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Flashcards in Nephrology Deck (62):
1

Presentation of Goodpasture's syndrome

Cough, hemoptysis, SOB
Glomerulonephritis

2

What are best initial and most accurate test for Goodpasture's syndrome?

Initial: anti-basement membrane Abs
Accurate: Renal bx showing "linear deposits"

3

Tx Goodpasture's

Plasmapharesis and steroids

4

Presentation of Churg-Strauss Syndrome

Asthma, cough, eosinophilia with renal abnls

5

Best initial and most accurate test for Churg-Strauss Syndrome

Initial: CBC for eosinophil count
Accurate: biopsy

6

Best treatment of Churg-Strauss Syndrome

Prednisone
If not responding then cyclophosphamide

7

Presentation Wegener's granulomatosis

Upper respiratory problems (e.g. sinusitis/otitis)
Lung problems
Systemic vasculitis symptoms

8

Best initial and most accurate test for dx of Wegener'S

Initial: cANCA (antineutrophil cytoplasmic antibodies)
Accurate: biopsy kidney

9

Tx Wegener's

Cyclophosphamide and steroids

10

Presentation of polyarteritis nodosa

Systemic vasculitis affecting every organ system except the lung
Multiple motor and sensory neuropathies are key to dx

11

Best initial and most accurate test of polyarteritis nodosa

Initial: ESR and markers inflammation
Accurate: Biopsy of sural nerve or kidney

12

What disease are assd with PAN and should be tested for?

HBV and HCV

13

Angiography showing "beading" may be positive for what disorder

Polyarteritis nodosa

14

Tx PAN

Cyclophosphamide and steroids

15

What is the essential test for IgA/Berger's nephropathy?

Renal biopsy (no good initial tests)

16

What is beneficial treatment for IgA/Berger's nephropathy?

No good treatment really. Steroids and ACEi can be used to alleviate proteinuria; fish oil may delay progression

17

What is the most accurate test and finding for HSP (even though it isn't necessary for confirmation)?

Renal biopsy showing IgA deposits

18

Best initial test and most accurate test for PSGN

Initial: Antistreptolysin O, anti-DNase, antihyaluronidase; also low complement levels
Accurate: biopsy showing subepithelial deposits of IgG and C3

19

How is HTN managed in PSGN?

Diuretics

20

A patient presents with joint pains, purpuric skin lesions, and has a hx of HCV. Dx?

Cryoglobulinemia

21

Best initial test for cryoglobulinemia?
Accurate?

Initial: serum cryoglobulin component levels
Accurate: biopsy

22

What are treatments of type I cryoglobulinemia? What are other options for other genotypes?

Type I: ledipsavir and sofosbuvir
Sofosbuvir and ribavirin are used for all other genotypes

23

Unlike other renal diseases, why is the biopsy in lupus nephritis especially important?

Because the extent of disease guides therapy

24

How is lupus nephritis treated based on the following levels of injury:
Sclerosis only
Mild disease
Severe disease

Sclerosis only: no treatment
Mild: steroids
Severe: mycophenolate mofetil and steroids

25

What are treatment options in HUS or TTP?

Plasmapharesis

DO NOT GIVE PLATELETS

26

What amount of protein on spot testing or 24 hr urine is concerning for nephrotic disease?

Spot protein: creatinine >3.5:1
24 hr urine protein > 3.5g or protein

27

Primary renal disorders such as MCD, FSGS, mesanigal, membranous, or membranoproliferative are all treated in the same manner, how?

Initial: steroids
If no response then add cyclophosphamide

28

If a patient has isolated proteinuria what should you do first?

Recheck and inquire as to why they might have that (e.g. infection, exercise, CHF, fever)

If still present it may be orthostatic proteinuria (e.g. in people that stand all day)

29

You suspect a patient to have orthostatic proteinuria. What further testing do you do?

Split the urine testing into morning and afternoon. If only proteinuria in afternoon that confirms orthostatic proteinuria. If persistent then get a 24hr urine or spot protein:creatinine. If that remains elevated consider a renal biopsy

30

How can you use urine volume in response to DDAVP to distinguish central from nephrogenic DI?

Prompt reduction in urinary volume with central DI but not in nephrogenic

31

Causes of hypervolemic hyponatremia

CHF
Nephrotic syndrome
Cirrhosis

32

Causes of hypovolemic hyponatremia

Diuretics
GI loss
Skin loss

33

What meds may cause SIADH?

Sulfonylureas, SSRIs, carbamazepine

34

What does urine look like (electrolyte wise) in SIADH?

High urine sodium and urine osmolality
Low serum osmolality

35

Tx SIADH

Fluid restriction

*In severe cases give saline infusion with loop diuretics, HTS, or consider ADH blockers like coinvaptan, tolvaptan

36

What are causes of hyperkalemia?

Metabolic acidosis
Beta-blockers
Insulin deficiency
Digoxin toxicity
Aldosterone deficiency (e.g. spironolactone)
ACEi/ARBs (inhibit aldosterone)
Type IV RTA
Renal failure
Prolonged immobility, seizures, rhabdo, crush injury

37

Why do beta blockers cause hyperkalemia?

They inhibit Na/K ATPase which normally brings K into cells

38

Why does pseudohyperkalemia occur?

Hemolysis in RBC sample from prolonged waiting or excessive time of tourniquet placement during phlebotomy

39

What ECG abnormalities arise in hyperkalemia and in what order?

1) Peaked T waves
2) Loss of P waves
3) Widened QRS

40

A patient presents with severe hyperkalemia with ECG abnormalities. What therapies do you want to give and in what order?

Calcium gluconate
Insulin and glucose
Kayexylate

41

If a patient has moderate hyperkalemia but no ECG abnormalities what therapies do you want to provide and in what order for correction?

Insulin and glucose IV
Bicarbonate if d/t metabolic acidosis
Kayexylate

42

What acid-base disturbance causes hypokalemia?

Metabolic alkalosis

43

What potent antifungal med causes hypokalemia?

Amphotericin

44

How does hypokalemia develop in Bartter syndrome?

Failure to absorb Na and Cl leads to secondary hyperaldosteronism which causes hypokalemia

45

What ECG abnl seen with hypokalemia?

U wvaes

46

What are signs and symptoms of hypermagnesia?

Muscle weakness and loss of DTRs

47

How do you treat hypermagnesia?

Restrict oral intake
Saline to promote diuresis
Occasionally dialysis if needed

48

How does hypomagnesia present?

Hypocalcemia and cardiac arrhytymias

49

How does Mg effect Ca levels?

Mg is required for PTH release which then leads to increased Ca. This is why Mg is given during torsades de pointes

50

What are causes of normal AG metabolic acidosis?

Diarrhea and RTA

51

Hyperchloremic normal AG metabolic acidosis caused by ...

Diarrhea

52

Type I RTA (distal type) is due to ....
Potassium and bicarb levels are ....
Treatment is ....

Inability to excrete hydrogen ions in distal tubuke
Low
Bicarbonate (still absorbed at proximal tubule)

53

Type II RTA (proximal type) is due to ...
Urine pH is ....
Treat with ...

Inability to absorb bicarbonate at proximal tubule
Low
Diuretic (contraction alkalosis increases serum bicarbonate)

54

Type IV RTA caused by ...
Potassium is ...
Treat with ...

Lack of aldosterone production or effect
High (only RTA to have increased)
Aldosterone (i.e. Fludricortisone)

55

What is the only RTA with a high urine pH?

Type I (d/t inability to excrete H+ at distal tubule)
*as a result kidney stones form in this one

56

What is the utility of the urine anion gap?

Helps distinguish between diarrhea and RTA as causes of normal AGMA. Urine Na - Urine Cl.
If acid can be excreted from the kidney then urine Cl increases thus in diarrhea UAG is NEGATIVE.

In RTA UAG will be POSITIVE

57

Ingestion of too much antacid leads to what acid base disorder

Milk-Alkali syndrome (metabolic alkalosis)

58

What acid base disturbance does volume contraction cause?

Activation of RAAS system leads to secondary hyperaldosteronism which increases Na, decreases K. This leads to increased urinary loss of acid and thus a metabolic alkalosis

59

What is the most common cause of death in patients with cystic disease which develop cysts throughout body?

ESRD

60

How do you test for urge incontinence and what is used for treatment?

Urodynamic pressure monitoring
Anticholinergic agents

61

What therapies are used for stress incontinence?

Kegel exercises
Estrogen cream

62

What medication is used for HTN control in pregnant woman?

Alpha-methyldopa