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MTBs Step 2CK > Nephro > Flashcards

Nephro Flashcards

1
Q

when are urine nitrates positive? what 3 UTIs are they not positive in?

A

positive with gram -.

3 gram + UTIs: GBS, Staph Saph & Enterococcus

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2
Q

Urinalysis shows pyuria, what does this tell u? what does this not tell u?

A

great! theres wbc in the urine. cant tell u which ones though so u dnt know if its a bunch of neutrophils or eosinophils(AIN)

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3
Q

how can you detect eosinophils on urinalysis?

A

Wright & Hansel Stain

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4
Q

Casts associated with…

glomerulonephritis

A

RBC

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5
Q

Casts associated with…

pyelonephritis

A

WBC

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6
Q

Casts associated with…

Acute/Allergice intersitial nephritis

A

eosinophils

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7
Q

Casts associated with…

dehydration

A

hyaline

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8
Q

Casts associated with…

chronic renal disease

A

broad/waxy

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9
Q

Casts associated with…

acute tubular necrosis

A

granular “muddy/brown”

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10
Q

whats another name for acute renal failure?

A

acute kidney injury!

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11
Q

3 type of AKI/ARF

A

prerenal azotemia, postrenal azotemia & intrinsic

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12
Q

symptoms of SEVERE AKI

A

confusion(uremia), Arrhythmia(hyperkalemia and acidosis), Pleuritic chest pain(uremic pericarditis)

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13
Q

Prerenal Azotemia
BUN/Cr? Una?Uosm?
^why?

A 
BUN/Cr = >20:1
Una = low <20
Uosm = high >500

*prerenal = kidney not getting enough blood flow =thinks ur hypotensive = responds by absorbing Na & water = urine has low Na and is very concentrated =)

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14
Q

Postrenal Azotemia

causes?sx?

A

causes: stones, strictures, cancers, neurogenic bladder
sx: distended bladder, large volume diuresis, bilateral hydronephrosis on U/S

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15
Q

Intrarenal Azotemia
BUN/Cr? Una?Uosm?
^why?

A

BUN/Cr = 10:1, Una = high >40, Uosm = low <350

*kidney itself is damaged = cant do what its suppose to do = absorb water and na =(

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16
Q

Causes of Intrarenal azotemia

A

Acute tubular necrosis, allergie interstitial nephritis, Toxin-induced injury, rhabomyolytisi, crystal-induced/ethylene glycol, contrast induced,

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17
Q

Acute Tubular Necrosis

whats dis?

A

hypoperfusion or some shit that has caused death of the tubular cells. = intrarenal azotemia(BUN/Cr = 10:1, Una = high >40, Uosm = low <350) + granular muddy/brown casts

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18
Q

Allergic Interstial Nephritis

sx?

A

allergy to some shit pissed off the kidney!
sx: intrarenal azotemia(BUN/Cr = 10:1, Una = high >40, Uosm = low <350) , eosinophilic casts(wright& Hensel stain), rash, fever, ARTHRALGIAS

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19
Q

Toxin-induced renal failure drugs?

A

aminoglycosides, amphotericin, vancomycin, acyclovir, cyclosporin, cisplatin

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20
Q

How long before chemo drugs dmg the kidney?

A

5-10 days

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21
Q

How long before abx dmg kidney?

A

4-5 days

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22
Q

How long before you see tumor lysis syndrome(hyperuricemia) dmg kidney?

A

1-2days

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23
Q

How long before you see contrast fuck up the kidney?

A

12 hours

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24
Q

Why is contrast nephropathy so different from the other Intrarenal azotemias?

A

it causes intrarenal dmg but it does by causing spam of arrerent arteriol = presents like pre-renal(BUN/Cr = >20:1, Una = low <20, Uosm = high >500)

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25
What will you see with Ethylene Glycol induce nephritis?
renal failure, HYPOCALCEMIA, ENVELOPED SHAPED CYRSTALS IN URINE + intrarenal azotemia(BUN/Cr = 10:1, Una = high >40, Uosm = low <350)
26
What will you see with Rhabdomyolysis induced nephritis?
hx of large M necrosis = - intrarenal azotemia(BUN/Cr = 10:1, Una = high >40, Uosm = low <350) - ELEVATED CPK, K, HYPERURICEIMIA(crap from inside cells) - hypocalcemia bc K binds the Ca - elevated urine myoglobin
27
tx of ethylene glycol induced nephritis?
FOMEPIZOLE + Dialysis
28
tx of Rhabdomyolysis induced nephritis?
Bolus NS, mannitol & diuresis +/- alkalinization of the urine
29
person comes in with obvious Rhabdomyolysis. whats the first thing u shoudl do? why?
ECG!! = all that K poring out of cells can cause arrhythmias
30
How can you prevent contrast induced renal failure?
give lots of water!
31
NSAID induced kidney dmg | sx?
AIN, Nephrotic synd, decreased perfusion due to afferent arteriolar vasoconstriction & PAPILLARY NECROSIS(fever, flank pain, hematuria but no bacteria(ddx pyelo))
32
Glomerulonephritis | whats this? what will you see?
Kidney filter is messed up = kidney is losing crap it shouldnt be loosing! sx: hematuria, RBC casts, Protinuria, edema * NORMAL Una or Low bc tubules are working fine
33
Goodpastures syndrome | sx? tx?
Ab to A3 chain of T4 collagen = lung & kidney probelms sx: cough, hemoptysis, SOB and lung shit tx: plasmapheresis & steroids
34
Churg-Strauss Syndrome
Eosinophilic granulomatosis with polyangiitis = lungs + kidneys, eosinohphilic pneumonitis, allergies, asthma, PANCA **looks alot like wegners but with peripheral eosinophilia!
35
Wegner's Granulomatosis | sx?
C-dz = lungs, kidneys & nasopharynx
36
``` Polyarteritis Nodosa(PAN) sx? dx? tx? ```
* systemic vasculitis that spares the lungs sx: renal, myalgias, GI bleeding/ab pain, purpuritc skin lesions(petechia, livedo reticularis), stroke, uveitis, neuropathy(mononeuritis multiplex) dx: assoc hep B/C, inflammatory markers elevated, angiography showing beading tx: cyclophosphamide and steroids
37
IgA Nephropathy | sx? dx? tx?
IgA & IC depo in glomerulus 1-2 days after infection sx: painless recurrent hematuria, recent viral infection dx: bx tx: steroids & ACEi
38
Henoch-Schonlein Purpura | sx? dx? tx?
systemic IgA mediated vasculitis sx: raised nontender purpuric skin lesions, abdominal pain, bleeding, joint pain, renal involvement dx: bx tx: none
39
PSGN | sx? dx? tx?
* compliment deposition in subepithelium sx: hematuria(coca-cola colored urine), PERIOBITAL EDEMA, HTN, hx of skin infection 1-3 weeks ago dx: Antistretolysin Ab(ASO), Anti-DNase, Anti-Hyaluronidase, low compliment tx: PCN + control HTN w/diuretics
40
Drug induced lupus spares....
kidney and brain!
41
Alport Syndrome | sx? tx?
* XL defect in T4 collagen sx: eye, ear and kidney prob tx: none
42
Nephrotic Syndrome | sx?
* >3.5g/protein/d - edema - hyperlipidemia - thrombosis(los of PC&PS
43
What is associated with the nephrotic syndrome: | minimal change disease
children
44
What is associated with the nephrotic syndrome: | membranous glomerulonephritis
adults, cancers
45
What is associated with the nephrotic syndrome: | membranoproliferative glomerulonephritis
Hep C
46
What is associated with the nephrotic syndrome: | FSGS
HIV, heroin use
47
End-Stage Renal Disease Sx?
- hyperphos = cant excrete - hypermag = cant excrete - anemia = no epo - hypocalcemia = no 1,25D - Osteoporosis = 2nd Hyperparathyroidism due to hyperP&hypoCa cause increased in PTH - Bleeding = platelets cant degraulate, neither can wbc = infections
48
Diabetes Insipidus(DI)
failure to produce ADH or failure of kidneys to respond to ADH
49
Neprogenic Vs Central DI | dx?
*water deprivation test corrects = psycogenic doesnt correct = give ADH ~ if this corrects = central DI if doesnt correct = nephrogenic DI
50
tx of Nephrogenic DI
Thiazide Diuretics or correct underlying cause
51
tx of central DI
vasopressin
52
Na excess/deficits cause ---- where as K causes -----.
Na=CNS sx | K=Muscle weakness & heart sx
53
sx of hyper/hyponatremia
neurological abnormalities, confusion, disorientation, seizures, coma
54
Causes of Hypervolemic Hyponatremia
CHF, nephrotic syndrome, Cirrhosis =decrased intravascular volume = ADH baroreceptors activated = increased free water absorption
55
Causes Hypovolemic Hyponatremia
Diuretics, GI loss of fluids(vomiting, diarrhea), Skin loss of fluids(burns, sweating) = isotonic fluid loss
56
Causes of Euvolemic Hyponatremia
SIADH, Hypothyroidism, Psychogenic polydipsia, Hyperglycemia, Addisons
57
Why does hyperglycemia cause hyponatremia
Na drops 1.6pts for each 100mg of glucose above normal
58
tx of moderate hypoglycemia
loop diuretics
59
tx of severe hypoglycemia
hypertonic saline, ADH blockers(conivaptan, tolvaptan)
60
Causes of hyperkalemia
1. decreased excretion = low aldo, renal failure | 2. increased release from tissues = cell lysis, low insulin, acidosis, drugs
61
metabolic ------ causes hyperkalemia
acidosis
62
Pseudokyperkalemia
artifact caused by the hemolysis of red cells in the laboratory or prolonged tourniquet placement during phlebotomy == repeat the test!
63
EKG sx seen with Hyperkalemia
1st = peaked T-wave 2nd = absent/flat P-waves 3rd = wide QRS *in this order
64
tx of hyperkalemia without EKG changes
Insulin + glucose & Kayexalate
65
tx of hyperkalemia with EKG changes
Calcium gluconate IV, insulin+glucose + Kayexalate
66
EKG changes seen with hypokalemia
Uwave = repolarization of the purkinji fibers seen as a peak just after the Twave
67
refractory hypokalemia despite K replacement coudl be caused by....
hypoMg = low Mg increases excretion of K in kidneys
68
Formula to calculate anion gap
Na - (Cl + HCO3) = 6-12
69
Aspirin overdose causes what pH abnormality? tx?
respiratory alkalosis from hyperventilation then metabolic acidosis. tx: bicarb
70
Methanol intoxication | sx? tx?
sx: metabolic acidosis, Inflammed retina tx: fomepizole
71
Ethylene Glycol | tx?
fomepizole
72
causes of normal metabolic acidosis
1. Diarrhea 2. Renal Tubular Acidosis - RTA1 =cant excrete H - RTA2 =cant reabsorb HCO3 - RTA4 = decreased aldosterone production
73
RTA 1 | Urine pH? serum K? Stones? tx?
high pH, low K, stones, tx bicarb
74
RTA 2 | Urine pH? serum K? Stones? tx?
low pH, low K, no stones, tx thiazide diuretic + HD bicarb
75
RTA 4 | Urine pH? serum K? Stones? tx?
low pH, high K, no stones, tx fludrocortisone(aldo agonist)
76
HTN in person >60
150/90
77
HTN in normal person
140/90

MTBs Step 2CK (20 decks)

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