Nephrology

Question 1

What is the pH for measuring acidemia or alkalemia

Answer 1

7.4

Question 2

What is the CO2 content of the body?

Answer 2

40

Question 3

Anion gap formula? Normal?

Answer 3

Na-Cl-bicarb; 12 is normal

Question 4

Why do you always calculate anion gap?

Answer 4

Always check it because if you have an increased anion gap acidosis then you always have anion gap acidosis nomatter what else is going on

Question 5

What do you do after you identiy a respiratory acidosis?

Answer 5

• 7.4 - (dimes x 0.08) = pH if acute
• 7.4 - (dimes x 0.04) = pH if chronic

Question 6

What do you do after you after you figure out if the acidosis is acute or chronic?

Answer 6

• 24+ (dimes*1) = expected bicarb if acute
• 24 + (dimes x 3) = expected bicarb if chronic

Question 7

What do you do after determining that there is a respiratory alkalosis?

Answer 7

Dime changes in CO2 to determine chronicity

• 7.4 - (dimes x 0.08) = pH if acute
• 7.4 - (dimes x 0.04) = pH if chronic

Question 8

What do you do after determining the chronicity of a respiratory alkalosis?

Answer 8

Dime changes in CO2

• 24-(dimes x 2) = Expected bicarb if acute
• 24-(dimes x 4) = expected bicarb if chronic

Question 9

What do you do after checking the anion gap in metabolic acidosis?

Answer 9

Expected CO2 using winters formula

• Expected CO2 = Winters = (Bicarb x 1.5) + 8 +/- 2

Question 10

What do you do after doing winters formula in metabolic acidosis?

Answer 10

Add back method

• Current anion gap - normal anion gap = x
• X + current bicarbs = needed value
• If this value is over 24 = metabolic alkalosis
• If this value is under 24 then there is a metabolic acidosis

Question 11

Causes of anion gap acidosis?

Answer 11

MUDPILES

• Methanol
• Uremia
• DKA
• Propylene
• Iron
• Lactic acidosis
• Ethylene glycol
• Salicylates

Question 12

What are the causes of Non gap acidosis?

Answer 12

RTA or diarrhea depending on the urine anion gap

Question 13

What is the normal urine chloride?

Answer 13

10

Question 14

What is volume responsive metabolic alk?

Answer 14

• Diuretics, dehydration, emesis, NG suction
• Cl under 10 (because tubes can reabsorb Cl)

Question 15

UCl > 10 and HTN is caused by

Answer 15

Inappropriate aldosterone

Question 16

UCl >10 and no HTN is caused by

Answer 16

Genetic diseases

Question 17

Euvolemic hyponatremia causes

Answer 17

RATS

• RTA
• Addisons
• Thyroid
• SIADH

Question 18

Formula for serum osmoles

Answer 18

Serum osmoles = (2 x Na) + Glucose/18 + Bun/2.8

Question 19

EKG changes in hyperkalemia

Answer 19

“Everything gets bigger”

• Peaked T waves
• Prolonged QRS
• PR interva lincrease

Question 20

Treatment of hyperkalemia

Answer 20

C BIG K DIE

• C: Calcium - stabilize myocardium
• B: Bicarb - Shifts K into cells
• IG: Insulin and glucose - Shift K into cells
• K: Kayexalate - Decreased K
• D: Dialysis - Decreased K

Question 21

Hypokalemia causes

Answer 21

Renal losses

• Hyperaldosterone
• Loop diuretics
• Thiazides

GI losses

• Vomiting
• Diarrhea

Question 22

What do you do if there is hypokalemia on labs? What do you do if confirmed?

Answer 22

Recheck K and check anEKG for findings

• If confirmed replete at 10 mEq/hr by peripheral line and 20 mEq/hr by central line

Question 23

GFR ratings in kidney failure?

Answer 23

• I: Over 90
• II: 60-90
• III: 30-60
• IV: 15-30
• V: Under 15

Question 24

A1C and glucose goals of people on insulin

Answer 24

A1C under 7 and bG 80-110

Question 25

Complications of renal failure and corresponding treatments

Answer 25

* Anemia: EPO and iron with goal hemoglobin of 11-12 * Scondary hypoparathyroidism: Phosphate binders like sevelamer and cincalcet * Volume overload: Loops and hemodialysis * Metabolic acidosis: Bicarb pills

Question 26

Acute renal failure presentation. What is the first thing you should notice?

Answer 26

Elevated creatinine or decreased urinary output

Question 27

Causes of prerenal acute kidney injury

Answer 27

* Pump: CHF, MI * Fluid: Diarrhea, dehydration, diuresis, bleeding * Pipes: Nephrotic, cirrhosis, gastrosis * Clog: FMD, RAS

Question 28

Intrarenal causes of acute tubular necrosis

Answer 28

* Prolonged ischemia * Toxins (drugs, myoglobin, Ig) * Contrast induced

Question 29

Intrarenal causes of acute interstitial nephritis

Answer 29

* Allergic (NSAIDs and beta lactams) * Infection - pyelo * Infiltrative (sarcoid, amyloid)

Question 30

Glomerulonephritis causes

Answer 30

* Glomerular disease

Question 31

Labs to check in acute renal failure? Treatment?

Answer 31

* BUN:Cr Under 20 * UNa \< 10 * FENa \<1% * Tx: IVF or Diuresis

Question 32

How is postrenal kidney injury diagnosed? Treatment?

Answer 32

* Ultrasound (Hydroureter and hydronephrosis) * Tx: Stent or remove obstruction

Question 33

If you suspect intrarenal acute kidney injury, what labs do you check?

Answer 33

Urinalysis, (look for casts) and do a biopsy if youre really really curious

Question 34

Indications for dialysis

Answer 34

AEIOU * Acidosis * Electrolyte imbalance * Ingestion of toxins * Overload (CHF, Edema) * Uremia (Pericarditis)

Question 35

Contrast induced ATN is prevented by what?

Answer 35

Hydration, prophylactic N acetyl cysteine, stopping ACEs, ARBs and duretics

Question 36

Phases of Acute Tubular Necrosis

Answer 36

1. Prodrome: Creatinine rises but urine output remains the same 2. Oliguric phase: Creatinine rises and urine output plummets 3. Polyuric phase: Patient pees a lot

Question 37

Treatment of prerenal azotemia

Answer 37

IVF if dry, diuresis if wet