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Flashcards in Nephrology Deck (51):
1

Define Hydronephrosis

Unilateral or bilateral edema of the collecting system

2

Indications for renal biopsy

1. Nephrotic syndrome
2. Acute nephritic syndrome
3. Unexplained acute renal failure

3

Acute Kidney Injury (AKI)

-Abrupt (within 48 hrs) decline in renal filtration function
-Usually reversible

4

Acute Renal Failure (ARF) criteria

1. Decrease in GFR and UOP (< 0.5 mL/kg/hr for >6 hrs)
2. Increase in urea and Creatinine. (azotemia)

5

End stage renal disease time criteria

>3 months

6

What is the MC AKI?

Prerenal= 55-70%

7

Define prerenal AKI

Hypoperfusion leading to decrease in renal perfusion

8

List causes of prerenal AKI

1. Decrease in intravascular volume: Hemorrhage, dehydration, nephrotic syndrome
2. Change in vascular resistance: Cirrhosis, sepsis, anaphylaxis
3. Low CO: CHF, PE, tamponade

9

What is the BUN/Cr ratio in Prerenal AKI

20:1

10

What nephrotoxic drugs do you want to avoid?

1. NSAIDs
2. ACE-1
3. Digoxin

11

What are some of the main causes of intrinsic AKI

1. Acute Tubular Necrosis. (ATN)
2. Interstitial (AIN)
3. Glomerular (GN)
4. Vascular

12

What is the MC cause of intrinsic AKI?

Acute Tubular Necrosis. (ATN)

13

Define ATN

Tubular damage due to:
1. Ischemia: Prolonged hypotension/hypoxemia
2. Nephrotoxins:
-Aminoglycosides
-Ampicillin
-Vancomycin
-IV contrast
3. Sepsis

14

ATN treatment

1. Avoid volume overload
2. Avoid Hyperkalemia
3. Protein restrict
4. +/- diuretics

15

What do you want to give to renal protect from radiographic contrast?

N-acetylcystine/IVF with bicarb

16

What do you see in the urine in ATN?

Muddy brown casts

17

Define interstitial intrinsic AKI

Inflammatory response leading to edema and possible tubular cell damage

18

What is the MC of interstitial intrinsic AKI

Nephrotoxic drugs

19

UA findings in interstitial intrinsic AKI

eosinophiluria

20

interstitial intrinsic AKI treatment

1. Steroid
2. +/- dialysis

21

Glomerulonephritis (GN) etiology

Immune complex deposition

22

List the causes of glomerulonephritis

1. IgA nephropathy (Berger dz)
2. Postinfectious strep GN
MPGN
3. Goodpastures (anti GBM), 4. Wegeners:Granulomatosis with Polyangiitis

23

UA findings in glomerulonephritis

RBC casts

24

Glomerulonephritis treatment

1. Steroids
2. Plasma exchange

25

Postrenal AKI causes

Obstruction due to:
1. BPH
2. Urolithiasis
3. Bladder dysfunction (anticholinergic drugs)
4. Bladder CA

26

MC sx in postrenal AKI

lower abdominal pain

27

Postrenal Diagnostics

Bladder US

28

Postrenal lab findings

elevated BUN: Cr ratio

29

Postrenal tx

1. Catheter
2. Stent
3. Surgery depending on etiology

30

Define Azotemia

-Nitrogen in the blood
-Occurs when renal function can no longer efficiently clear metabolites

31

What does Azotremia lead to?

Uremia

32

What are the markers of nitrogen accumulation?

1. Blood Urea Nitrogen (BUN)
2. Cr

33

Where is urea produced? Excreted? How is it monitored?

Produced by liver
Excreted by urine
Monitored with BUN

34

What is the gold standard diagnostic test for CKD?

GFR

35

CKD lab findings

1. Elevated BUN and Cr
2. Proteinuria
3. Microalbuminuria
4. Abnormal Hgb, Hct, electrolytes, UA

36

CKD treatment

1. ACE-1 or ARBS
2. Antiplatelet therapy: ASA
3. Epo, FE
4. Low protein diet
5. Fluid restriction
6. Calcium and Vitamin D supplements
7. Consider dialysis/transplant

37

ESRD/CKD causes

1. Polycystic kidney disease
2. DM
3. Glomerulonephritis
4. Hypertension
5. Systemic Lupus
6. Erythematosus
7. Nephrolithiasis

38

SLE renal disease presentation

1. Nephritis
2. Proteinuria

39

What is the most common renal stone?

Calcium=75-85% (radiopaque)

40

Nephritic syndrome clinical presentation

1. Hematuria
2. RBC casts
3. Mild proteinuria
4. HTN

41

Nephritic syndrome treatment

1. Diuretics
2. Salt/water restriction
3. Dialysis

42

Nephrotic syndrome etiology

1. Membranous Nephropathy: Immune complexed from infection
2. Amyloidosis
3. DM

43

Nephrotic syndrome presentation

APLE
A-hypoAlbuminermia
P- Proteinuria
P-hyperLipidemia
E- Edema

44

What are the 3 major causes of death for dialysis patients?

1. CV dz
2. Infection (S.aureus)
3. Dialysis withdrawal

45

Hypercalcemia clinical presentation

1. Bones
2. Stones
3. Groans

46

Hypercalcemia treatment

1. Primary hyperparathyroid
2. Malignancies

47

Hypocalcemia signs

1. Trousseau sign: carpal tunnel spasm)
2. Chevostek sign: spasm of facial muscles

48

Hyperphosphatemia cause

MC= secondary to CKD

49

What is Hypophosphatemia associated with?

EtOH

50

EKG findings in Hypomagnesemia

Widening of QRS

51

Type 1 DM clinical presentation

1. Polydipsia
2. Polyuria
3. Nocturia
4. Weight loss
5. Blurred vision
6. Pruritus
7. Weakness
8. Postural hypotension
9. Gastroparesis