Nephrology Flashcards
(38 cards)
In what situations would you give IV fluids before and after contrast exposure?
Current AKI or GFR <30
what data is there for HD after contrast exposure?
mixed results, no proven benefit (studies in early 2000s)
what result indicates primary membranous nephropathy?
PLA2R Ag +
What conditions may lead to secondary membranous nephropathy?
malignancy (solid tumor, lymphoma), lupus, hepatitis, drug-induced (NSAIDs, gold salts), infection (Hep B/C, syphilis, malaria)
What increase in Cr 2-3 weeks after starting ACE/ARB indicates need for stopping or decreasing dose?
> 30% increase
What are the indications for kidney biopsy?
-Glomerular hematuria
-Severely increased albuminuria
-AKI or CKD unclear cause
-Kidney transplant dysfunction or monitoring
What is the risk of PPI to the kidneys?
increased risk of CKD and progression of CKD. Also will decrease Magnesium and Potassium levels.
What size of stone is likely to require shock wave or laser lithotripsy?
> 10mm or 1 cm
what symptoms and signs come with pathologic hypermagnesemia (usually levels >4.8), and what is the treatment?
weakness, hypotension, bradycardia (blocks Ca and K channels)
-Tx: IV calcium gluconate then HD
How do you calculate the urine anion gap? What kind of metabolic derangement makes it helpful?
(UNa + UK) - UCl
-Non anion gap metabolic acidosis
What does a positive urine anion gap mean? Explain.
Kidney is the cause of acidosis. Could indicate bicarbonate loss in the urine (invisible anions).
NeGUTive means cause is the gut (invisible positive ions like NH4+ means good kidney H+ secretion).
What factors might make you suspect renovascular hypertension? Fill in the blanks.
1) Onset after age ___
2) AKI after ____ or ____
3) kidney measurement < ___ cm or a ___ cm difference in size between kidneys
1) 55
2) starting ACE/ARB, after achieving good BP control
3) 9, 1.5
what is the time frame for start of AIN after exposure to:
1) PPI
2) NSAIDs
1) 10-11 weeks
2) 6-18 months
What are the signs of CINAC
increased Cr, UA with leukocytes, low grade proteinuria, RUS with increased echogenicity, +/- HTN
(CIN agricultural communities, usually young to middle age males in agricultural communities. This often progresses to ESRD).
what specialist should kidney transplant patients see regularly due to increased risk from medications?
Dermatologist, increased risk skin cancer
How do you treat acute hyponatremia with severe symptoms?
100 mL bolus 3% NS
Who is 5x more likely than whites to have FSGS?
African descent
What are secondary causes of minimal change disease?
malignancy (Hodgkin lymphoma, thymoma) and meds (NSAIDs, Li, pamidronate, interferons)
What are the urea splitting organisms?
Proteus, Klebsiella, Pseudomonas
Which of the following is true? 1) IgA nephropathy usually progresses quickly to ESRD.
OR
2) IgA nephropathy is usually benign and does not progress to CKD.
2! IgA nephropathy usually has recurrent gross hematuria with only rare progression to CKD.
What condition with renal injury has been associated with clopidogrel?
HUS
How do you treat Salicylate toxicity?
IV sodium bicarbonate (increases urinary elimination) with goal of pH >7.5
-consult for HD right away if AKI, severe symptoms, high ASA levels
What medications are useful for calciphylaxis?
Sodium thiosulfate. Cinacalcet helps to decrease PTH and has shown promise for prevention.
What should you consider in woman <35 yo with abrupt onset HTN
Fibromuscular dysplasia
