Nephrology Flashcards
(131 cards)
1
Q
Main cause of cystitis
A
E. coli #1 cause
Enterobacteria
2
Q
Typical signs of cystitis
A
dysuria, frequency, urgency, +/- hematuria
3
Q
Antibiotic treatment for cystitis
A
Nitrofurantoin
Fluoroquinolones (Cipro)
TMP-SMX (Bactrim) becoming less effective due to resistant organisms
4
Q
An ascending urinary tract infection
A
pyelonephritis
5
Q
How does patient with pyelonephritis present differently than cystitis?
A
Fever, radiating flank pain, abd pain, nausea and vomiting
CV tenderness
6
Q
UA results of pyelonephritis
A
Pyuria
WBC casts
7
Q
Pyelonephritis treatment
A
- Abx per urine culture: Cipro, Cephalosporins, gentamycin, Bactrim
- Nephrectomy
8
Q
Most common presenting symptom of bladder carcinoma
A
hematuria
9
Q
Treatment of bladder carcinoma
A
Surgery: transurethral resection of bladder tumor (TURBT), partial or radical cystectomy
Adjuvant chemotherapy and radiation may be used
10
Q
Hematuria + palpable abdominal mass + smoker
A
renal cell carcinoma
11
Q
Child with hematuria and palpable abd mass or distended abd
A
Wilms tumor
12
Q
1 risk factor of bladder cancer
A
smoking
13
Q
I came in to see my physician assistant because of…
Nocturia Hesitancy Decreased urine flow Incomplete bladder emptying Frequency Firm enlarged prostate on rectal exam Negative urine culture
A
Benign Prostatic Hyperplasia (BPH)
14
Q
How to treat BPH?
A
Behavior modification: decrease fluids before bed, decrease alcohol and caffeine, routine voiding schedule
Meds:
Alpha blockers - relax smooth muscle; Tamsulosin (Flomax), Prazosin, Terazosin
5 alpha reductase inhibitors - block DHT production which causes BPH; Finasteride, Dutasteride
Surgery:
Transurethral resection of the prostate (TURP)
Prostatectomy
15
Q
3 types of urinary incontinence
A
Stress incontinence – Leaking of urine due to physical stress. Coughing, jumping, laughing etc. This is often due to urethral incompetence.
Urge incontinence – A sudden feeling of urgency and an associated loss of urine. Often associated with an overactive detrusor muscle. This may be due to neurologic disease
Overflow incontinence – Involuntary voiding without an urge to urinate typically secondary to urinary retention. This is often due to an outlet obstruction (think BPH) or an underactive detrusor muscle
16
Q
I came in to see my physician assistant because of…
Sudden onset of severe flank pain
Nausea and vomiting
Hematuria
A
Nephro/urolithiasis (kidney stone)
17
Q
Most kidney stones composed of what
A
calcium
18
Q
Treatment of nephrolithiasis
A
Prevention: increased fluid intake
Meds: alpha blockers (Flomax, Prazosin), NSAID, corticosteroids
Ureteroscopic stone extraction
Extracorporeal shock wave lithotripsy
19
Q
Normal GFR
A
100-130 mL/min/1.73 m^2
20
Q
Symptoms of uremia may include…
A
Anorexia, Fatigue, Malaise, Dyspnea, Orthopnea, Change in mental status, restless legs, Weakness, Pruritis, Insomnia, Irritability, Cramping, etc
21
Q
3 categories of AKI
A
Prerenal (decreased blood flow to kidney)
Intrinsic (kidney is having the problem)
Postrenal (urinary tract obstruction)
22
Q
Prerenal causes of AKI
A
Renal artery stenosis Renal artery thrombosis Heart failure Severe dehydration NSAIDS
23
Q
Intrinsic causes of AKI
A
Crush injury Antibiotic reaction Contrast dye Glomerulonephritis ATN AIN
24
Q
Postrenal causes of AKI
A
OBSTRUCTIONS!
BPH
Kidney stone
25
Most common types of AKI
prerenal and ATN
26
BUN/CR greater than 20:1 in ________.
acute GN, prerenal and postrenal AKI
27
BUN/CR less than 20:1 in ___________.
ATN, AIN
28
Lab findings of AKI
elevated BUN:Cr
hyperkalemia
anemia
decreased GFR
29
How is AKI treated?
Treat underlying cause
- Correct CHF
- Fluids if dehydrated
- Avoid nephrotoxins
- Treat post renal problem
- Stenting of renal arteries
Dialysis
Transplant
30
How long until AKI becomes chronic?
over 3 months
31
Most CKD is secondary to what?
HTN or DM
32
Lab findings of CKD that are not seen in AKI
Broad waxy casts
Proteinuria
HTN
* both have elevated Cr/BUN, decreased GFR, hyperkalemia, anemia
33
CKD treatment
Aggressive treatment of HTN and DM
Treat hyperkalemia with calcium chlorid or bicarb
Diet: protein restriction, salt and water restriction, K+ restriction, Phos restriction
Hemodialysis if GFR below 15
34
I came in to see my physician assistant because of…
- Edema (periorbital or scrotal area)
- Dark (Tea Colored) urine
- Red cell casts
glomerulonephritis
35
Causes of glomerulonephritis
Berger disease (IgA nephropathy)
Endocarditis
Lupus
Strep infection
36
Glomerulonephritis treatment
high dose corticosteroids
37
proteinuria > 3.5g/day, high cholesterol, edema
nephrotic syndrome
38
causes of nephrotic syndrome
```
Primary renal disease
SLE, rheumatoid etc
Post infectious causes
DM
NSAIDS
Lithium
Toxins
Pregnancy
Multiple myeloma
```
39
UA results of nephrotic syndrome
fatty casts, oval fat bodies
40
Nephrotic syndrome treatment
Diet - increase proteins to match loss of proteinuria, salt restriction
Diuretics - ACE or ARB
Steroids
41
How to differentiate nephrotic syndrome and nephritis?
proteinuria levels (3.5 nephrotic syndrome)
UA results (RBC casts in nephritis, fatty casts in nephrotic syndrome)
42
Causes of nephritic syndrome
Specific strains of Group A strep
Bacterial or viral infection
Lupus
Goodpasture’s syndrome
43
I came in to see my physician assistant because of…
```
Hematuria (coca cola urine)
Proteinuria
HTN
Oliguria
Edema
Pruritus
Loss of appetite
```
nephritic syndrome
44
Nephritic syndrome treatment
Treat HTN
ACEI or ARB
Corticosteroids
45
Causes of hydronephrosis
Abnormal anatomy leading to poor outflow (often congenital)
Obstruction of any kind
Compression of the bladder causing reverse urine flow
46
How is hydronephrosis detected?
Renal ultrasound during prenatal testing
47
I came in to see my physician assistant because of…
Flank pain
History of UTIs and kidney stones
Kidneys may be large and palpable
polycystic kidney disease
48
50% of patients with PCKD have ________ by 60 years old
end stage renal disease
49
PCKD treatment
```
Supportive care and pain meds
Cyst decompression
Antibiotics if cyst is infected
Decreased caffeine intake
Dialysis
Renal transplant
```
50
Granular or muddy brown casts on UA =
acute tubular necrosis
51
Broad waxy casts on UA =
Chronic kidney failure
52
Fatty casts on UA =
nephrotic syndrome
53
Red blood cell casts on UA =
glomerulonephritis/nephritic syndrome
54
WBC casts on UA=
infection, pyelonephritis
55
Epithelial casts on UA =
acute tubular necrosis
56
Nephrotic syndrome consists of huge losses of ________.
protein
57
Maltese crosses indicates _______.
nephrotic syndrome
58
Tea colored urine indicates __________.
glomerulonephritis
59
Causes of hypernatremia
Hypervolemic: iatrogenic (hypertonic saline), hyperaldosteronism
Hypovolemic: extrarenal loss (diarrhea, sweating, burns), urinary/renal loss (diuretics, renal disease)
Euvolemic: Diabetes Insipidus (ADH deficiency or insensitivity), hypodipsia
60
Normal sodium levels
135-145
61
Signs/sx's of hypernatremia
Thirst, Lethargy, Irritability, Weakness, Change in mental status, dry mucous membranes, lack of tears (infants), hyperreflexia
62
When should dialysis be done in hypernatremia?
Na > 200
63
How should hypernatremia be treated based on circulating volume?
ISOTONIC IV FLUIDS
Hypovolemia: 0.9% NS, D5W
Normal volume: Drink water, D5W
Hypervolemia: Loop diuretic, D5W
64
Causes of hyponatremia with hypervolemia
CHF, nephrotic syndrome, cirrhosis
65
Causes of hyponatremia with euvolemia
SIADH (high ADH release)
Adrenal insufficiency
Hypothyroidism
Polydipsia
66
Causes of hyponatremia with hypovolemia
Sodium loss (renal or extrarenal)
67
Signs/Sx's of hyponatremia
Nausea, Malaise, Headache, Lethargy, Mental status changes, Muscle cramps, Seizures
68
Hyponatremia treatment
```
Fluid restriction
Hypertonic saline (D5 1/2 or D5 NS), but be very careful
```
69
Normal serum pH
7.35-7.45
70
Normal PCO2
35-45 mmHg
71
Normal serum bicarb
22-26 mEq/L
72
Acid-base imbalances of respiratory causes show up with changes in _______ and metabolic causes with changes in ________.
carbon dioxide
| bicarb
73
Metabolic acidosis treatment
Treat underlying cause
| Give bicarbonate
74
Metabolic alkalosis treatment
Stop diuretics or nasogastric suctioning
Give IV Normal saline
75
Describe mneumonic "ROME" for acid-base disorders
Respiratory will be opposite (the RO in rome)
- so pCO2 will be opposite the pH (so in respiratory acidosis the pH is low but the pCO2 is high)
Metabolic always relate with Bicarb & if pH is alkalosis the bicarb will be the same (ME for metabolic equal)
- so for metabolic alkalosis pH is high and bicarb is also high
76
Functions of the kidneys
Blood filtration
Regulation of blood volume and pressure
Activation of Vit D
Production of erythropoietin
77
How does CHF contribute to renal failure?
inadequate heart pumping -> effective blood volume depletion -> decreased renal perfusion -> prerenal failure
78
How does cirrhosis contribute to renal failure?
scarring of the live -> portal HTN -> blood pools in gut's venous system -> effective blood volume depletion -> decreased renal perfusion -> prerenal failure
79
How do the kidneys react to low blood volume?
kidneys reabsorb sodium and water in attempt to replenish intravascular volume
80
What is elevated serum creatinine a sign of?
GFR is inadequate and renal function is impaired
81
What is lab that distinguishes prerenal from intrinsic renal failure?
BUN/Cr >20:1 in prerenal and less than 20:1 in intrinsic AKI
82
Why is BUN/Cr not as elevated in intrinsic AKI?
renal reabsorption is defective
83
Urine changes in intrinsic AKI
reabsorption defective so wastes both water and sodium in urine -> urine dilute with high sodium
84
Urine changes in prerenal AKI
reabsorbs Na and water to increase intravascular volume -> urine very concentrated with low sodium
85
Function of ADH
increases water reabsorption from renal tubules to blood
86
How can postrenal AKI be dx'd?
ultrasound of ureter, bladder, or urethra for possible obstruction
87
Two categories of glomerulopathies
nephrotic and nephritic syndromes
88
Signs of nephrotic syndrome
edema, proteinuria, hyperlipidemia
89
Pathophysiology behind nephrotic and nephritic syndrome
damage or inflammation to filtering mechanism of glomerulus, allowing proteins through
90
Signs of nephritic syndrome
HTN, hematuria, proteinuria
91
Changes in the serum that occur with chronic kidney failure
increase: Na, K, H, Mg, Phos, ammonia, PTH
decrease: Vit D, calcium, erythropoietin
92
Why does calcium concentration decrease in CKD?
In renal failure, Vit D activation decreases. Without Vit D, calcium cannot be absorbed from the diet and calcium in serum decreases
93
What hormone increases serum calcium by releasing it from bone?
PTH
94
Why does renal failure cause anemia?
kidneys are responsible for erythropoietin production
95
Urethritis most often caused by what?
Gonorrhea and Chlamydia
96
What is the significance of cells vs casts on UA?
cells with normal morphology -> lower GU tract disease
cells with abnormal morphology -> renal disease
casts are conglomerates of protein and cells -> glomerular or tubular disease
97
White cells from kidney =
| White cells from lower UG =
AIN
| infection - cystitis or urethritis
98
Red cells from kidney =
| Red cells from lower UG =
glomerulonephritis
nephrolithiasis, hemorrhagic cystitis, or bladder cancer
99
What kind of casts occur in ATN and pyelonephritis?
white and epithelial casts
100
Which IV solution increases sodium in blood to increase intravascular volume?
hypertonic saline (D10W, 3% NS)
101
Which IV solution dilutes sodium in blood vessels and causes water to leave bloodstream and enter cells?
hypotonic saline (1/2 NS)
102
Which saline causes intravascular volume increase without any fluid shifts?
isotonic saline
103
Which IV saline should be used in hypovolemic patient?
isotonic (0.9% NS, D5W, LR)
104
What can occur if electrolyte imbalances are corrected too quickly with IV fluids?
central pontine myelinolysis; brain does not have time to re-equilibrate
105
Function of aldosterone
reabsorption of sodium and secretion of potassium
106
______ is the main extracellular cation and _____ is the main intracellular cation.
sodium
| potassium
107
How are "-volemias" (hyper, hypo, euvolemia) determined?
based on perceived clinical exam (edema, dryness, skin tenting, etc.)
108
Hypervolemic hypernatremia most commonly caused by what?
iatrogenic - administration of sodium bicarb or dialysis solutions
109
How can renal and extrarenal losses of water and/or sodium be distinguished in hypovolemic hypernatremia?
renal - higher concentration of sodium in urine
extrarenal - kidneys hold on to as much sodium as possible, so lower concentration in urine
110
Central vs Nephrogenic diabetes insipidus
central - decreased production of ADH from posterior pituitary
nephrogenic - decreased sensitivity of kidneys to ADH
111
Well known med that causes renal toxicity
lithium
112
Main signs of diabetes insipidus?
excess and dilute urine (ADH is not absorbing water)
113
How do diabetes insidious and polydipsia present similarly in clinic? How can they be differentiated?
both have polyuriaserum [Na]
| will be low in polydipsia and high in DI
114
What is SIADH and what does it cause to happen in body?
inappropriate and excessive secretion of ADH, which dilutes serum and causes hyponatremia
115
What would you expect on UA of SIADH?
concentrated urine, elevated urine [Na]
116
Pathophysiology behind pseudohyponatremia?
- increase in glucose, lipids, proteins, or urea in blood causes increased water reabsorption
- dilutes intravascular space and causes hyponatremia even though there is actually no change in serum sodium
117
_________ is a net gain in sodium or a net loss in water.
hypernatremia
118
3 basic mechanisms that cause hyperkalemia:
increased intake
decreased urinary excretion
increased movement of K+ from cells into bloodstream
119
Hyperkalemia on ECG
peaked T waves
120
Shifts of K+ and H+ in acidosis and alkalosis
acidosis: H+ into cell, K+ out of cell = hyperkalemia
alkalosis: H+ out of cell, K+ into cell = hypokalemia
121
Which drugs cause H+ to rush into cell and cause hyperkalemia?
beta blockers
122
How does insulin affect H+ shift into and out of cells?
low insulin = H+ into cellhigh insulin = H+ out of cell* opposite for K+
123
______ and ______ are main players in acid-base balance.
kidney and lungs
124
Respiratory acidosis is caused by elevated _____.
CO2
125
How does body compensate for respiratory acidosis?
kidney reabsorbs more HCO3- to buffer
126
How does body compensate for metabolic alkalosis?
lung retains more CO2 to buffer
127
What causes respiratory acidosis?
decreased expiration of CO2: obstruction, damage to lungs or chest wall, problem with respiratory muscles
128
What causes respiratory alkalosis?
hyperventilation
129
What causes metabolic alkalosis?
hyperaldosterone
vomiting
diuretics
130
Causes of acid gain in metabolic acidosis
```
"MUD-PILES"
Methanol
Uremia
DKA
Paraldehyde
Isoniazid or Iron
Lactic acid
Ethylene glycol
Salicylates
```
131
How to determine the cause of metabolic acidosis?
Calculate serum anion gap: Na - (Cl + HCO3)
- Over 10-12 (another acid present) -> MUD-PILERS
- Normal -> diarrhea or renal
Calculate urine anion gap: Na + K - Cl = -NH4
- Negative -> diarrhea
- Positive or zero -> renal tubular acidosis
