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MTBs Step 3 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What is Prerenal Azotemia? What are some causes?

A

hypoperfusion of the kidneys leading to failure.

May be due to: hypotension, Hypovolemia, Low oncotic pressure, CHF, Constrictive Pericarditis, Renal Artery Stenosis

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2
Q

Urine sodium with prerenal azotemia? low or high?

A

LOW!

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3
Q

What type of casts will you see with prerenal azotemia?

A

Hyaline Casts

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4
Q

Why do you get elevation of BUN with prerenal azotemia? (i want mechanism)

A

low volume = increased ADH –> ADH increases urea transport activity =D

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5
Q

What are some causes of Postrenal Azotemia?

A

Stone in bladder or ureters, bilateral strictures, cancer of the bladder, prostate cancer, cervical cancer or neurogenic bladder

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6
Q

Urine sodium with intrarenal failure? high or low?

A

high >40

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7
Q

What is Acute Tubular Necrosis(ATN)?

A

death of the tubular cells of the kidney due to either hypoperfusion or various toxic injuries to the kidney(aminoglycosides, amphotericin, chemo, contrast)

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8
Q

What is the mechanism of contrast induced renal failure?

A

Contrast is directly toxic to the kidney tubule and causes vasoconstriction of the afferent arteriole. ==> decreased perfusion = rapid increase in Cr & decreased in urine Na.

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9
Q

What type of casts would you see with Acute tubular necrosis(ATN)?

A

“muddy brown” or granular

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10
Q

What is Allergic/Acute Interstitial Nephritis(AIN)?

A

Hypersensitivity reaction to medications. Look for UA with WBCs, fever and rash.
*use Wright Stain or Hansel Stain of the urine to detect eosinophils.

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11
Q

Pt has AIN for >48hrs. What do you do?

A

give them steroids

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12
Q

What is Rhabdomyolysis? What do you see with kidneys?

A

large-volume muscular necrosis –> Myoglobin from muscles is toxic to kidney tubules = UA with blood, Elevated Urine myoglobin, elevated CPK level, increased K & decreased Ca.

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13
Q

What is the mechanism of hypocalcemia with rhabdomyolysis?

A

damaged muscle releases SERCA. SERCA takes up Ca lowering the blood level of Ca.

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14
Q

How do you treat rhabdomyolysis?

A

Bolus NS, mannitol diuresis(decrease contact time of myoblin with tubule) & Alkalinization of urine to help precipitate myoglobin + EKG(hyperkalemia induced arrhythmia)

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15
Q

Pt with a UA showing envelope-shaped oxalate crystals. What did this person do? How do you tx them?

A

prob suicide by ingestion of antifreeze(ethylene glycol). Treat with Ethanol or Fomepizole + immediate dialysis

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16
Q

Pt with UA showing uric acid crystals. Whats the most common cause of this? How do you treat?

A

MCC = tumor lysis syndrome due to chemotherapy(often for lymphoma).

tx: hydration, allopurinol & rasburicase(breaks down uric acid)

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17
Q

What blood stuff would you see with a cholesterol embolism?

A

on skin = livedo reticularis

blood = low C3 &C4 + eosinophilia

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18
Q

What can you do to prevent contrast induced renal failure?

A

Pt who can still get contrast with renal failure will have a Cr between 1.5-2.5. Give NS + N-acetylcysteine + bicarb

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19
Q

Slight elevations of Cr above normal(1.5-2.5) means a loss of _______% of renal function at a minimum.

A

60-70%

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20
Q

How do NSAIDs cause kidney damage?

A
  • directly toxic and cause papillary necrosis
  • Allergic Interstitial nephritis = WBC + eosinophilia
  • Nephrotic Syndrome
  • afferent arteriolar vasoconstriction & decreased perfusion to the glomerulus = worsening renal function
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21
Q

Goodpastures Syndrome

sx?

A

cough, hemoptysis, SOB, lung shit

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22
Q

Goodpastures Syndrome

Best initial test? dx? tx?

A

best initial: Anti-basement membrane Abs
Most accurate: bx
Tx: plasmapheresis + steroids

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23
Q

Churg-Strauss Syndrome

sx? whats another name for this?

A

(aka Eosinophilic Granulomatosis with Polyangiitis)

sx: asthma, cough, eosinophilia + renal abnormalities

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24
Q

Churg-Strauss Syndrome

best initial test? dx? tx?

A

Best initial test: CBC for eosinophilia count, MPO-ANCA

dx: bx
tx: Glucocorticoids, if no response add cyclophosphamide

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25
Q

Wegeners Granulomatosis with Polyangiitis

sx?

A

“C-disease”

Upper respiratory problems(sinusitis, otitis), lung problems(cough, hemoptysis, abnormal CXR), Systemic vasculitis(joint, skin, brain, GI probs) + renal involvement

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26
Q

Wegeners Granulomatosis with Polyangiitis

best initial test? dx? tx?

A

initial: C-ANCA or anti-proteinase 3-ANCA
dx: bx
tx: cyclophosphamide + steroids

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27
Q

Microscopic Polyangiitis

sx? dx? tx?

A

sx: lung + renal vasculitis, no eosinophils or asthma. just lung and kidneys
dx: NO GRANULOMAS on bx, MPO-ANCA present
tx: steroids + cyclophosphamides

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28
Q 
Polyarteritis Nodosa(PAN)
sx?
A

sx: SYSTEMIC vasculitis involving EVERY ORGAN EXCEPT lungs. (myalgias, GI bleed + ab pain, purpuric skin lesions, stroke, renal shit, uveitis, neuropathy)
* multiple nonspecific findings + fever and weight loss with multiple motor and sensory neuropathy with pain = dx key!

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29
Q 
Polyarteritis Nodosa(PAN)
initial test? dx?
A

initial: ESR for inflammation markers, Hepatitis B & C(associated with 30% of PAN)
dx: Bx of sural nerve or the kidney, angiography showing “beading”

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30
Q 
Polyarteritis Nodosa(PAN)
tx?
A

tx: cyclophosphamide & steroids

31
Q

IgA Nephropathy

whats another name for this? sx?

A

aka Berger Disease

sx: painless recurrent hematuria, recent viral respiratory infection, Proteinuria

32
Q

IgA Nephropathy

initial test? dx?

A

initial: no specific test!
dx: renal bx is essential!!!

33
Q

IgA Nephropathy

tx?

A

no proven effective therapy!

  • give steroids for worsening proteinuria
  • ACEi
  • Fish oil MAY delay progression
34
Q

Henoch-Schonlein Purpura

sx?

A
  • Raised, nontender, purpuric skin lesions(particularly on buttocks)
  • abdominal pain
  • possible bleeding
  • joint pain
  • renal involvment

**seen in a kid

35
Q

Henoch-Schonlein Purpura

best initial test? dx?

A

initial: physical exam!
dx: bx showing IgA deposits but it is not necessary to make dx

36
Q

Henoch-Schonlein Purpura

tx?

A

no specific tx = will resolve on its own!

*give steroids if proteinuria worsens with the use of ACEi

37
Q

Post-streptococcal Glomerulonephritis(PSGN)

sx?

A

recent illness followed by “tea/cola colored” urine, periorbital edema, HTN.

38
Q

Post-streptococcal Glomerulonephritis(PSGN)

best initial test? dx?

A

initial: Anti-streptyolysin O, anti-DNase, Anti-hyaluronidase & low compliment lvls
dx: bx! but not done routinely bc blood test are often sufficient. bx would show IgG depo + C3

39
Q

Post-streptococcal Glomerulonephritis(PSGN)

tx?

A

Penicillin for infection, control HTN and fluid overload with diuretics

40
Q

Cryoglobulinemia

sx?

A

hx of hepatitis C with renal involvement, joint pain, purpuric skin lesions + low compliment & cryoglobins(igm)

41
Q

Cryoglobulinemia

best initial test? most accurate?

A

initial: serum cryoglobin component leves, compliment levels low (especially C4)

most accurate: bx

42
Q

Cryoglobulinemia

tx?

A

tx: treat hep C + rituximab

43
Q

Alport Syndrome

sx? dx? tx?

A

sx: congenital problem with eye and ear + deafness & renal failure in 2nd decade of life.

no dx & no specific tx

44
Q

Thrombotic Thrombocytopenic Purpura(TTP)

sx? tx?

A

TTP = FAT RN

  • fever
  • anemia(intravasular hemolysis)
  • Thrombocytopenia
  • renal probs(elevated Cr)
  • Neurological abnormalities

tx with plasmapheresis in severe cases. steroids

45
Q

Hemolytic Uremic Syndrome(HUS)

sx? tx?

A

HUS = ART

  • anemia(intravasular hemolysis)
  • renal probs(elevated Cr)
  • Thrombocytopenia

tx with plasmapheresis in severe cases.
**DO NOT GIVE ABX as they may worsen

46
Q

Nephrotic Syndrome

sx?

A

Hyperproteinuria, hypoprotemia, hyperlipidemia(lipoprotein lost in urine = not available to uptake LDL & VLDL), Edema, Thrombosis(due ot loss of antithrombin 3, PC & PS)

47
Q

What is associated with minimal change disease?

A

children!

48
Q

What is associated with membranous glomerulonephritis?

A

adults, cancer(especially lymphoma)

49
Q

What is associated with Membranoproliferative glomerulonephritis?

A

hepatitis C

50
Q

What is associated with Focal Segmental Glomerulonephritis(FSGN)?

A

HIV, heroine use

51
Q

Under what circumstances is dialysis essential?

A

hyperkalemia, metabolic acidosis, uremia with encephalopathy, fluid overload, uremia with pericarditis, drug intoxication that requires dialysis(lithium, ethylene glycol, ASA), uremia induced malnutrition

52
Q

4 main blood symptoms of uremia & how to treat them

A
  1. hyperphosphatemia: Ca-acetate, Ca-carbonate phosphate binders
  2. hypermagnesemia: restrict intake
  3. Anemia: EPO
  4. Hypocalcemia: Vita D replacment
53
Q

What is Calciphylaxis?

A

type of extraskeletal calcification = calcification of blood vessels and skin vessels clotting and necrosis. See with ESRD, hyperparathyroidism, milk-alkali syndrome

tx by increasing dialysis and normalizing Ca lvls

54
Q

What is Nephrogenic Systemic Fibrosis? When would you see this?

A

skin fibrosis in response to the MRI contrast agent Gadolinium in patients with ESRD or severely low GFR (<30). Proliferation of dermal fibrocytes, leading to hardened areas of fibrotic nodules developing in the skin and in some cases joint and skin contractions.

55
Q

Central DI

sx? tx? What will giving DDAVP do?

A

sx: low urine osmolality, low urine sodium, increased urine volume + NO CHANGE IN URINE OSMOLALITY WITH WATER DEPRIVATION.

Giving DDAVP: decrease in urine vol, increase urine osmolality.

tx: Give DDAVP or vasopressin

56
Q

Nephrogenic DI

sx? tx? What will giving DDAVP do?

A

sx: low urine osmolality, low urine sodium, increased urine volume + NO CHANGE IN URINE OSMOLALITY WITH WATER DEPRIVATION.

Giving DDAVP: no change in urine volume, no change in urine osmolality.

tx: correct underlying cause such as hypokalemia, hypercalcemia & in the meantime use TZD.

57
Q

3 common causes of hypervolemic hyponatremia?

tx?

A

congestive heart failure(CHF), nephrotic syndrome, cirrhosis

tx: treat underlying cause

58
Q

3 common causes of hypovolemic hyponatremia?

tx?

A

Diuretics(elevated urine Na), GI loss of fluids/vomiting/diarrhea(low urine Na), Skin loss of fluids/burns/sweating(low urine Na)

tx: correct cause and replace with NS

59
Q

4 common causes of euvolemic hyponatremia?

A

SIADH, hypothyroidism, psychogenic polydipsia, hyperglycemia

60
Q

Hyperglycemia causes an _____ drop in Na by ___ for each ___ points of glucose.

A

ARTIFICAL, 1.6, 100

61
Q

Addisons Disease cause?

electrolyte sx? tx?

A

hyponatremia due to insufficient aldosterone production.

sx: hyponatremia, hyperkalemia, mild metabolic acidosis
tx: alosterone replacement(fludrocortisone)

62
Q

4 common causes of SIADH

A

any problems with CNS, any lung disease, cancer, medications(sulfonylureas, SSRIs, carbamazepine)

63
Q

Electrolyte abnormalities with SIADH

A

high urine Na(>20), High urine Osm(>100), Low serum Osm(<290), Low serum uric acid, normal BUN, normal Cr, normal Bicarb

64
Q

Treatment of Mild, Moderate & chronic SIADH?

A

mild: fluid restriction
Mod: NA, loops, ADH blockers(conivaptan, tolvaptan)
*do not correct Na more than 10-12 mEq/L in the first 24 hr
Severe: Demeclocycline to block ADH on kidney.

65
Q

List some causes of Hyperkalemia

A
  • metabolic acidosis from transcellular shift out of cells
  • adrenal aldosterone deficiency(addisons disease)
  • BB
  • digoxin tox
  • insulin deficiency (DKA)
  • diuretics(spironolactone)
  • ACEi, ARBs
  • prolonged immobility, seizures, Rhabdomyolysis, or crush injury
  • T4 RTA
  • renal failure preventing K secretion
66
Q

How do BB cause hyperkalemia?

A

Normal Na/K ATPase lowers blood K. BB decrease the activity of the Na/K ATPase, causing K levels to increase.

67
Q

Effects of hyperkalemia on EKG

A

1st peaked Twaves then loss of P waves then widened QRS

68
Q

tx of severe hyperkalemia(you have EKG abnormalities)

A

Ca-gluconate IV to protect the heart, insulin + glucose IV & kayexalate

69
Q

tx of moderate hyperkalemia(no EKG abnormalities)

A

insulin +glucose, Bicarb to shift K into cells when acidosis is the cause, Kayexalate PO.

70
Q

What will you see on a EKG for hypokalemia?

A

U-waves = extra wave after the T wave

71
Q

Hypermagnesemia

sx? tx

A

sx: muscular weakness, loss of DTRs
tx: restrict intake, NS to promote diuresis +/- dialysis depending on severity

72
Q

Hypomagnesia always presents with hypo—- & cardiac arrhythmias.

A

hypocalcemia

73
Q

causes of metabolic acidosis

A

MUDPILES:

methanol, uremia, DKA, Paracetamol, INH, Lactic Acidosis, Ethylene Glycol, ASA

MTBs Step 3 (30 decks)

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