiate between RTA and diarrhea
Na minus Cl (in urine)
- Positive in RTA
- Negative in Diarrhea
279
Causes of elevated anion gap metabolic acidosis
```
Methanol
Uremia
DM
Paraldehyde
INH
Lactate
Ethylene glycol
Salicylates
```
280
Compensation for all forms of metabolic acidosis
Respiratory alkalosis from hyperventilation
281
Test for methanol OD
Inflamed retina
282
Rx methanol OD
Fomepizole, dialysis
283
Test for ketoacidosis
Acetone levels
284
Rx lactic acidosis
Correct hypoperfusion
285
ABG in metabolic acidosis
pH
286
Etiologies of metabolic alkalosis
```
GI loss
Increased aldosterone
Diuretics
Milk-alkali syndrome
Hypokalemia
```
287
ABG in metabolic alkalosis
pH > 7.4
Increased pCO2 (resp acid compensation)
Increased bicarb
288
Features of respiratory alkalosis
Decreased pCO2
Increased minute ventilation
Metab acid as compensation
289
Features of respiratory acidosis
Increased pCO2
Decreased minute ventilation
Metab alk as compensation
290
What is minute ventilation
RR x TV
291
Causes of resp alkalosis
```
Anemia
Anxiety
Pain
Fever
Interstitial lung disease
Pulm emboli
```
292
Causes of resp acidosis
```
COPD/emphysema
Drowning
Opiate OD
A1AT def
Kyphoscoliosis
OSA/morbid obesity
```
293
MCC nephrolithiasis
Calcium oxalate
| Forms frequently in alkaline urine
294
MCC hypercalcemia
Hyperparathyroidism
295
Why does crohn's cause kidney stones
Increased oxalate absorption
296
Rx pain in nephrolithiasis
Ketorolac
297
Most accurate test for kidney stones
CT w/o contrast
298
Best initial therapy for acute renal colic
Analgesics (ketorolac) and hydration
| CT and sonography
299
How to determine kidney stone etiology
Stone analysis (once passed)
Serum Ca, Na, uric acid, PTH, Mg, PO4
24hr urine for volume, Ca, oxalate, citrate, cysteine, pH, uric acid, PO4, Mg
300
How to manage stones between 0.5cm and 2-3cm
Lithotripsy
301
How to manage stones greater than 2-3cm
Surgical stent placement
| Relieves hydronephrosis
302
Stones in UTI
Struvite (Mg, NH4, PO4)
| Remove surgically
303
Recurrence of kidney stones
50% will recur over next 5 years
304
Long term management for recurrent kidney stones
HCTZ to remove Ca from urine
305
How does metab acid affect stone production
Removes Ca from bone and increases formation
| Citrate binds Ca, making it unavailable
306
Sx for stress incontinence
Painless leakage w/ coughing, laughing, lifting heavy objects
307
Test for stress incontinence
Stand or cough and observe for leakage
308
Rx stress incontinence
Kegel
Estrogen cream
Surgical tightening
309
Sx for urge incontinence
Pain in bladder and overwhelming urge to urinate
310
Test for urge incontinence
Pressure management in half-full bladder
| Manometry
311
Rx urge incontinence
```
Bladder training exercises
Local anticholinergics
- oxybutinin
- tolterodine
- solifenacin
- dariferancin
Surgical tightening
```
312
MC disease in USA
HTN
313
MCC HTN
Essential
314
What is HTN
> 140/90
| Repeated at calm state over time
315
HTN in DM or chronic renal disease
>130/80
316
Known causes of HTN
```
Renal artery stenosis
Glomerulonephritis
Coarctation
Acromegaly
OCPs
OSA
Pheochromocytoma
Hyperaldosteronism
Cyshing
CAH
```
317
How do Sx occur in HTN
End organ damage from atherosclerosis
318
Sx in HTN
```
CAD
Cerebrovascular disease
Visual disturbance
Renal insufficiency
CHF
PAD
```
319
Sx renal artery stenosis
Bruit
Best initial test - U/S
Rx angioplasty
320
Sx Coarctation
Upper extremity BP > lower extremity BP
321
Sx Pheochromocytoma
Episodic HTN w/ flushing
| Most accurate test - MIBG scan
322
Sx hyperaldosteronism
Weakness from hypokalemia
323
Dx tests for HTN
EKG
UA
Glucose
Cholesterol
324
Best initial therapy for HRN
```
Weight loss
Na restriction
Dietary modification
Exercise
Tobacco cessation
```
325
How long is lifestyle modification attempted before meds in HTN
3-6mos
326
Best initial drug therapy for HTN
Thiazides
327
When to give 2 meds for HTN
>160/100
328
Most appropriate next step if thiazides aren't controlling
ACEIs
ARBs
BBs
CCBs
329
Pregnancy safe HTN drugs
BB (#1)
CCB
Hydralazine
Alpha methyldopa
330
Rx HTN w/ CAD
BB
ACE
ARB
331
Rx HTN w/ DM
ACE
| ARB
332
Rx HTN w/ BPH
Alpha blockers
333
Rx HTN w/ depression and asthma
Avoid BBs
334
Rx HTN w/ Hyperthyroidism
BB first
335
Rx HTN w/ osteoporosis
Thiazides
336
What is hypertensive crisis
HTN + end organ damage
337
DBP in hypertensive crisis
120-130
338
Sx hypertensive crisis
Confusion
Blurry vision
Dyspnea
CP
339
Best initial therapy in hypertensive crisis
Labetalol or nitroprusside
340
Alternative therapy in hypertensive crisis
Enalapril
CCBs - verapamil, diltiazem
Esmolol
341
BP goal in acute management for hypertensive crisis
DBP above 95-100 (25% decrease)
342
Complications of HTN
MI
Aneurysm
PVD
Stroke
