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Foundations II Exam 5 (Jess) > Nephrology > Flashcards

Flashcards in Nephrology Deck (76):
1

What are the MC ways to get imaging on kidneys?

US and CT

2

What is the benefit of US?
what is is not good at identifying?

-safe/easy to use
-initial test MCly used
-choice for obstructive dz

less sensitive to renal masses

3

US with doppler is used for what?

assess vascular flow
(MR/CT more sensitive)

4

What are benefits of CT?

Gold standard for renal stones

-locate ureteral obstruction
-higher sensitivity for PKD
-Evaluate tumor
-dx RVT

5

Who can you not give gadolinium to? why

in moderate to advanced kidney disease (GFR < 30)
leads to nephrogenic systemic fibrosis

6

What are ateriorgraphy and venography used for?

arterial and venous occlusions

7

What is intravenous pyelogram (IVP)?

used for caliceal anatomy, size of kidney, shape of kidney

high sensitivity and specificity for stones

8

Indications for renal biopsy?

Not indicated?

Indicated:
Nephrotic syndrom
acute nephrotic syndrome
unexplained ARF

NOT:
Isolated glomerular hematuria
low grade proteinuria

9

What is hydronephrosis?
how does it present?

Unilateral or bilateral edema of the collecting system

almost always asymptomatic
(possible pain or change in UOP)

10

What are causes of obstructive hydrogenphrosis? What do you do for dx?
Tx?

-bladder outlet obstruction consider GI and GYN masses, stones, BPH

US

stent

11

What are causes of non obstructive hydrogenphrosis? What do you do for dx?
Tx?

Large diuresis can distend intrarental collecting system (EX. Diabetes insipidus)

-CT if US is not indicative

stent

12

What is AKI? Is it reversible/not?

abrupt (w/in 48 hrs) decline in renal filtration function

usually reversible

13

What are lab values for acute renal failure?

-decrease in GFR
-UOP less than 0.5 ml/kg/hr for > 6 hrs

-increase in Urea and creatinine (azotemia)
-serum creatinine increases abruptly by more than 50% of baseline

14

What are the levels of kidney failure? (RIFLE)

R- risk of renal dysfunction
GFR decrease more than 25% and UOP less than .5 mL x6 hrs

I- injury to kidney
GFR decrease more than 50% and UOP less than .5 x 12 hrs

F-failure of kidney function
GFR decrease more than 75% and UOP less than .5 x24 hrs

L- loss of kidney function
for more than 4 weeks

E- end stage Renal dz
more than 3 months

15

Examples of pre-renal AKI?

Anything before the kidneys

renal hypo perfusion, hypovolemia, shock, GI fluid loss, poor fluid intake

16

Examples of intrinsic AKI?

damage to the glomeruli, tubular or interstitial, glomerularnephritis, acute tubular necrosis

17

Examples of post-renal AKI?

Obstruction nephrology: prostatic hyperplasia, neoplasia, nephrolithiasis, tumors

18

MC type of AKI?

Prerenal

19

Causes of Prerenal AKI

hypo perfusion leading to decrease in renal perfusion:

-decrease in intravascular volume (hemorrhage, gI losses, burns, dehydration)

-change in vascular resistance (cirrhosis, sepsis, anaphylaxis)

-low CO (CHF, PE, tamponade)

20

What will the BUN/Cr ratio be in prerenal AKI?

upper limit of nl 20:1

increase ratio in prerenal dz

21

Tx for prerenal AKI? Avoid?

Tx: maintain envolemia

Avoid: nephrotoxic drugs (NSAIDS, ACEI, Digoxin)

22

Intrinsic causes of AKI? (types)

-acute tubular necrosis (ATN)
-interstitial (AIN)
-glomerular (GN)
-vascular

23

Acute tubular necrosis is causes by?

characteristic KEY WORDS?

*muddy brown casts;
ischemia, nephrotoxin, sepsis*

-tubular damage due to ischemia or nephrotoxins (ahminoglycosides, vancomycin, contrast)

-prolonged hypotension/hypoxemia

24

Tx of Acute tubular necrosis?
Avoid?

avoid volume overload
avoid hyperK
protein restrict
+/- diuretics

-Give N-acetylcystine/IVF w/ bicarb to renal protect from radiographic contrast

25

What is AIN? causes of AIN?

Inflammatory response leading to edema and possible tubular cell damage

70% caused by nephrotoxic drugs
(others= strep infections)

26

What will UA show in AIN? how do you treat?

Eosinophiluria

steroids +/- dialysis

27

What is GN caused by?

Immune complex deposition/etiology:
-IgA nephropathy (Berger dz)
-postinfectious strep GN
-MPGN, Goodpastures, Wegeners

28

What does UA in GN show? Tx?

UA: RBC casts (bleeding from kidneys)

Tx: steroids, plasma exchange

29

What type of Intrinsic AKI is MC?

ATN- 85%

30

What are causes of post renal AKI?

Obstruction:
BPH, urolithiasis, bladder dysfunction, bladder CA

31

What is a common sx of pt w/ postrenal AKI?
DX? Tx?

Lower abd pain

Dx: bladder US, elevated BUN/Cr ration

Tx: catheter, stent, surgery depending on etiology
(key point= fix whatever is causing obstruction)

32

Again,
What is tx:
Prerenal
intrarenal
Postrenal

Tx for all?

prerenal: IVF w/ goal to nl hemodynamics

intrarenal: avoid nephrotoxic agents

Postrenal: removal of obstruction

For all: consider short-term dialysis

33

What should be considered when debating to dialyze or not? (Who should have dialysis)

-weight
-Physical exam/ fluid overload
- UOP/uremic complications
-unresponsive acidosis pH < 7.1

34

What are the stages of Chronic Kidney Disease?

1-5
1, 2, 3a, 3b, 4, 5

5= ESRD

35

What does GFR tell you?

Degree of impairment

varies by age, gender, body size

36

What is creatinine?
What is it dependent on?

Waste product of creatinine phosphate from muscle which passes in the blood through kidneys

*Dependent on muscle mass

37

What is Azotemia? What is it measured by?

Nitrogen in the blood

Measured by BUN and Cr (markers of nitrogen accumulation)

38

Why does Azotemia occur? What does it lead to?

Occurs when renal fxn can no longer efficiently clear metabolites

results from renal parenchymal damage

Leads to uremia

39

Uremia is monitored by what? What stages is it in?

Monitored w/ blood urea nitrogen (BUN), urea produced by liver excreted by urine

stages 3-5

40

Sx of Uremia

lotssssss some are:

malaise
N/V
insomnia
cardiac arrest
weight loss
HTN
ecchymosis
Kussmaul respirations

41

Dx studies for CKD?

GFR= gold standard!

BUN and Cr elevated, proteinuria, microalbuminuria may be present in early stages, Abnormal hgb, hct, lytes, UA

42

Tx for CKD?

-slows progression: ACE/ARB

-Epo, Fe, antiplatelet therapy (goal hgb 11-12)

-low protein diet, fluid restriction, Ca/VitD supplementation

-dialysis/transplant

43

Hypervolemia causes what and is seen in what?

Causes hyponatremia w/ hypervolemia

seen in CHF, nephrotic syndrome, ESRD

44

In Hypervolemia, what happens to HgB and Hct?
Tx?

Decreased

fluid restrict
consider diuretic therapy or dialysis

45

Hypovolemia is caused by?

what happens to HgB and Hct?

lost from extracellular compartment > intake
-usually GI tract, kidneys

Hgb and Hct increase, urine Na down, Urea increases

46

Tx of hypovolemia

Give isotonic IVFs

rapid correction can lead to central pontine myelinoysis

47

What is polycystic kidney disease? Signs/sx?

multiple b/l cysts, (autosomal dominant MC 75%)

hematuria, infection, pain from rupture, nephrolithiasis, nocturia

weight loss, early satiety, N/V

48

Dx tool for Polycystic kidney dz? Tx

US is choice method

Tx: pain management, ACE/ARB, aggressive abx if symptomatic, transplantation

49

Diabetes Mellitus causes...

1/2 of ESRD cases!

50

What should be avoided in pts w/ Cr greater than 1.4 in women and 1.5 in men?

how many days after scan do you hold it?

Metformin

2 days

51

MC cause of renal artery stenosis?

atherosclerosis

52

Dx and tx of renal artery stenosis

Dx: renal angiogram is gold standard
however, Doppler US is good start

Tx: angioplasty, +/- stenting

53

DX and Tx of renal htn?

Dx: 2 episodes of SBP > 140 or DBP > 90

Lifestyle modifications then medications
-thiazide diuretic, ACE/ARB, Ca chan blockers

54

MC sx of HTN?

Trick-
usually asymptomatic

55

SLE is MC in? What does it cause

young female 9x more likely than males

Nephritis w/ proteinuria

56

Types of stones in Nephrolithiasis?
are they radiopaque or radiolucent

1. Calcium 75-85%- - radiopaque
2. Uric acid- radiolucent
3. Cystine- radiolucent
4. Stuvite- radiopaque. Pts w/ UTIs and recurrent caths

57

Most of Glomerulonephropathies are seen in?

kids ages 2-12 60%

58

Signs of Nephritic syndrome?
Tx?

hematuria, RBC casts, mild proteinuria, hTN

RBC casts present!

Tx: diuretics, salt/water restrict, dialysis

59

Sx of nephrotic syndrome?

Hypoalbumunemia
heavy proteinuria
hyperlipidemia
edema

60

Major causes of death for dialysis pts?

CV disease, infection, withdrawal from dialysis

61

What is KDRI? Explain

Kidney Donor risk Index summarizes risk of graft failure

KDPI 80% has higher expected risk of graft failure t

62

Antibodies in recipient blood can cause reaction resulting in a positive crossmatch

previous tip
pregnancy
blood transfusions

63

What do you need to watch for post transplant?

-new meds and drug-drug interactions
-hyper/hypoglycemia
-HTN/hypotension
-N/V/D
-wound complications
-anemia
-watch for hyper/hypovolemia

64

Hyperkalemia:
sign on ekg
tx

Sx: peaked T waves

hemodialysis, sodium bicarbonate, D50 + insulin, Kayexalate

65

Hypercalcemia:
sx

sx: bones, stones, and groans

common in hyperparathyroid and malignancies

66

Hypocalcemia:
sx

Trousseau sign (carpal tunnel spasm)

Chevostek sign (spasm of facial muscles)

67

hyperphosphatemia cause?
hypophosphatemia?

Hyper: MC 2/2 CKD

hypo: EtOH

68

Hypomagnesemia sign on EKG?

widening of QRS

69

HbA1C is ___ or great to dx DM?

6.5%

70

Type 1 DM characteristics, sx

autoimmune, early onset, risk of DKA

sx: polydipsia, polyuria, nocturia, gastroparesis

71

Type 2 DM characteristics

later onset, +FH, obesity, hyperinsulinemia

72

What dz is a risk factor in pts who have kidney/pancreas tx?

Gastroparesis

tx: metoclopramide, domperidone, erythromycin

73

What is key in preventing rejection after transplant?

Always steroids

74

What is Cytomegalovirus?
sx?
tx?

CMV MC viral infection found in immunocompromised pts

most prominent 1st 3 months

fevers, malaise, arthralgias, lymphocytes, thrombocytopenia

gastroenteritis, myocarditis, pneumonitis, fatality

tx= antivirals

75

EBV and BK virus causes what?

mononucleosis

45-50% reactivation after kidney transplant

76

What is the 2nd leading cause of death in liver transplant recipients?

Malignancy