Nephrology Flashcards
(9 cards)
Primary renal causes of nephrotic syndrome and associations
1) MCD - NSAIDs, lymphoma
2) FSGS - AA and Hispanic, obesity, HIV, heroin
3) Membrane nephropathy - adenocarcinoma (breast and lungs), NSAIDs, hepatitis B, SLE
4) Membranoproliferative glomerulonephritis - Hep B and C, lipodystrophy
5) IgA nephropathy - URI
Milk-alkali syndrome
Excessive intake Ca2+ and absorbable alkali (eg calcium carbonate preparations used for osteoporosis) –> hypercalcemia leads to renal vasoconstriction and decreased glomerular blood flow.
Additionally, Na-K-2Cl cotransporter inhibited due to activation of Ca2+Sr in thick ascending loop and impaired ADH activity –> loss of Na+ and free water –> hypovolemia and increased reabsorption of bicarbonate.
RCC and paraneoplastic syndromes
Flank pain, hematuria, palpable abdominal renal mass Scrotal varicoceles (left-sided)
Paraneoplastic: anemia/erythrocytosis, thrombocytosis, fever, hypercalcemia, cachexia
Mechanism of metabolic alkalosis in setting of diarrhea?
Potassium loss in stool impairs chloride reabsorption, resulting in decreased activity of chloride/bicarb exchange. This increases serum bicarb concentration.
Best markers for DKA resolution?
Anion gap or beta hydroxybutyrate (predominant ketone in DKA)
Contrast-induced nephropathy - etiology and prevention
Direct cytotoxicity causing ATN and/or renal vasoconstriction causing pre-renal injury even in absence of clinical volume depletion
Avoid NSAIDs that can worsen vasoconstricion, preprocedural IV NS, using minimal contrast.
How to differentiate saline responsive vs saline resistant metabolic alkalosis?
Saline responsive = low urine chloride <20 mEq/L
Saline resistant = high urine chloride >20 mEq/L
Management of severe hypercalcemia (>14) or symptomatic
Short term/immediate treatment: NS hydration to help promote urinary calcium excretion + calcitonin (acts quickly and can be administered concurrently with NS) AVOID LOOP DIURETICS UNLES VOLUME OVERLOADED (eg HF).
Long term treatment: bisphosphonates (zoledronic acid) –> effects delayed until 2-4 days
Association conditions for AL vs. AA amyloidosis
AL amyloidosis (amyloid light chain) a/w MM and waldenstrom macroglobulinemia.
AA amyloidosis a/w chronic inflammatory conditions like RA and IBD, as well as chronic infections like osteomyelitis and TB. Might find bilateral enlarged kidneys (nephrotic syndrome) and hepatomegaly.
