Nephrology Flashcards
(83 cards)
1
Q
Urinalysis measures?
A
Protein WBC or Leuk esterase RBCs Specific gravity and pH Nitrites
2
Q
Pyuria +Nitrates=
A
UTI
3
Q
3 UTI organisms not measured on nitrates
A
Enterococcus
Staph saprophyticus
Group B Strep
4
Q
1+ proteinuria = g/day
A
1 g/day
5
Q
less than
is normal protein loss in 24 hours
A
30-50 mg
6
Q
work up for proteinuria?
A
UA/Dip
Urine protein: creatinine or 24 hour urine
Renal biopsy
7
Q
Dipstick only measures what kind of protein?
A
albumin
8
Q
Dipstick is important for what patient?
A
the Diabeetus pt
9
Q
What detects eosinophils in urine?
A
Wright and hansel stains
10
Q
Dysmorphic RBCs
A
glomerulonephritis
11
Q
Hematuria w/o infection w/o trauma
tests to order?
A
Ultrasound/CT if it shows nothing order
cystoscopy is the most accurate
12
Q
Red cell think?
A
glomerulonephritis
13
Q
White cell think?
A
Pyelonephritis
14
Q
Eosinophils think?
A
Acute interstitial nephritis
15
Q
Hyaline think?
A
Dehydration
16
Q
Broad, waxy think?
A
Chronic renal disease
17
Q
Granular, “muddy-brown”
A
Acute tubular necrosis (are dead tubular casts)
18
Q
AKI
A
Acute Kidney injury
decrease in creatinine clearance
sudden rise in BUN and creatinine
19
Q
Prerenal Azotemia
A
Decreased perfusion
Hypotension (sepsis, anaphylaxis, bleeding, dehydration)
Hypovolemia (Diuretics, burns, pancreatitis, dec. in pump function, low albumin, cirrhosis)
20
Q
Postrenal Azotemia
A
Obstruction
BPH/Prostate cancer Ureteral stone Cervical cancer urethral stone Neurogenic bladder Retroperitoneal fibrosis (chemo or XRT)
21
Q
Intrinsic Renal disease
A
ischemia and toxins
ATN: Toxins (NSAIDs, AG, ampho, CIsplastin, cyclophosphamide), Prolonged ischemia
AIN: PCN, sulfa Rhabdo/hemoglobinuria Contrast Crystals Bence Jones protein Post Strep Infection
22
Q
AKI tests?
A
Initial? BUN/Creat
image?
unclear: U/A, UNa, FEUrea, Urine osmolality
23
Q
Prerenal Azotemia Labs will show??
A
BUN/creat: >20:1 low UNa (below 20) Low FENa (500 mOsmo/kg
24
Q
Acute Tubular Necrosis Labs will show?
A
BUN/creat: 1%)
Urine osmolality
25
Increase risk of toxic/insult ATN
hypoperfusion of kidney
Renal insuff (HTN, diabetes)
older age
26
ATN causes by time
(5-10 days)
(24-48 hrs)
5-10 days: Drugs related injury--aminoglycosides, amphotericin, cisplatin, vancomycin, acyclovir, cyclosporine
24-48 hrs: Contrast media- prevent with saline
27
Rhabdomyolysis
| Causes
trauma, prolonged immobility, snake bites, seizures, crush injuries
28
Rhabdo initial test?
UA (dipstick and microscopic analysis)
| Blood positive no RBCs seen
29
rhabdo most specific test?
urine myoglobin
30
Rhabdo other lab findings on CMP?
```
Increased cpk
hyperkalemia
hyperuricemia
hyperphosphatemia
hypOcalcemia
```
31
Tx Rhabdomolysis
Saline hydration
mannitol
bicarbonate
32
Txs THAT DO NOT HELP WITH ATN
low dose dopamine
diuretics
mannitol
steroids
33
Dialysis Indications
```
Acidosis
Electrolytes
Intoxications
Overload
Uremia
```
34
Furosamide SE
SE damages inner hair cell
35
Hepatorenal syndrome
Sever liver disease
new onset renal failure with no other explanation
very low urine sodium (>10-15 mEq/dL)
FeNa 20:1)
36
Acute Interstitial Nephritis
antibodies and eosinophils attack cell linings
Reaction to drugs, infection and autoimmune disorders
37
Papillary Necrosis
```
onset a few hours
necrotic material in urine
Urine culture: negative
CT scan : bumby contour of kidney interior
Tx: no treatment
```
38
Glomerular disease all have
```
UA with hematuria
Dysmorphic red cells
Red cell casts
urine sodium and FENA are low
Proteinuria
```
39
Goodpasture
Lung and kidney only
ANA antibodies
best test : lung or kidney biopsy: linear deposits
40
Goodpasture tx
plasmapheresis, steroids,cyclophosphamide
41
IgA Nephropathy (Berger Disease)
MCC of acute glmoerulonephritis
1 to 2 days after URI
increased IgA levels (>50%)
no tx unless severe and you give steroids and ACEI
42
Postinfectious Glomerulonephritis
MC infection is streptococcus
follows throat infection or skin infection by 1-3 weeks
Presentation:
cola colored urine, edema, HTN, Oliguria
Test: UA, ASO titers, anti-DNAse antibody titers, biopsy
43
Postinfectious glomerulonephritis
tx: antibiotics, diuretics to control fluid overload
44
Alport syndrome
Type 4 collagen defect
Hearing loss, visual problems, glomerular problems
No treatment
45
Polyarteritis Nodosa
systemic vasculitis of small and medium sized arteries
spares the lung
associated with Hep B
46
Polyarteritis Nodosa
| Labs and treatment
```
anemia and leukocytosis
Increased ESR and c-reactive protein
biopsy most accurate
Tx: Prednisone, cyclophosphamide
treat the Hep B
```
47
Lupus Nephritis
any degree of renal involvement: membraneous glomerulonephritis, glomerulosclerosis "scars kidney"
Biopsy
tx: steroids, cyclophosphamide, mycophenolyate
48
Amyloidosis
Abnormal protein produced by
| myeloma, chronic inflammatory disease, rheumatoid arthritis, inflammatory bowel disease, chronic infections
49
Accurate test for Amyloidosis
| tx?
apple-green birefringence with congo-red staining
tx: control underlying disease
2nd line: melphalan and prednisone
50
Nephrotic Syndrome
| definition
protein >3.5g/24 hr
edema
hyperlipidemia
thrombosis
51
Nephrotic syndrome
most common cause
pt & associations
```
diabetes and HTN
assoc.
cancer: membranous
children: minimal change
IVDU/AIDS: focal segmental
NSAID: minimal change disease and membranous
SLE: any of them
```
52
Nephrotic Syndrome Tx:
1st: Glucocorticoids
2nd: cyclophosphamide
ACEI or ARB
salt restriction/ diuretics
Statins
53
End Stage Renal Disease
Loss of renal function defined by symptoms and abnormalities that are collectively known as uremia.
54
Uremia signs
```
Metabolic acidosis
Fluid overload
encephalopathy
hyperkalemia
Pericarditis
```
55
Treatment of hyperphosphatemia
calcium acetate
calcium carbonate
Use the following when Ca is high:
sevelamer
lanthanum
56
Aluminum causes dementia which is why
you never use aluminum containing phosphate binders to lower hyperphosphatemia
57
HLA-identical, related donor kidneys last 24 yrs on average
Kidney transplant
58
TTP and HUS
TTP is assoc with HIV, cancer, drugs
HUS is assoc w/E coli
59
TTP
Tx: plasmapheresis
if not an option treat with FFP
Steroids don't help and you don't give platelets (b/c it is consumptive problem)
60
Simple Cyst
echo free
smooth, thin walls
sharp demarcation
transmission good through to back
61
Complex Cyst
mixed echogenicity
irregular, thick walls
lower density on back wall
debris in cyst
62
Polycystic Kidney Disease
Autosomal dominant disorder
Pain, hematuria, stones, infection, HTN
63
Central DI
loss of ADH production
CNS disorders: stroke, tumor, trauma, hypoxia, infection
64
Nephrogenic DI
Loss of ADH effect
Lithium, demeclocycline, chronic kidney disease, hypokalemia, hyperkalemia
65
CDI Treatment
ADH replacement
66
NDI Treatment
Correct the potassium and calcium
stop lithium or demeclocycline
Given HCTZ or NSAID
67
Cerebral edema
sodium levels brought down too rapidly
68
Addison disease
loss of adrenal function --> loss of aldosterone
69
hypervolemia hyponatremia
CHF
Nephrotic syndrome
cirrhosis
70
Euvolemic hyponatremia
Pseudohyponatremia
psychogenic polydipsia
hypothyroidism
SIADH
71
Hyponatremia symptoms
confusion, lethargy, disorientation, seizures, coma
72
Central pontine myelinolysis
if the sodium level is brought up to normal too rapidly
73
Hyperkalemia
| 3 types
Pseudohyperkalemia
decreased excretion
increased release from tubules
74
Hyperkalemia order which test first
EKG
| peaked Twaves, wide QRS, PR interval prolongation
75
Treatment Hyperkalemia
```
Calcium chloride or calcium gluconate
Bicarb/beta agonist
Insulin
Glucose
Kayexalate
D
```
76
Hypokalemia presentation
weakness, paralysis, loss of reflexes
77
Hypokalemia EKG findings
```
U waves
ventricular ectopy (PVC), flattened t waves and ST depression
```
78
Anion gap calculation
Na - ( CL+ HCO3)
| normal gap is 6-12
79
Nonanion gap calculation
| causes
RTA and diarrhea
80
Nephrolithiasis most common type
calcium oxalate
| forms in alkaline urine
81
Nephrolithiasis most common risk factor
overexcretion of calcium in urine
82
Diagnostic test for nephrolithiasis
CT scan
83
how do you manage cystine stones?
alkalinze the urine
