Nephrology Flashcards
(27 cards)
What stain is used to detect eosinophils in urine?
Wright and Hansel stains
Muddy brown casts
Hyaline Csts
Waxy Casts
Muddy brown - ATN (dead tubular cells)
Hyaline - pre-renal, dehydration, normal protein concentrates into cast when dehydrated
Waxy - chronic renal disease
Where do NSAIDs affect kidney?
Constrict AFFERENT
Where do ACE inhibitors affect kidney?
Dilation of EFFERENT
Renal Effects of Sickle Cell Trait
Isothenuria - inability to concentrate urine
Continue to make dilute urine even when dehydrated
Timing of Various Causes ATN
Contrast - induced = 24 to 36 hrs later
Meds (vancomycin, gentamicin, amphotercin) = after at least 5-10 days of use
Labs in Contrast-Induced AKI
Look like pre-renal
Low urine Na, FeNa < 1%, able to concentrate urine
PPX to Prevent Tumor Lysis Syndrome
Allopurinol
Rasburicase
Hydration
Tx of Rhabdomyolysis
IV normal saline + mannitol (osmotic diuretic)
DEC CONTACT TIME BETWEEN MYOGLOBIN AND TUBULES
EKG stat - hyperkalemia
What do you do when Cr continues to rise in AIN after stopping offending drug?
Give steroids
Good pasture v. Alport
Both glomerular diseases
GP - anti BM antibodies, hematuria and lung/hemoptysis
Alport - sensorineural hearing loss, loss of fibers that hold eye lenses
IgA Nephopathy
Asian women
Give ACE inhibitors
Hematuria 1-2 days after URI (as opposed to post-strep GN which is 1-2 weeks later)
Tx of TTP-HUS
1- may need urgent plasmaphoresis
2 - FFP (not platelet transfusion)
3- Eculizumab if atypical HUS (aka not from infection)
4 - steroids in TTP but not HUS
Causes of Nephrogenic DI
Lithium, demeclocycline, CKD, hypokalemia, hypercalcemia
Correction of Na for high glucose
Add 1.6 x however many 100’s glucose is increased by above 100
Tx of Hyponatremia
Fluid restriction
Saline + loop diuretics
If severe, hypertonic saline + ADH antagonists (tolvaptan, conivaptan)
What is the relationship between K and Mg?
If Mg is low then potassium channels open and spill K into urine
Low Mg –> low K
Barter
Gitelman
Liddle
Barter - acts like loop diuretic, no Na absorption, more K excretion
Gitelman - act like HCTZ, no Na absorption, more K excretion, less Ca excretion
Liddle - act like aldosterone, inc ENaC, more Na absorption, more K excretion
RTA I, II and IV
I - problem w/ distal tubule H+ secretion (alkalotic urine - STONES), caused by amphotercin, topirimate and autoimmune diseases, treat w/ bicarb
II - problem w/ proximal tubule bicarb absorption, caused by acetazolamide, Fanconi, treat with HCTZ
IV - problem with distal aldosterone resistance so dec ENaC, HYPERKALEMIA, fludocortisone
Urine Anion Gap
Tells you diarrhea v. RTA in normal anion gap metabolic acidosis
UAG = urine Na - urine Cl
Pos … less Cl because defective acid secretion (RTA)
Neg … more Cl because body comps for metabolic acidosis by excreting acid in urine (DIARRHEA)
Pain Mgt in Kidney Stones
Ketorolac
Associations w/ ethylene glycol OD and methanol OD
Ethylene - oxalate stones
Methanol - inflamed retina
First Presentation of HTN Work-Up
EKG
UA
Blood glucose
Lipids
General Kidney Stone Mgt
Analgesia + hydration
CT best imaging, can do US to look for hydronephrosis
If < 5 mm pass on own
If 5-7 mm use nifedipine and tamsulosin to help pass
If .5 - 2 cm use lithotripsy
If > 2 cm require surgery
