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Nephrology Flashcards

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1
Q

What does severe proteinuria mean?
What can increase urinary protein excretion?
What protein does urine dipstick check?
What is normal protein in 24 hours?

A

Glomerular damage
Standing, physical activity
Albumin

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2
Q

What is the initial test for proteinuria?
What is the accurate test?
What is faster and easier - P/Cr or 24hr urine

A

UA
P/Cr ratio
P/Cr

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3
Q

What is done to determine the cause of proteinuria?

A

Biopsy

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4
Q

What is the best initial therapy for proteinuria in a DM patient?

A

ACEi/ARB

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5
Q

How is Bence Jones protein detected?

A

Immunoelectrophoresis

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6
Q

How do you detect eosinophils in urine?

What disease do these tests diagnose?

A

Wright and Hansel stains

Allergic interstitial nephritis

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7
Q

If you see mild recurrent hematuria, what disease should you be thinking?

A

IgA nephropathy

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8
Q

What would give you a false positive for hematuria?

A

Hemoglobin or myoglobin

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9
Q

What renal disease is suggested by dysmorphic red cells?

A

Glomerulonephritis

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10
Q

What is the most accurate test of the bladder?

When is this test utilized (2)?

A

Cystoscopy
No trauma/infection + hematuria + imaging does show issue
No trauma/infection + hematuria + possible mass in bladder

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11
Q 
What is indicated by red cell casts?
White?
Eosinophils?
Hyaline?
Broad waxy?
Granular muddy brown?
A 
Glomerulonephritis
Pyelonephritis
AIN
Dehydration
CKD
ATN (dead tubular cells)
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12
Q

How do you define an AKI?

A

Decrease in CrCL resulting in sudden rise in BUN/Cr

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13
Q

How many kidneys must be obstructed for the creatinine to rise?

A

Both

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14
Q

What is the best initial test for AKI?
What do the results suggest?
What is the best imaging test initially?
What is the next step (and then next 3 after that)?

A

BUN:Cr
>20:1 is pre or post renal –> 10:1 is intrinsic
U/S
UA > UNa = FeNA > Urine osmolality

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15
Q

What is the best advice for someone with sickle cell trait?

A

Remain hydrated b/c of defect in concentrating urine

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16
Q

Best initial tests in urology (2)

A

UA

BUN + Cr

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17
Q

How do you determine the cause of ATN?

A

Acute renal failure with a toxin in the history

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18
Q

What has a very rapid onset in producing an AKI?
How long does it take?
How can it be prevented?

A

Contrast media
1 day
Saline hydration (1-2Ls prior and during)

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19
Q 
How does a patient with contrast induced renal failure present on lab values?
Urine sodium
FENa
Urine specific gravity
Why?
A

Very low

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20
Q

What causes a creatinine rise 2 days after starting chemotherapy?
Prevention?

A

Hyperuricemia due to tumor lysis syndrome

Allopurinol + H2O + Rasburicase

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21
Q

Ethylene glycol ingestion is associated with what electrolyte abnormality?
Why?
When does it occur?

A

Low Ca
Oxalate crystals precipitate with Ca
3 days after ingestion

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22
Q

What electrolyte deficiency can increase the risk of aminoglycoside or cisplatin toxicity?

A

Magnesium

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23
Q

What are 3 things that a urine dipstick cannot tell the differences between?

A

Hemoglobin
Myoglobin
RBCs

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24
Q 
What is the most specific test for Rhabdo?
What are 3 major electrolyte changes?
What other test needs to be ordered?
How do you treat?
What does not need to be treated?
A 
Urine myoglobin
HyperK, HyperUric, HypoCa
EKG
Saline + Mannitol + Bicarb 
Low Ca
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25
What are 4 INeffective ways to manage ATN?
Low dose Dopamine Diuretics Mannitol Steroids
26
When should you dialyze an ATN patient? | When do you NOT dialyze and what do you do instead?
``` Fluid overload Encephalopathy Pericarditis MetAcid HyperK HypoCa --> VitD/Ca ```
27
What are treatments for hepatorenal syndrome? (3)
Midodrine Octreotide Albumin
28
What are hints at atheroemboli? | What is the most accurate test?
Eosinophilia/eosinophils in urine/high ESR | Biopsy of a purplish lesion on fingers/toes
29
The same meds that cause AIN also cause ____ (4)
Drug allergy/rash SJS TEN Hemolysis
30
How do you treat an AIN?
Resolves spontaneously with the removal of the drug
31
Papillary necrosis is usually caused by _____ + ______ (4)
NSAIDs | SCD/DM/urinary obstruction/chronic pyelo
32
What is the most accurate test for papillary necrosis?
CT scan showing abnormal kidney
33
``` Tubular diseases occur ____ They are usually caused by _____ They never cause ______ syndrome They are not usually diagnosed with _______ They are not treated with ____ or ______ They are treated with ____ + ________ ```
``` Acutely toxins Nephrotic Biopsy Steroids, immunotherapy Correcting hypoperfusion, removing the toxin ```
34
Glomerular diseases are _____ The most accurate test? Typical treatment? Sometimes you also treat with _____ such as __ ____
Chronic Biopsy Steroids Immunosuppressives --> cyclophosphamide, mycophenolate
35
Name 5 characteristics of all forms of glomerulonephritis
``` Hematuria on UA Dysmorphic red cells Red cell casts Na/FeNa low Proteinuria ```
36
What additional features are in Goodpasture? Initial test? What is seen on biopsy? Treatment?
Lung involvement as well but no UR AntiGBM test Linear deposits Plasmapheresis and steroids
37
what is the most common cause of acute GN in US? How does it present? Most accurate test? What corresponds to severity of the disease?
IgA nephropathy Hematuria 1-2 days after URI Biopsy Increased protein = worse disease
38
``` When does PSGN occur? How does it present? How can you confirm? What is the most accurate test? How do you treat? ```
``` 1-3 weeks after throat or skin infection Dark urine, periorbital edema, HTN, oliguria ASO or antiDNAse titers Biopsy (but not actually done often!) Abx + diuretics ```
39
What is Alport syndrome due to? | What else is affected?
Congenital collagen defect | Hearing loss + visual disturbance
40
What organ tends to be spared by polyarteritis Nodosa? What is it associated with? What 2 findings are suggestive of a vasculitis (specifically PAN) Why are neurological complications possible? What is the best initial test? What is the standard of care?
``` Lungs HepB Stroke or MI in young person Damaged blood vessels that surround the nerves Angiography Prednisone + Cyclophosphamide ```
41
What is the most accurate test for lupus nephritis? | What is it used for?
Biopsy | Guiding intensity of therapy
42
What are 4 diseases that cause large kidneys on CT and U/S?
Amyloid HIV nephropathy PCOD DM
43
``` What are the symptoms of nephrotic syndrome? What are the disease associations (5)? What is the best initial test? What is the more accurate test? What is the most accurate test? Treatment? ```
PEaL Cancer (membranous), kids (MCD), drugs/AIDS (FSGS), NSAIDs (MCD/MN), SLE (all) UA --> shows Maltese crosses (lipid deposits from tubular cells) Albumin:Cr ratio Renal biopsy Glucocorticoids + ACEi + Na restriction + diuretic + station
44
``` What is the definition of ESRD? What are the 2 most common causes? What is the most common cause acutely? How do you define uremia? (5) What are the manifestations + their treatments? (10) ```
Kidney failure necessitating dialysis DM, HTN RPGN MetAcid, Fluid overload, Encephalopathy, HyperK, Pericarditis Anemia (EPO, Fe) + HypoCa/Osteodystrophy (VitD, Ca) + Bleeding/Infection (DDAVP) + Pruritis (UV light) + HyperP (Sevelamer, Lanthanum) + HyperMg (restriction) + Atherosclerosis (dialyze) + Endocrinopathy (E/T replacement)
45
What is the only necessary finding to establish a dx of TTP or HUS? How do you treat HUS? Treat TTP?
Intravascular hemolysis Usually spontaneous resolution Plasmapheresis > FFP infusion
46
If you are concerned for a complex cyst what do you do? | Why?
Remove | CA risk
47
What is the most common death from PKD
Renal failure
48
What is the first clue to the presence of DI?
High volume nocturia
49
What is the best initial test for DI? | What is the most accurate test?
Water deprivation --> urine volume decrease = psychogenic polydipsia ADH administration --> urine volume decrease = CDI
50
How do you manage mild hypoNa? Moderate? Severe?
Restrict fluids Saline + loop Hypertonic saline + Conivaptan/Tolvaptan
51
What are causes of pseudohyperK? | What is the next step?
Hemolysis, leukocytosis, thrombocytosis | Repeat the sample
52
What is the most urgent test for HyperK? What might it show if positive? What are the next steps? (3)
``` EKG Peaked T waves, wide QRS, PR prolongation 1) CaCl or Ca gluconate 2) Insulin + glucose 3) Bicarb (especially if due to MetAcid) ```
53
How does low K present? What is found on EKG? How do you treat? What must be corrected first?
Weakness/paralysis --> rhabdo if severe U waves, flat T waves IV K but must go slow! Mg
54
How do you calculate anion gap? What is normal? What are the 2 most common causes of normal AG MetAcid?
Na-Cl-HCO3 6 to 12 RTA, diarrhea
55
``` RTA type 1 occurs where? Is due to? Initial test? Accurate? Treatment? ```
Distal tubule Drugs (amphotericin), AI (SLE, sjogrens): HCO3 not generated pH >5.5 Infuse with NH4Cl and see if acid is secreted Replace HCO3
56
What is proximal RTA due to? What can cause this? What is the most accurate test? How do you treat?
Damage to the proximal tubule --> decreased HCO3 absorption Amyloid, Myeloma, Fanconi, Acetazolemide, heavy metals Give HCO3 and see if it is absorbed Thiazides diuretics --> decreased V --> enhance bicarb resorption
57
What is type 4 RTA? What is it due to? What is a major clue? How do you treat?
Decreased amount or effect of aldosterone Typically DM High K Fludrocortisone (aldosterone like steroid)
58
What is the urine anion gap? | What is it used for?
``` =Na-Cl distinguishes RTA (+) from Diarrhea (-) ```
59
What compensates for metabolic acidosis?
RespAlk from hyperventilation
60
What are the 6 causes of MetAcid with AG?
``` Lactate (HypoTN, Hypoperfusion) Ketoacids (DKA, starvation) Oxalic acid (Ethylene glycol) Formic Acid (Methanol) Uremia (renal failure) Salicylates (ASA OD) ```
61
Diagnose and treat lactate AGMA
Blood lactate level | Correct hypoperfusion
62
Dx and tx for Ketoacids
Acetone level | Insulin + fluid
63
Dx + tx for oxalic acid OD
Crystals on UA | Fomepizole + dialyze
64
Dx + tx for formic acid
Inflamed retina | Fomepizole + dialysis
65
Dx + tx for uremia
BUN/Cr | Dialysis
66
Dx + tx for Salycilates
ASA level | Alkalinize urine
67
What 3 findings are always seen on the ABG in MetAcid
Decreased pH
68
What is the compensation for MetAlk?
RespAcid = hypoventilation to increase pCO2
69
What 3 things are always seen on ABG in MetAlk?
Increased pH >7.4 Increased pCO2 indicates RespAcid compensation Increased HCO3
70
What is minute ventilation?
RespRate x Tidal V
71
What is the most common cause of kidney stones? What kind of urine does it form in? What is the most common risk factor?
CaOxalate Alkaline Over excretion of Ca
72
What disease causes kidney stones because it increases oxalate absorption?
Crohns
73
What is the most accurate test for nephrolithiasis? | What stones are not detectable on one test but are on another?
CT | Uric acid is not seen on X-ray but seen on CT
74
What is the best initial therapy for acute renal colic?
Analgesics (i.e. Ketoralac) + hydration CT + U/S to detect hydronephrosis Stones
75
When is a lithotripsy performed? | What is used to relieve hydronephrosis?
.5-2cm (2-3 will fragment into big pieces) | Stent placement
76
How are cysteine stones managed? | How are struvite stones formed and managed?
Alkalinize the urine | UTI - surgical
77
How many people with a stone will have them again in 5 years? What are 2 ways to reduce this risk?
1/2 | Hydrate + HCTZ
78
What acid base disorder increases the risk of stones?
MetAcid --> removes Ca from bones and increases stone formation + decreases citrate (Ca binder) levels
79
What is the goal BP in a diabetic patient? What is the goal BP in a >60 patient? What is the most effective treatment? How long should you trial it?
140/90 150/90 Weight loss --> 3-6 months
80
What is the best initial drug therapy for HTN? When do you use 2? What are safe in pregnancy?
Thiazides/CCB/ACEi/ARB all work equally Use 2 if pressure >160/100 BB > CCB/Hydralazine/Methyldopa
81
``` What is the best HTN drug if you have CAD? DM? BPH? Depression/asthma? Hyperthyroidism? Osteoporosis? ```
``` BB/ACEi/ARB ACEi/ARB Alpha blocker NOT BB BB Thiazides ```
82
What is the best initial therapy in HTN crisis? What is a caveat with one of the choices? What do you want to avoid doing?
Labetolol or Nitroprisside > Enalapril/Dilt/Verapamil/Esmolol/Hydralazine Nitroprusside needs to be monitored with an ART line Do not bring BP to normal --> can cause a stroke

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