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Nephrolgoy Flashcards

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1
Q

Urine pH > 7.0 DDx

normal urin pH4.6-8

A 
Distal RTA (type 1)
Infection with Proteus, Klebsiella, or Pseudomonas
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2
Q

Glucose in UA DDx

A
  1. Hyperglycemia BS>180
  2. Proximal RTA (type 2)
  3. Physiologic response in preg
  4. SGLT2 inh use= Dapagliflozin/Canagliflozin-invokana/Empagliflozin (Na-glu cotransporter 2 inh)
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3
Q

Blood in UA DDx

A
  1. Hg
  2. Myoglobin
  3. Erythrocytes
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4
Q

UA : Blood + and RBC -

DDx

A

Rhabdo

Hemolysis

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5
Q

Random (spot) protein-Cr ratio

  1. moderately increased
  2. severely increased
A
  1. 30-300mg/g corresponds to 30-300mg 24hr urine protein

2. >300mg/g

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6
Q

Protein:Cr ratio range

  1. normal range
  2. glomerular dz
  3. nephrotic range
  4. Tubulointerstitial dz
A
  1. <150mg /day
  2. > 1,500mg / day
  3. > 3,000 mg / day
  4. normal to <1,000mg /day
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7
Q

Granular / muddy brown cast

A

ATN

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8
Q

Inc AG MA + Inc Osmolol gap + visionary changes

A

Methanol poisoning

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9
Q

Inc AG MA + Inc Osmolol gap + flank pain/hematuria/urinary calcium oxalate crystals

A

Ethylene glycol poisoning

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10
Q

Inc Osmolol gap + acetone on breath/ketones/CNS depression

A

Isopropyl alcohol poisoning

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11
Q

Plasma (serum) Osmolality formula and normal level

A

2xNa + BUN/2.8 + Glu/18

Normal osmolal gap <10

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12
Q

Osmotic Demyelination Synd

A 
Appears 2-6 days after rapid correction of Na
IRREVERSIBLE NEURO DEFICITS
-speech and swallowing d/o
-behavioral distrubances
-seizures
-paraparesis or quadriparesis
-"locked-in" synd
-obtundation or coma
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13
Q

Treat Na overcorrection with

A

Desmopressin

IV 5% dextrose

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14
Q

SIADH tx
1st line
2nd line
3rd line

A

1st line - fluid restriction without limiting Na intake

2nd line - loop diuretic + oral salt

3rd line - vasopressin Ag

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15
Q

Vasopressin Ag (tolvaptan or conivaptan)

  1. adverse affect
  2. contraindicated in
A
  1. liver toxicity so limit use to 1 mo

2. hyponatremia 2/2 vol depletion

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16
Q

Other causes of HypoNa

A
  1. thiazide use (block Na resoprtion)
  2. cerebral wasting (assoc with CNS dz)
  3. Marathon runner’s (fluid intake > loss)
  4. Ecstasy (NMDA) ingestion (inc H20 intake and drug induced ADH secretion)
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17
Q

DI

2 tests to diagnose

A

Water restriction test
- urine osm <600
- serum osm >295
If + test desmopressin to differentiate between central vs nephrogenic

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18
Q

Loop diuretic cause: HIGH/LOW K

A
  1. LOW K
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19
Q

Hyperkalemia EKG changes

A

peaked T wave –> sine wave pattern (absent P wave and widened QRS)

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20
Q

Hypokalemia symptoms

A
  • weakness / paralysis
  • decreased GI motiliy/ileuus
  • cardiac arrhythimias
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21
Q

Hypokalemia EKG changes
vs
Digoxin EKG changes

A 
LOW K
ST segment dep
Dec T wave amplitude
Inc U wave amplitude
Prolonged QT

Digoxin
Everything as above except shortening of QT interval

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22
Q

Spot urine K-Cr ratio is used to determine

A

Renal vs Extrarenal loss of K

- <13mEq/g is seen in extrarenal losses

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23
Q

HypoMg can lead to what electrolyte abnormality

A

HypoCa2+ and HypoK

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24
Q

MC causes of HypoMg

A
  • heavy alcohol intake
  • diuretics
  • diarrhea
  • PPI
  • cisplatin , cetuximab
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25
HyperMg symptoms
Nausea, HA, Lethargy Absent reflexes Bradycardia
26
MC causes of HyperMg
Renal insuff | Mg inf therapy (preeclampsia)
27
HyperMg Mx
IV Ca inf if sxic Saline inf and loops HD
28
HypoPhosphatemia causes
- alcoholic and diabetic ketoacidosis - refeeding synd - hungry bone synd - diarrhea, alcoholism, antacids
29
HypoPhosphatemia symptoms
- delirium, seizures, coma - HF - respiratory failure - Rhabdo and hemolysis
30
AKI criteria
1. inc in cr by ≥ 0.3 within 48hrs 2. inc in cr to ≥ 1.5 x baseline in 7 days 3. dec urine vol to <0.5mL/kg/h for 6 hours
31
``` Pre-renal AKI FEna FEurea Urine spot Na Uosm ```
FEna <1% FEurea . <35% Urine spot Na <20mEq/L Uosm >500
32
ATN FEna Uosm most common casts seen
FEna >2% (myoglobinuric and constrast nephropathy can be <1%) Uosm 300 Granular cast
33
Acute IS Nephritis
Rash, fever, eosinophilia (only in 10 %)
34
Meds that can cause IS Nephritis
Abx - gradual inc 7-10 Ds after exposure NSAIDs/COX-2 inh - 6-18mos after exposure PPI - 10-11 wks after exposure
35
NSAIDs can be associated with what type of parencyhmal sydnrome
Nephrotic
36
Acute Glomerulonephritis FEna Urine spot Na additional workup ?
FEna <1% Urine spot Na >20 + complement levels, ANA, ANCA, anti-GBM Ab, cryoglobulins
37
Radiocontrast Nephropathy onset | -FEna
Within 24-48hrs FEna <1%
38
Atheroemboli-induced AKI pathophysiology
Plaque rupture causing cholesterol embolization s/p recent cath or vascular surgery
39
Atheroemboli-induced AKI 3 signs
Livedo reticularis Blue toe synd Hollenhorts plaque
40
Dialysis indications
``` A cidosis E lectrolyes refractory I ntoxi O verload fluid U remic (enceph, pericarditis) ```
41
Dialyzable drug/toxins
``` I INH, isopropyl alcohol S alicyclates T heophylline B arbiturates L ithium U remia E thylene glycol M ethanol D abigatran (pradaxa) Depakote ```
42
Orlistat causes what kind of kidney damage
Leads to calcium oxalate deposition
43
ADPKD - genetic mutations - MC px
``` PKD 1 (85%) PKD 2 (15%) ``` HTN
44
ADPKD associated with
liver cysts (40%) cerebral aneurysms (5-10%) cardiac valvular dz renal cancer
45
ADPKD Cx
- prog renal insuf - infected cysts - hemorrhage into cysts
46
Alport Synd
- glomerular dz assoc with | - sensorineural hearing loss
47
Thin Glomerular Basement Membrane Disease
hematuria without significant proteinuria | -good prognosis and rarely progress to CKD
48
``` CKD Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 ```
``` Stage 1 ≥ 90 Stage 2 60-89 Stage 3 30-59 Stage 4 15-29 Stage 5 <15 ```
49
Atrophic kidney size on U/S that does not require bx to look for cause
<10cm
50
when to start using ACEi/ARB in CKD Stage? Albumin-Cr ratio ?
Stage ≥ 3 | Albumin-Cr ratio >300mg/g
51
Leading cause of death in CKD
CVD
52
ESA is indicated when Hg level is | ESA is associated with inc risk for serious CV events if adminestered ---
Hg <10 Hg >11 and with hx of stroke
53
HCO3 and CKDA association
Metab Acidosis is common and leads to progression of CKD and inc mortality - Start supplement when HCO3 level is <22 to target normal***
54
Osteitis fibrosa cystica
high bone turover from excessive PTH | leading to asxic bone reabsroption, bone cysts, subpreiosteal bone reabsroption
55
Acrolimus and Cyclosporine AE Cyclosporine alone AE***
nephrotoxicity Inc uric acid level ***
56
Mycophenolate and Azathioprine AE
leukopenia anemia viral infs
57
Sirolimus AE
Leukopenia HLD Proteinuria poor wound healing
58
Hematuria evaluation with CT uroscopy and cystoscopy indications
age ≥ 35 with ca risk factors - smoking - analgesic abuse - benzene exposure
59
3 Primary Nephrotic Syndrome
1. Minimal change dz 2. FSGS 3. membranous glomeruopathy (anti-PLA2R Ab+)
60
4 Secondary Causes of Nephrotic Syndrome
1. DM 2. Deposition dz (MM, Walndenstrom, CLL, MGRS, AL amyloid, type 1 cryoglobulinemia) 3. SLE 4. Membranous glomerulopathy (anti-PLA2R Ab - )
61
Minimal change dz - primary etiology - secondary etiologies
Primary : idiopathic Secondary: lymphoma, NSAIDs, lithium, syphilis, mycoplasma, strongyloides
62
Minimal change dz TX
glucocorticoids if resistant | immunosuppressants
63
FSGS MC gene mutation
APOL1 gene esp in Afr Amer
64
Secondary causes of FSGS
``` Morbid obesity HIV Reflux nephropathy Heroin use Interferon Lithium ```
65
Membranous Nephropahty Primary cause Secondary cause
Primary : anti-PLA2R Ab + | Secondary : SLE, HBV, solid tumors
66
3 glomerular changes in diabetic nephropathy
mesangial expansion glomerular BM thickening glomerular sclerosis
67
Dx for nephritis, low complement, and purpuric skin rash
Cryoglobulinemia
68
Tx of TTP
Plasma exchange
69
Signs of Tubular dysfunction
Electrolyte abnormalities Diluting or concentrating defects Mild proteinuria <2g/d
70
Acute Tubulointerstitial Nephritis commonly due to
Allergic drug reaction | Infection
71
Acute TubuloIS Nephritis tx
stop offending drug
72
Type 1 Distal RTA
NAGMA HypoK urine pH >5.5 (inability to excrete acid) Kidney stones
73
Type 2 Proximal RTA
Renal HCO3 loss Urine pH <5.5 Low or nml K Fanconi syndrome : glycosuria, phosphaturia, uricosuria, aminoaciduria, proteinuria
74
Type 4 Hyporeninemic Hypoaldosteronism
``` Aldosterone deficiency or resistance urine pH <5.5 HyperK Assoc w./ Diabetes AND urinary obstruction *** ```
75
Cerebral Aneurysm screening in ADPKD indicated with following RFs
FHx of cerebral aneursym or hemorrhagic stroke Personal hx of aneurysm rupture Severe HA (warning sx) High risk occupation On chronic AC
76
When to start checking for diabetic nephropathy *** T1DM T2DM
T1DM - 5 yrs later | T2DM - at the time of diagnosis then q yearly
77
Aminoglycosides causes what kind of kidney damage
Reversible non-oliguric ATN after 5-7 Ds
78
What can be done to minimize aminoglycoside nephrotoxicity? Is nephrotoxity proportionate to the total dose of amino glycoside?
Correct hypoK and hypoMg YES
79
Which 4 conditions present with Increased risk for calcium oxalate stones ? What supplement prevent calcium oxalate stone formation?
Bypass surgery Pancreatitis Chrons Bacterial overgrowth synd Citrate
80
Sjogren syndrome is associated with what renal disorder
RTA 1 > 2
81
Treatment for uremia induced platelet dysfunction --> to decrease bleeding risk
Desmopressin
82
Posttransplant lymphoproliferative disorder (PTLDs) usually occur when? Pathogenesis is thought to be related to ? Tx?
Within 1st yr of solid organ transplant EBV + B cell proliferations in the setting of chronic immunosuppressive drug therapy Rituximab +/- chemo
83
Fanconi syndrome can be associated with which 2 kidney conditions?
Tubuloinstertitial disease Type 2 RTA
84
Additional tx for Ethylene glycol or methanol poisoning in addition to Fomepizole and HD ? Activated charcoal IV ethanol IV NaHCO3
NaHCO if pH < 7.30
85
Patients with enteric hyperoxaluria and calcium oxalate nephrolithiasis tx
Cholestyramine (Bile salt binders) to decrease intestinal oxalate absorption NOT CITRATE if urine citrate levels are nml.
86
Common causes of ATN
Ischemic / Pre-renal Nephrotoxic : --myoglobinuria - rhabdo --hemoglobinuria - hemolytic anemia --contrast --drugs (gentamicin/amphotericin/cisplaitn) --osmotic nephropathy (sucrose/mannitol/dextran)
87
Which electrolyte abnormality can cause Rhabdo (2)
low phosphorus | low K
88
Rhabdo tx
Early aggressive hydration (>10L IVF) to keep UO 250-300ml/hr Urine alkalization pH >6.5
89
Acute IS Nephritis triad
Fever Rash Eosinophilia
90
Acute IS Nephritis U/A
WBC or WBC cast with no evidence of infection (sterile pyuria)
91
Acute IS Nephritis MC medications
NSAIDs | PPI
92
PEARL | Acute IS Nephritis associated with which 2 syndrome/diseases
Sjogren | Sarcoidosis
93
Acute IS Nephritis tx
discontinue offending medications
94
AKI Cr | contrast nephropahty vs arterial catheterization
contrast - Cr inc 24-48 hrs atheroembolic dz - if not recovering by D5 post-contrast low complement, eosinophilia
95
Atheroembolic dz s/p arterial catheterization tx
consider stopping AC
96
Atheroembolic disease sings
Hollenhorts plaque- retinal artery occlusion Livedo reticularis Peripheral emboli
97
Analgesic abuse nephropathy common UA finding
sterile pyuria
98
Eosinophils in urine are seen in (2)
Drug induced IS nephritis | Atheroembolic dz
99
Lupus Nephritis tx
Induction : cyclophosphamide or MMF + Steroids Maintenance : MMF or Azathioprine
100
Minimal change dz is associated with which medication (1) and dz (1)
NSAIDs Hodgkin disease
101
Sjogren and SLE is associated with which RTA
RTA 1 (distal)
102
HIV is associated with which GN?
FSGS
103
How do you treat uric acid nephrolithiasis
Alkalization of urine pH > 6 with K Citrate or KHCO3 if not responding then Allopurinol

Nephrology (1 decks)

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