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Flashcards in Nephrology Deck (80):
1

causes of nephrogenic DI

hypokalemia
hypercalcemia
lithium toxicity

2

Tx. of central DI

Desmopressin
- prompt decrease in urine volume and increase in urine osmolality

3

tx. nephrogenic DI

correct underlying cause
thiazide diuretics

4

causes: hypervolemic hyponatremia

CHF
cirrhosis
nephrotic syndrome

5

causes: hypovolemic hyponatremia

GI losses - diarrhea, vomiting
skin loss of fluids - burns, sweating
diuretics

6

Tx. hypervolemic hyponatremia

fluid restriction

7

Tx. hypovolemic hyponatremia

NS

8

hyponatremia + hyperkalemia and mild metabolic acidosis

Addison's disease
- tx. fludrocortisone

9

causes: euvolemic hyponatremia

SIADH
psychogenic polydipsia
hyperglycemia

10

effect of glucose on na level

every 100 mg increase in glucose drops Na by 1.6 points

11

Tx. hyponatremia 125-135

no tx or tx the cause

12

tx. hyponatremia 115-125

water restriction, if asymptomatic

13

Tx. mod -severe hyponatremia <115 or symptomatic hyponatremia

saline infusion
loop diuretics

14

appropriate rate of rise of Na in correction of hyponatremia

no more than 0.5 mEQ/L/hour (12 mEQ/L/day) in first 24 hours, no more than 18 in 48 hours

15

Tx. chronic SIADH ex from malignancy

demeclocycline

16

EKG changes in hyperkalemia

1) peaked T waves
2) loss of P waves
3) wide QRS complex

17

Tx. severe hyperkalemia

calcium gluconate - cardioprotective
insulin + glucose

18

causes of hypokalemia

diuretics
Conns syndrome
vomiting - metabolic alkalosis w/ cellular shifts
proximal and distal RTA
amphotericin
Barter syndrome

19

Bartter syndrome

inability of the loop of henle to absorb NaCl which causes secondary hyperaldosteronism and renal potassium wasting

20

Tx. hypokalemia

replace K+ = no max rate on oral K+ replacement as bowel regulates absorption; you should avoid glucose containing fluids, which may worsen hypokalemia from cellular shifts

21

causes: hypermagnesemia

Mg containing laxatives
iatrogenic administration
rare unless underlying renal insufficiency

22

Tx. hyperMg

restrict intake
saline administration to promote diuresis
occasionally, dialysis

23

causes: hypomagnesemia

loop diuretics
alcohol withdrawl
gentamycin
cisplatin

24

fastest, single test to tell if patient's hyperglycemia is life threatening

low serum bicarb

25

isoniazid toxicity

stop medication, move the clock forward

26

electrolyte disturbances with diarrhea

metabolic acidosis -- increased loss of HCO3 from colon
hypokalemia
hyperchloremia - increased Cl- absorption

27

distal RTA (type 1)

inability to excrete H+ ions in distal tubule
- serum K+ low (K+ is cation that is excreted instead)
- serum HCO- low
- alkaline urine

28

test for distal RTA

IV acid (ammonium chloride)
- should lower urinary pH secondary to H+ formation; in RTA, the pts urine stays basic

29

Tx distal RTA

Bicarb

30

proximal RTA (type 2)

inability to reabsorb bicarb in proximal tubule
- low urine pH
- osteomalacia

31

how do you test for proximal RTA

give bicarbonate
- urine pH will rise because unable to absorb the bicarb

32

Tx. proximal RTA

thiazide diuretic
large amts of bicarb

33

type IV RTA

decreased aldosterone production or effect
- hyperkalemia
- urine pH low
test: urine Na loss

34

Tx. type IV RTA

fludrocortisone

35

how do you distinguish from metabolic acidosis caused by diarrhea vs RTA

UAG = Urine Na - Urine Cl-
negative UAG = diarrhea
positive UAG = RTA

36

volume contraction

metabolic alkalosis --> secondary hyperaldosteronism (increased loss of urinary acid)

37

routine tests for HTN cases on CCS

EKG
urinalysis
eye exam for retinopathy
cardiac exam for murmur and gallop

38

most effective lifestyle modification for HTN

weight loss

39

first line therapy for HTN if lifestyle mods dont work

1. thiazides
2. if diabetic - ACEI

40

coexisting conditions that you tx HTN with a BB

CAD
CHF
migraine
hyperthyroidism

41

in which conditions should you avoid BB for tx of HTN

asthma
depression

42

when should you investigate for 2ndary HTN

young 60 yo
failure to control pressure with 2 meds
specific findings on physical exam

43

you begin treating a pt with an ACEI, and on labs, their CR level rises - what should you suspect

renal artery stenosis

44

best initial test for renal artery stenosis

renal doppler usg

45

most accurate test for renal artery stenosis

renal angiogram

46

pt with varicocele with any of: bilateral, right sided or does not go away with supine position

needs further evaluation for obstruction of IVC
- order CT abdo

47

who gets tx for asymptomatic bacteriuria

pregnant pts
urologic intervetions
hip arthroplasty pts

48

clues that renal failure is short duration

normal size
normal hematocrit
normal calcium level

49

diagnostic features of prerenal failure

1. BUN/Cr > 20:1
2. U sodium LOW
3. FE na < 1%
4. Uosm >500
5. hyaline casts

50

on CCS, all renal cases should have what three tests

urinalysis
chemistries
renal usg

51

Dx. postrenal azotemia

1. obstruction of kidney (must be b/l)
2. elevated BUN/Cr > 15:1
3. clues:
- distended bladder
- large volume diuresis after cath
- b/l hydronephrosis on us

52

diagnostic features: intrarenal causes of RF

BUN/Cr ~ 10:1
U na > 40
U osm < 350
UA: muddy brown or granular casts

53

common toxins that cause renal failure

aminoglycosides - hypomagnesemia is suggestive
amphotericin
contrast agents
chemotherapy - cisplatin

54

pt on penicillin, develops rise in BUN/Cr with fever and rash - dx? best initial test?

allergic interstitial nephritis
best initial test: UA - increased WBCs

55

most accurate test for allergic interstitial nephritis

wright stain or hansel's stain of urine

56

effect of cyclophosphamide on kidney

hemorrhagic cystitis - it does NOT cause renal failure

57

best initial test for rhabdo

UA - will see blood but no cells

58

most accurate test for rhabdo

urine myoglobin level

59

Dx. findings in rhabdo

UA - blood but no cells
urine myoglobin +
CPK elevated
hyperkalemia
hypocalcemia
low serum bicarb

60

Tx. rhabdo

bolus NS
mannitol and diuresis
alkalinization of urine

61

first test to order in pt who you suspect has rhabdo

EKG - to r/o any arrhythmia secondary to hyperkalemia

62

envelope shaped urine crystals

calcium oxalate crystals
- ethylene glycol poisoning

63

best method to prevent contrast induced nephropathy

1. IVF with NS
2. possibly bicarb, N acetylcysteine or both

64

best initial test: Goodpasture's syndrome

anti-basement mb abs

65

most accurate test: Goodpasture's syndrome

renal biopsy - shows linear deposits

66

Tx. goodpasture's syndrome

plasmaphoresis
steroids

67

best initial test: churg strauss

CBC for eosinophil count

68

best initial therapy: churg strauss

steroids - prednisone

69

best initial test: Wegener's

c-ANCA

70

best initial therapy: wegeners

cyclophosphamide
steroids

71

most accurate test for dx. polyarteritits

biopsy of sural N or kidney

72

best diagnostic test for dx. IgA nephropathy

biopsy
- no specific blood test or physical exam findings

73

Tx. IgA nephropathy

1. steroids - for acute episodes
2. ACEI
3. fish oil - may delay progression

74

best initial test for Henoch Schonlein purpura

clinical presentation

75

Tx. Henoch Schonlein purpura

resolves spontaneously over time

76

best initial test for post-strep GN

ASLO, anti-DNAase B, antihyaluronidase
complement low

77

when should you do a biopsy with post-strep GN

1. atypical course
2. normal complement level
3. sx > 2 months
4. acute renal failure

78

pt with hepatitis C presents with joint pain and purpuric skin lesions. Exam shows LAD, hepatosplenomegaly and peripheral neuropathy. labs show hematuria, proteinuria and increased Cr. - Dx?

cryoglobulinemia

79

best initial test for cryoglobulinemia

serum cryoglobulin component levels
decreased C3, C4 and CH50

80

Tx. cryoglobulinemia

alpha interferon - alone, if renal dysfxn
+ ribavirin, if no renal dysfxn
and bocepravir or telaprevir