Nephrology Flashcards
(164 cards)
1
Q
Important information
A
Major extracellular buffer in human blood is the carbon dioxide-bicarbonate buffer pair, which has a pK of 6.1
2
Q
How seizures cause High Anion Gap Metabolic acidosis?
A
Due to increased production of lactate from muscles and decrease hepatic uptake of lactate
3
Q
Name the cause of high anion gap metabolic acidosis in which is osmolal gap is increased
A
Ethylene glycol
Methanol
Propylene glycol
4
Q
Name the acid which causes mixed anion gap metabolic acidosis viz anion gap metabolic acidosis and respiratory alkalosis
A
Aspirin
Lactate
Sulfuric acid
Phosphoric acid
5
Q
Name the causes of Metabolic Alkalosis in which urine chloride level is low
A
Vomiting
NG aspiration
Prior Diuretic use
6
Q
Name the causes of Metabolic Alkalosis in which urine chloride is high but patient is normotensive
A
Current diuretic use
Gitelman syndrome
Bartter syndrome
7
Q
Name the causes of Metabolic Alkalosis in which urine chloride is high but patient is Hypertensive
A
Excessive mineralocorticoid activity due to;
Conn syndrome
Cushing syndrome
eCtopic ACTH production
8
Q
Important information regarding Metabolic Alkalosis
A
If urine chloride level is <20mEq/L = Saline responsive
If urine chloride level is >20mEq/L = Saline un-responsive
9
Q
Important information
A
In pregnancy Respiratory alkalosis occurs due to activation of respiratory center by Progesterone
10
Q
Triad of Type 1 RTA
A
- Inability of distal cells of nephron to secrete H+
- Low body pH But high urine pH
- Low Potassium level
11
Q
Why kidney stones developed in type 1 RTA?
A
Due to inability of distal cell of nephron to secrete H+ in lumen results alkaline urine produce which increases the formation of stones
12
Q
Which type of Renal tubular acidosis occur in sickle cell trait?
A
Type 1 RTA
13
Q
Traid of type 2 RTA
A
- Inability of proximal cells of nephron to absorb HCO3-
- Low pH of body as well as urine (due to distal cells )
- low potassium in body
14
Q
How to d/f liddle syndrome and Conn syndrome?
A
In former Sr aldosterone is undetectable and in latter Sr aldosterone is detectable and very high
Liddle syndrome occurs due to mutation in collecting cells of nephron result excessive absorption of sodium ions
15
Q
Name the drugs causing Hyperkalemia
A
A = ACEI / ARBs B = BB C = Cyclosporine D = Digoxin
N = NSAID S = Succinylcholine K = K+ sparing diuretics H = Heparin
16
Q
What are the ECG findings of Hyperkalemia?
A
Tall T waves with PR Prolongation
QRS widening
17
Q
How to stabilise cardiac membrane in hyperkalemia?
A
Give Calcium Chloride Or Calicum gluconate
18
Q
Important information
A
Pts with chronic hyperkalemia may be asymptomatic until K+ gradually rises >/=7.0 mEq/L.
19
Q
INDICATIONS FOR EMERGENT TREATMENT OF HYPERKALEMIA
A
- Marked elevation (>6.5 mEq/L) without characteristic ECG changes OR
• Presence of hyperkalemia-related ECG changes
• Rapid rise in serum potassium level due to tissue breakdown
20
Q
How low level of Magnesium decreases potassium level?
A
Mg is imp.cofactor for K+ uptake and maintenance of intracellular K+ check and correct Mg in chronic alcoholics to correct hypokalemia.
Another cause of hypomagnesemia is diuretics
21
Q
How to t/m severe Hypercalcemic>14mg/DL Or Symptomatic?
A
- long term give Bisphosphonate
* Short term Hydrate PT & give calcitonin and Avoid to give diuretic unless volume overload
22
Q
How to t/m moderate Hypercalcemia that is 12-14mg/DL?
A
- No t/m unless Symptomatic
* And if symptomatic then t/m A/c to severe Hypercalcemia
23
Q
When to use hemodialysis as a t/m for Hypercalcemia
A
Hemodialysis is an effective treatment for hypercalcemia, but is typically reserved for patients with renal insufficiency or heart failure in whom aggressive hydration cannot be administered safely
24
Q
How to t/m Euvolemic Or Hypervolemic hypernatremia?
A
Free water supplementation Or 5% D/W in water
25
How to t/m Asymptomatic Hypovolemic hypernatremia?
5% D/W in 0.45% N/S
26
How to t/m Symptomatic Hypovolemic hypernatremia?
0.9% N/S until euvolemic then used 5% D/W
27
What are the causes of HyperVolemic Hypo osmolarity Hyponatremia ?
Hint = Body is edemic
* CHF
* Hepatic failure.
* Nephrotic syndrome
28
What are the causes of EuoVolemic Hypo osmolarity Hyponatremia ?
• If urine Sodium more than 20 and Urine Osm more than normal = SIADH
If urine Sodium more than 20 but Urine Osm is normal( due to intact ADH system )= Psychogenic polydipsia Or Beer Potomania
29
What are the causes of Hypovolemic Hypo osmolarity Hyponatremia?
* If urine Sodium less than 10 = Dehydration/Vomiting/Diarrhea
* If urine Sodium more than 10 = Diuretics/ACEI/Mineralocorticoid deficiency
30
What will be the t/m of moderate SIADH viz confusion and lethargy?
* Give hypertonic saline 3% in first 3-4 hrs to increased Sr.Na more than 120meq/l
* later on fluid restriction/ possible oral salt tablets/ loop diuretics if urine osmolality 2times greater than Sr osmolality
31
What will be the t/m of Severe SIADH viz fits/ not able to communicate and coma?
* Bolus of hypertonic saline until Sx resolute
| * Vasopressin Receptor Antagonist?
32
Name the enzyme deficient in syndrome of “Apparent” mineralocorticoid excess
11 beta hydroxysteriod dehydrogenase responsible to convert cortisol into cortisone
33
What happens in syndrome of apparent mineralocorticoid excess?
Due to deficiency of 11beta hydroxy dehydrogenase, cortisol will activate aldosterone receptors result:
HTN,
High Sr.Na,
low Sr.K and “low Sr Aldosterone”
34
How to t/m SAME?
Give potassium sparing diuretics
And Exogenous steroid which will inhibit endogenous production of steroid
35
Name the acid which can cause SAME?
Glycyrrhetinic acid present in Licorice
36
Name the bacteria which have positive Urease Test
Proteus
Klebsiella
Saprophyticus
37
Important information of UTI due to “Serratia marcescens”
Some strains produce a “red pigment;
often nosocomial and drug resistant
38
Important information of UTI due to “Pseudomonas aeruginosa”
Blue-green pigment and fruity odor;
usually nosocomial and drug resistant.
39
Important information of UTI due to “Proteus mirabilis”
Motility causes "swarming" on agar;
associated with struvite stones.
40
What is the t/m of Pyelonephritis esp in non pregnant females?
Gives Quinolones as “Outpatient t/m”
Give IV Quinolones Or Aminoglycosides with or W/O ampicillin
41
What is the t/m of Complicated Cystitis esp in non pregnant females?
Quinolones for 5-14 days
For severe cases Give extended Spectrum Abx( Ampicillin/Gentamicin)
42
What is the t/m of Un-Complicated Cystitis esp in non pregnant females?
Nitrofurantoin for 5 days
Tmx-Sx for 3days
Fosfomycin single dose
Quinolones If above options cannot be used
43
Name the Abx for UTI given in pregnancy instead of Quinolones
Augmentin
Fosfomycin
Cephalexin
Cefpodoxime
44
D/f b/w Glomerular* Vs Non Glomerular Hematuria**
Microscopic hematuria/RBC cast & dysmorphic RBC and protein in urinalysis*
Gross hematuria/No cast, normal shape RBC, blood present but not protein in urinalysis**
45
If “Spike and Dome” appearance seen on Electron microscope then what is the cause of nephrotic syndrome?
Membranous nephropathy
46
What will be seen on Light microscopy in membranous nephropathy?
Diffuse capillary and GBM thickening
47
Patient with HBV has strong potential to develop which kinda of nephrotic syndrome?
Membranous nephropathy
48
What will be seen on LM in focal segmental Glomerulosclerosis?
Segmental sclerosis and hyalinosis
49
immunofluorescence report of Post infectious glomerulonephritis will show what?
Stary sky granular appearance (Lumpy bumpy) due to IgG, IgM and C3 deposition along with GBM and Mesangium.
50
Granular immunofluorescence will seen in which conditions of nephrotic and nephritic?
Membranous nephropathy
PSGN & DPGN
51
Pattern of immune complex deposition in GoodPasture syndrome would be?
Linear immunofluorescence due to antibodies to alveolar basement and GBM
52
Name the cause of nephritic syndrome which shows “wire looping of capillaries” on LM?
DPGN
53
Name the cause of nephritic syndrome which shows “Basket weave” on electron microscope?
Alport syndrome
54
Triad of Mixed Essential CRYOGLOBULINEMIA
palpable purpura,
hematuria,
proteinuria
55
MC coagulopathy occur due to nephrotic syndrome
Renal vein thrombosis esp in membranous nephropathy
56
Important information for minimal change diseases
Renal biopsy is indicated in children age>10yrs with nephrotic syndrome, or
in any child with nephritic syndrome or minimal change disease that is unresponsive to steroids
57
Conditions associated with “AL amylodosis
Multiple myeloma
And Waldenstrom macro globulinemia
58
Composition of amyloid in “AL amyloidosis”
Light chains usually lambda
59
Conditions associated with “AA amyloidosis”
Chronic inflammatory conditions viz. RA and IBD
Chronic infections viz Tb and osteomyelitis
60
Composition of Amyloid in “AA amyloidosis”
Abnormally folded protein: beta 2 micro globulin
App lipoprotein Or Transthyretin
61
What is the earliest renal abnormality in diabetic nephropathy?
Glomerular hyperfiltration
62
What is the first changed in diabetic nephropathy that can be quantified?
Thickening Of GBM
63
Histological finding of diabetic nephropathy
Diffuse glomerulosclerosis but
Pathognomonic finding: nodular glomerulosclerosis (with Kimmelstiel Wilson nodules)
64
Why dipstick test not recommended in diabetic nephropathy?
B/c it only detects macro albuminuria which is not seen in early in Diabetic nephropathy
65
What are the clues that suggest albuminuria due to non diabetic nephropathy?
onset of proteinuria <5 years after disease onset,
active urine sediment (eg, red cells, cellular casts),
and >30% reduction of GFR within 2-3 months of starting ACEi or ARB
66
Important information regarding Renal artery stenosis
Suspect Renal artery stenosis if patient developeds resistant HTN and diffuse atherosclerosis
67
Non medical treatment for Renal artery stenosis
Renal artery stenting or surgical revascularization is reserved for patients with resistant hypertension OR
recurrent flash pulmonary edema and/or refractory heart failure due to severe hypertension
68
Important points of Renal artery stenosis
Asymmetric renal size with abdominal bruit
Increase in Sr creatinine more than 30% after using ACEI/ARBs
Unexplained atrophic kidney seen in imaging
69
Important information of Calcium stones
Calcium oxalate stones develops in normal serum calcium and high urine calcium
70
Risk factors to develop Calcium Oxalate stone
| All them result in fat bound with Calcium and oxalate get absorb result stone formation
Ethylene glycol ingestion
Vitamin C abuse
Decrease citrate level
Malabsorption
Crohn diseases
Bowel resection
71
What is the shape of calcium oxalate stone?
Envelope or Dumbbell
72
What are the risk factors to develop calcium phosphate stone?
```
primary hyperparathyroidism
And RTA (renal tubular acidosis)
```
73
What is the shape of calcium phosphate stones?
Wedge shape prism
74
What is the shape of uric acid stone?
Rhomboid Or Rosettes
75
What is the shape of cysteine stone?
Hexagonal
76
Name the especial test to diagnose cysteine stone
Positive urine nitroprusside test:
detect high level of urinary cysteine, used as qualitative screening procedure and help confirm diagnosis esp. in homozygotes
77
What is the shape of ammonium magnesium phosphate stone?
Coffin lid
78
Name the bacteria which are involved in ammonium magnesium phosphate stone formation?
Proteus
Staph saprophytius
Klebsiella
79
What’s the size of renal stone which need conservative management?
Less than 5mm and will pass spontaneously
80
When to consult urology ward for renal stone?
If stone size is less than 10 mm which doesn’t resolve with medical management
And if stone size is more than 1cm
81
How alpha blockers help in treating renal stones?
Αlpha receptors are found on distal ureter, base of detrusor, bladder neck and urethra so give alpha blocker which will relax these sites and stone will pass
82
How to prevent recurrent renal stones formation?
Reduce sodium intake / Protein / oxalate containing diet
| Increase fluid intake/ citrate containing diet
83
How stress incontinence occurred?
Due to outlet incompetence (uretheral hypermobility Or Intrinsic sphincteric Deficiency
84
What is Q tip test in stress incontinence?
place pt in dorsal lithotomy position --> insert cotton swab into urethral orifice--> angle >/=30* from horizontal on ↑ in intra-abdominal pressure signify urethral hypermobility
85
How to t/m stress incontinence?
Do kegel exercise as First line t/m otherwise do uretheral sling surgery if exercise fails
Pessary for poor surgical candidates
86
Why urge incontinence occurs?
Due to overactivity of bladder muscle and it is usually associated with UTI.
87
Name the medicine given in urge incontinence
Oxybutynin it is anticholinergic medicine
88
Why overflow incontinence occurred?
Due to underactivity of bladder muscle or outlet obstruction
89
Symptoms of overflow incontinence
Constant involuntary dribbling of urine and incomplete emptying
90
Name the condition occur in old age men causing overflow incontinence
BPH
91
Triad of bladder painful syndrome (interstitial cystitis)
- bladder pain with filling and relief with voiding
- more than 6 wks
- normal urinalysis and associated with psychiatric disorder and pain syndrome (fibromyalgia)
92
Name the drugs causing crystal induced AKI
| SAME P
```
SAME P
S sulfonamide
A acyclovir
M methotrexate
E Ethylene glycol
```
P protease inhibitors
93
Triad of Acute interstitial nephritis
Fever with maculopapular rash
+Ve Hx of drugs
Urinalysis show eosinophils
94
Name the drugs causing Acute interstitial nephritis
| Remember 6Ps
```
Pee drugs = Diuretic
Pain free = NASIDs
Penicillin and cephalosporins
PPI
rifamPin
```
95
Triad of Renal papillary necrosis
Gross Hematuria
Proteinuria
Associated with NASID/ SCD / DM / Acute pyelonephritis
96
MCC of AKI in Hospitize patient
Acute tubular necrosis
97
How CT contrast induced nephropathy present?
spike in creatinine within 24 hours of contrast administration, followed by return to normal renal function within 5-7
98
How to t/m CT contrast induced nephropathy?
Adequate pre-CT hydration
Acetylcysteine shown to prevent nephropathy by dilating vessels and neutralise oxidants
99
Most common cause of death in dialysis and renal transplant pt
cardiovascular disease
100
What are the Risk factors for cardiovascular disease due to ESRD and dialysis?
ESRD / Anemia
Increase homocysteine/ Calcium
Inhibition of nitric oxide
101
Features of Simple Renal cyst
Unilocular thin smooth regular wall cyst without septae
Homegenous content
Absence of contrast enhancement on CT/MRI
Usually Asymptomatic
102
Features of Malignant Renal cyst
Multilocular thick irregular wall cyst with multiple sepate
Heterogeneous content (solid / cystic)
Presence of contrast enhancement on CT/MRI
Usually symptomatic
103
Triad of RCC
Flank pain
Hematuria
Palpable abdominal Renal masses
104
Which imaging is sensitive and specific for RCC?
Ct scan
105
RCC incidence increases in which patients?
Smoker
| And Obese patients
106
Important information for RCC
It is resistant to chemotherapy and radiation therapy
107
What’s the histological presentation of RCC?
Polygonal clear cells filled with accumulated lipids and carbohydrates
108
Renal oncocytoma
Benign “Epithelial” cell tumor arising from collecting duct
109
What is the histological presentation of Renal oncocytoma?
Large eosinophils cells with abundant mitochondrion w/o peri nuclear clearing
110
Important information
Cystoscopy is recommended for all patients with unexplained gross hematuria or with microscopic hematuria and other risk factors
for bladder cancer
111
Conditions in which transitional cell carcinoma is associated;
Phenacetin
Smoking
Anyone dye
Cyclophosphamide
112
What are the indications for cystoscopy?
* Gross Hematuria w/o evidence of glomerular disease or Infection
* Increase risk of malignancy but Microscopic Hematuria w/o evidence of glomerular disease or Infection
* Recurrent UTI
* Obs symptoms with suspicion for stricture and stones
* Irritative Sx without urinary infection
* Abnormal bladder imaging Or urine cytology
113
How to approach symptomatic
| Ureteral stone if patient has any Urosepsis / Aki / complete Obs?
Stat uro consult
114
How to approach symptomatic Ureteral stone if patient doesn't have Urosepsis / Aki / complete Obs?
Check stone size --->if >1cm ----> Uro consult
If <1cm---> give fluids, alpha blocker , pain controller--->still present of stone or pain persist---> Uro consult
115
Why Ringer lactate than Normal saline given in Burn patient?
RL is balanced with physiological level of ions and contain Lactate which converts into HCO3 in liver
Whereas Normal saline is unbalanced fluid contain more chloride causing Met acidosis and hypo coagulation
116
Important point of D/f types of fluid
Hypotonic fluid like D/W 5% or half saline given in hypernatremia
Hypertonic fluid like 3% given in symptomatic hyponatremia
117
Important point of D/f types of fluid (2)
Isotonic fluid like Normal saline or Ringer lactate
Albumin 5% or 25% given in Spont bacterial peritonitis or Hepatorenal syndrome
118
Important point of ADPKD
Give ACEI for HTN
Dialysis or Renal transplant for ESRD
119
How to prevent recurrence of renal stones via meds?
Thiazides
Allopurinol
Alkalisation of urine via potassium citrate
120
Name the nephritic condition in which low complement noted
Post infectious GN
MPGN
Mixed cryoglobulinemia
121
How thin basements membrane syndrome present?
Adult with hematuria without proteinuria
Bx shows thin basement membrane
122
Association of MCD/ MPGN and IgA nephropathy
1) MCD—-> NASIDS , lymphoma
2) MPGN—->HBV, HCV and lipodystrophy
3) IgA nephropathy—->Upper RTI
123
Association of Membranous nephropathy
| ABC
A adenocarcinoma
B HBV
C SLE / NASIDS
124
Association of Focal segmental GS
```
HIV
Heroin
African American
Hispanics
Obesity
```
125
Define Oliguria
```
UOP
less than 250ml in 12 hrs
Less than 0.5ml/kg/hr
Less than 400 ml / day
Less than 6ml /kg /day
```
126
How ileus Occur due to stones and how to manage it?
Due to vagal reaction
| Rx—->Remove stones
127
Classified Proteinuria on the basis of Urine dipstick
1 plus —-> 30-100mg/dl
2 plus—-> 100-300mg/dl
3 plus ——> 300-1000mg/dl
4 plus —-> more than 1k mg/dl
128
Name the Edema causes which occur due to lymphatic obstruction / increase interstitial oncotic pressure
Lymph node obstruction
Malignant ascites
Hypothyroidism
129
Name the Edema causes which occur due to increases capillary permeability
Burns, Trauma and sepsis
Allergic Rxn
ARDS
Malignant ascites
130
Name the Edema causes which occur due to decreases oncotic pressure
Synthesis problem::
Cirrhosis / malnutrition
Protein loss::
Nephrotic syndrome
Protein losing enteropathy
131
Name the Edema causes which occur due to increase capillary hydrostatic pressure
HF
Venous Obs like cirrhosis and venous insufficiency
Primary renal sodium retention (renal diseases and drugs)
132
How to Evaluate Hyponatremia?
Start with Sr.Osmlality
If increase---> Renal failure Or hyperglycemia
If Decrease--->check urine osmolality
133
How to Evaluate Hyponatremia if patient has low Sr osmolality? Part 2
Check urine osmolality
If less than 100--->primary polydipsia Or beer drinker
If not less than 100--->check urine sodium
134
How to Evaluate Hyponatremia if patient has low Sr osmolality with urine osmolality not less than 100? Part 2
Check urine sodium
If less than 25 ---> volume depletion / CHF / cirrhosis
If not less than 25---->SIADH/ hypothyroidism/adrenal insufficiency
135
How to dx bladder cancer?
| Urine D/R
Gold standard is ---->flexible cystoscopy with Bx.
136
How to treat bladder cancer?
If No muscle invasion---->TURBT and Intravesical immunotherapy
If muscle invasion---->Radical cystectomy and systematic chemotherapy
If spread with postive mets---> systematic chemotherapy and Immunotherapy
137
What are the causes of Type 1 RTA?
| GAM
G genetic disorder
A autoimmune like RA / sjogren syndrome
M. Medicine
If type 2 -----> fanconi syndrome
138
What are the causes of Type 4 RTA?
Obstructive uropathy
| Congenital adrenal hyperplasia
139
Differentiate Pre renal and Intra renal AKI on the basis of parameters
```
Pre renal:
Met-alkalosis with low Sr.K
Urea to Cr >20
Urine Na <20 with feNa <1%
Urine osmolality>500
Specific gravity > 1.020
```
```
Intra renal
Met-Acidosis with increase Sr. K
Urea to Cr <20
Urine Na >20 with feNa >1%
Urine osmolality <500
Specific gravity < 1.020
```
140
Why dialysis relayed amylosis have affinity for osteoarticular feature?
Inclearance of B2 microglubin via dialysis further stabilize by Connective tissue that's why
Bone cyst , carpal tunnel syndrome
Scapulohumeral periarthritis
141
How ACEi helps in DM nephropathy?
By reducing glomerular hydrostatic pressure result slow down the development of glomerular capillaries sclerosis
(Afferent dilate and efferent constrict will not only maintain GFR but it increases the sclerosis process)
142
How to prevent recurrence of kidney stones via medical and non medical?
Non medical:
Increase fluid and citrate containing food
Decrease sodium, protein and oxalate.
Normal calcium intake 1200mg /day
Medical::
Thiazide
Allopurinol for uric acid stones
Make urine alkaline viz potassium citrate/HCO3 salt.
143
What are the side effects of Magnesium sulfate toxicity?
Somnolence
Loss of depp tendon reflex
Resp-distress
But there will not be focal weakness
144
How to Evaluate Red urine?
Check urinalysis
If ≥3 RBC ---->Hematuria
If 0-2 RBC-----> Due to myoglobinuria Or Hemoglobinuria (either due to hemolysis or Decrease haptoglobin and hemoglobin)
145
How to Evaluate Mixed incontinence?
Voiding diary and find pre dominant type then treat accordingly
146
What clinical features suggest Rhabdomyolysis?
Increase Ck level
1) It leads to Intra renal AKI
2) Increase k, Phosphate, AST to ALT ratio and decrease calcium
3) Dark urine due to myoglobinuria/pigmenturia
4) Though blood in Urine D/R but no RBC on microscopy
147
Name the d/f mechanisms causing Rhabdomyolysis
| Face
1) If direct myotoxicity --->fibrates, statins, cocaine, colchicine, ethanol
2) Vasoconstrictive ischemia like cocaine amphetamine
3) prolong immobilization leads to compression ischemia ---->benzo opioid ethanol
148
Important point of physiological hydronephrosis in pregnancy
Occurs due to progesterone induced Ureteral dilation which result in dilation of b/L renal pelvis and proximal ureters
It doesn't need any treatment
If bladder obstruction occur then there will be both proximal and distal ureter dilation
149
What does mean by Complicated cystitis?
If cystitis associated with:
1) DM and Pregnancy/ Immunosuppression
2) Renal failure, Urinary tract obstruction, Indwelling catheter
3) Urinary procedure like cystoscopy
4) Hospital acquired
150
How to manage Complicated cystitis non pregnant ?
Before giving ABx, obtain sample for urine culture and then adjust Abx as needed
Abx like Quinolones for 5-14 days
Or Extended spectrum Abx like ampicillin/Gentamicin
151
How to manage Uncomplicated cystitis non pregnant?
In this case, Urine culture sent only if treatment fail otherwise no need to send culture
1) Nitrofurantoin but avoid in pyelonephritis or CrCl less than 60ml/min
2) fosfomycin single dose only
3) TMX-Sd 3days only but avoid if sulfa allery or local resistance rate ≥20%
4) Quinolones only used when above meds fail or can't be used
152
How to manage Pyelonephritis in non pregnant?
Before giving ABx, obtain sample for urine culture and then adjust Abx as needed
1) If Outpatient----> PO Quinolones
2) If Inpatient----> (IV Quinolones) Or Aminoglycosides ± Gentamicin
153
How to approach Hematuria (>3RBC) which is non glomerular and asymptomatic?
Consider: U/S renal
| Urine culture and Urine Ca:Cr ratio
154
How to approach Hematuria (>3RBC) which is glomerular origin?
Cbc
Complement
Creatinine
155
How to approach Hematuria (>3RBC) which is non glomerular and symptomatic?
1) If renal stones with flank pain ---> US
2) if trauma Hx ---> CT scan abdomen
3) If UTI sxs whether sterile or unsterile pyuria ----> urine culture and Abx
4) if Perineal / Meatal Irritation ----> Reassurance
156
How Kidney compensate in Met-Acidosis
Increase Anhydrase activity
| Increase Chloride and Acid excretion
157
How HTN occur in AD-PKD and Name the chemical involve in cyst formation
HTN due to increase renin
increase vasopressin which grow the cyst
158
Important point Renal artery stenosis
In Renal artery stenosis---> affected kidney will have high Renin due to low perfusion and unaffected kidney has decreased renin( as high pressure due to activation of RAAS by affected kidney will suppress RAAS of unaffected kidney)
159
Triad of Analgesics nephropathy
Present as Tubulointerstitial nephritis or hematuria due to papillary necrosis
Urine D/R shows hematuria or sterile pyuria or mild proteinuria
Ct shows small kidneys with B/L renal papillary calcification
160
How to manage Uremic coagulapathy?
| Due to platelet problem not due to clotting problem
Desmopressin
cryoprecipitate
Conjugated estrogen
No platelets transfusion
161
What are the indications of Urgent DIALYSIS? Part 1
(AEI)OU
What are the indications of Urgent DIALYSIS?
Acidosis —-> metabolic ph <7.1 refractory to medical therapy
* Symptomatic hyperkalemia viz ecg changes Or k >6.5 refractory to medical therapy
* Volume overload refractory to diuretic
162
What are the indications of Urgent DIALYSIS? Part 2 (MALE
Uremic bleeding, encephalopathy or pericarditis
Ingestion viz methanol, aspirin, lithium ethylene glycol
Valproate and carbamazepine
163
What are the cause of ASYMPTOMATIC BACTERIAURIA in female?
Pregestational DM
Hx of UTI
Multiparty
164
What are the labs findings of SIADH?
Low Serum sodium and Sr Osmolality <275
Increase (Urine sodium >40 and Ur osmolality >100osm/kg)
Low Uric acid
Normal Sr.k and ABGs
