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MKSAP > nephrology > Flashcards

nephrology Flashcards

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1
Q

normal calcium with high pth

secondary due to CKD with normal phos

A

cannot be primary, has to be secondary

start activated vitamin D

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2
Q

hyponatremia+ normal plasma osmolarity in the presence of lipids/proteins (panc/ multiple myeloma) with no ingested osmoles

A

pseudohyponatremia

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3
Q

minimal change disease (podocyte foot processes) treatment

A

steroids, if contraindicated->cyclosporine

if refractory->cyclophosphamide

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4
Q

Thyrotoxic periodic paralysis

A

2/2 hypokalemia
precipitated by strenous exercise/high carb meal
treat hyperhyroidism

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5
Q

Metabolic alkalosis+ hypokalemia+ normal-low BP

A

Bartter syndrome

autosomal recessive

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6
Q

Preggo htn

A

No ACEI/ARB/direct renin inhibitor

labetalol if >160/105

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7
Q

lithium kidney

diagnosis

A

nephrogenic diabetes insipidus

water restriction test, then desmopressin administration

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8
Q

> 60 yo BP goal

A

150/90. Adding a second agent is more effective than increasing existing dose.

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9
Q

Acute acid-base compensation

chronic

A

for every 10 drop in co2, 2 drop in bicarb
for every 10, 4-5
for every 10 increase, 3-4

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10
Q

CKD with normal anion gap metabolic acidosis

A

oral bicarb, maintain bicarb 23-29

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11
Q

interstitial nephritis urinalysis
cause

membranous glomerulopathy

rapidly progressive glomerulonephritis

A

sterile pyuria and leukocyte casts
drugs (mesalamine)

heavy proteinuria and nephrotic syndrome (primary: anti pla2r, sec: cancer, autoimmune disease, hepatitis b, syphilis, meds). most associated with clots

hematuria, erythrocyte casts, hypertension

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12
Q

Preeclampsia

HELLP

A

hypertension+ proteinuria OR htn+end organ damage

hemolysis+ elevated LFTs+ low platelets

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13
Q

hyperphosphatemia in CKD treatment

A

sevelamer/ lanthum

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14
Q

hyporesponsiveness to EPO

give iron especially if

A

iron deficiency

transferrin <30% / ferritin <500

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15
Q

Lines in CKD5/ESRD patient

A

central venous access

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16
Q

preggo na

A

mild hyponatremia and hypo osmolality

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17
Q

IgA vasculitis (henoch-schonlein purpura)

A

URI->then fatigue, jt pain, abd pain, glumeronephritis, palpable purpura
NORMAL COMPLEMENT LEVELS

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18
Q

Vomiting urine labs

bartter
sjogren’s

A

increased sodium, low chloride, elevated urine potassium

increased everythang
hyperchloremic metabolic acidosis

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19
Q

Shiga-toxin associatd hemolytic uremic syndrome

diagnosis

A

bloody diarrhea, then microangiopathic hemolytic anemia, thrombocytopenia, kidney failure, shiga toxin e. coli

peripheral blood smear (even in TTP, smear before ADAMST13)
**can also be caused by chemo(bevacizumab, sunitinib)

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20
Q

Suspected kidney stone when CT is contraindicated (preggo)

A

kidney ultrasound

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21
Q

calcium oxalate stones with elevated urine oxalate (from too much oxalate or low calcium/fatty acids binding calcium)
deceased citrate in urine

idiopathic hypercalciuria

A

increase calcium intake/ cholestyramine (esp in patients who have undergone small bowel resection)/ UOP of at least 2L
give citrate to bind calcium in urine and prevent stones
thiazide

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22
Q

Medication induced tubulointerstitial disease (AIN/CIN) (tenofovir, PPI)

A

slowly progressive, no clear trigger, subnephrotic proteinuria, bland sediment, atrophic kidneys on u/s
glucosuria, hypophosphatemia

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23
Q

membranoprolif glomerulonephritis

A

chronic hep b, hematuria, dysmorphic casts, proteinuria, reduced GFR

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24
Q

Beware of refeeding syndrome in alcoholics and malnourished. can occur even with dextrose containing fluids, due to

A

hypophosphatemia

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25
Hypertension diagnosis Rule out meds such as
140/90 3 different times over 1 week or longer | NSAIDs (also cause hyperkalemia) and herbs
26
Anion gap metabolic acidosis in patients with short bowel ethylene glycol/methanol/propylene glycol
D-lactic acidosis confusion, slurred speech, ataxia osmolal gap >10
27
dialysis catheter related infection
abx, then remove catheter if blood cultures are positive
28
Metabolic alkalosis with uncertain volume status
measure urine chloride low: hypovolemia, give saline high: saline resistant
29
Bilateral abdominal masses with kidney symptoms
ADPKD, hematuria and acute pain occur with rupture of cysts *MRA to screen for cerebral aneurysm only if family history of aneurysm/hemorrhage or personal history or occupation where sudden rupture would affect others*
30
TLS Rasburicase Dialysis if
hyperphosphatemia, hyperuricemia, hyperkalemia, hypocalcemia rapidly decreases uric acid oliguric/anuric/persistent hyperkalemia/syptomatic hypocalcemia/
31
Rasburicase vs allopurinol
reduces circulating uric acid vs prevents formation
32
IgA nephropathy treatment
low risk: observe, serial BP, urine studies and creatinine | high risk: steroids (urine-protein creatinine ratio >1000, low GFR, hypertension, kidney dysfunction)
33
preeclampsia treatment
delivery at 37 weeks
34
FSGS primary treatment secondary collapsing form FSGS caused by
low albumin, podocyte foot process effacement, hypertension, nephrotic range proteinuria immunosupression weight loss and ACEI/ARB (enlarged glomeruli, mild effacement, minimal edema) HIV (can be slowed by HAART and ACEI/ARB)
35
atheroembolism treatment
peripheral eosinophilia, hypocomplementemia, eosinophiluria | supportive care
36
black people hypertension
ccb, hctz (ccb is not first choice if patient is on statin) | avoid ACEI as they don't work as well
37
ethylene glycol intoxication | treatment
anion gap+ osmolal gap+ kidney failure+ AMS | sodium bicarb+ fomepizole+ dialysis+ hydration
38
ESRD referral
stage 4-5, transplant eval once GFR<20
39
Kidney dysfunction in patients who have had abd surgery, have received fluids, have ascites + tense abdomen diagnosis
Abdominal compartment syndrome bladder pressure management
40
ESRD on dialysis renal cysts and atrophic kidneys
acquired cystic kidney disease, associated with RCC
41
CKD screening in DM
urine albumin
42
hyperosmolar hyponatremia
glucose: every 100 increase, 1.6 drop in sodium
43
primary respiratory acidosis
hypoventilation, opioids
44
prevent CIN with
IV isotonic saline, discontinue diuretics
45
AIN urinalysis
erythrocytes, lekocytes, leukocyte casts
46
coffin lid shaped crystals
struvite stone->removal | caused by chronic UTI with proteus or klebsiella
47
worsening kidney function+ htn+ proteinuria+hematuria+ dysmorphic erythrocytes+ erythrocyte casts fever+arthralgia+ palpable purpura+ weight loss
glomerulonephritis->kidney biopsy vasculitis
48
Overcorrection of sodium | treatment
>8/ 24 hours | desmopressin in dextrose
49
Hypertension in frail people
frail=can't complete 6 meter walk in less than 8 secs don't need to lower *in non frail elderly people, 130/80*
50
Hypertension in frail people
frail=can't complete 6 meter walk in less than 8 secs don't need to lower *in non frail elderly people, 130/80*
51
SIADH vs beer potomania
high urine osmolality
52
Type 1 (hypokalemic distal) RTA ``` acetaminophen Type 2 (proximal) RTA ``` Type 4 (hyperkalemic distal) RTA
hyperchloremic metabolic acidosis, normal anion gap, ph>6, stones anion gap metabolic acidosis normal anion gap, hypokalemia, glycosuria, proteinuria, phosphate wasting, urine ph <5.5 urine ph<5.5, hyperkalemia, hypoaldosteronism
53
Aminoglycoside AKI
ATN, granular casts, FeNa >1%, 5-10 days after
54
immunosupression complications
DM and HLD, HTN, infection, cancer | always check for medication interactions before starting treatment
55
Stone larger than 1cm/ failed medical management/ urosepsis/ AKI/ anuria
mechanical removal
56
IgG4 related interstitial nephritis treatment
interstitial nephritis=mild proteinuria, leuks associated with autoimmune panc, diffusely enlarged kidneys steroids
57
ANCA-associated vasculitis anti-GBM anti-GBM treatment vs microscopic polyangitis lupus nephritis
significant proteinuria and hematuria pulmonary-renal syndrome, protein, erythrocytes and leuks in urine, normal complements, crescents on biopsy cyclophosphamide, steroids, plasmapheresis pauci immune glomerulonephritis on biopsy significant proteinuria
58
hypovolemic metabolic alkalosis normal urine response
low urine sodium and choride | if high->suspect diuretic use/Bartter/Gittelman
59
decreased muscle mass creatinine
decreases
60
normal anion gap metabolic acidosis workup
urine anion gap (Na+K-Cl) positive: losing acid in urine negative: GI loss (laxative abuse)
61
screening in kidney transplant patients
skin cancer and lymphoprolif disease in addition to age and sex appropriate screening
62
risk factors for AKI after cardiac surgery
CKD, elevated preop creatinine, age, female, LV dysfunction, DM, PVD, COPD
63
bone pain + hypophosphatemia+ low 1,25 vitamin D+ normal 25 hydroxy + elevated alk phos treatment
oncogenic osteomalacia resection
64
ATN with oliguria (needing dialysis) + hemodynamic instability
CRRT, not hemodialysis
65
Bactrim causes creatinine increase without affecting GFR.
Continue therapy
66
Feurea<35 or FeNa <1
pre-renal
67
lupus nephritis treatment
Class III/IV->prednisone + mycophenolate/ cyclophosphamide
68
Balkan endemic nephropathy
tubulointerstitial disease linked to aristolochic acid, increased risk of transitional cell carcinoma annual urine cytology
69
hemoglobinuria
no erythrocytes | can be caused by intravascular hemolysis from mechanical valve
70
Resistant hypertension In CKD
3 agents including DIURETIC. if BP uncontrolled, start diuretic. use loop diuretic
71
AL amyloidosis
infiltration: cardiomyopathy, organomegaly, peripheral neuropathy, purpura, macroglossia, proteinuria , diarrhea, postural hypotension apple green on congo red staining *Myeloma proteins cannot be seen on dipstick testing*
72
Hematuria | glomerular hematuria
glomerulus vs somewhere else | tea-colored urine with dysmorphic erythrocytes+ proteinuria
73
Thin glomerular basement membrane disease hereditary nephritis (Alport syndrome)
family history of hematuria, normal kidney function ESRD, x-linked, sensorineural hearing loss, lenticonus
74
combination antihypertensive therapy when
>20/10 above goal
75
ESRD in elderly patients with plenty of comorbidities and poor functional status
no dialysis
76
uric acid kidney stones treatment | if refractory
water for increased UOP, urine alkalinization, | allopurinol
77
isolated hematuria in young person
serial kidney function and urine protein measurements
78
infection related glomerulonephritis
treat underlying infection (hematuria and leuks in septic patient)

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