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Online Med Ed > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

tests to get in AKI

A

U/A
Protein/Cr ratio
Ultrasound
Best: biopsy - NEVER CORRECT

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2
Q

U/A in AKI

A

casts, hints, never definitive

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3
Q

Protein/Cr ratio in AKI

A

nephrotic syndrome

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4
Q

Ultrasound in AKI

A

hydro

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5
Q

what the nitrates in urine means

A

infection

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6
Q

what leukocyte esterase in urine means

A

infection

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7
Q

what RBCs in urine mean

A

hematuria

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8
Q

what no RBC’s but positive blood in urine mean

A

rhabdo (check myoglobin)

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9
Q

what eosinophils in urine mean

A

AIN

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10
Q

what RBC casts mean

A

glomerulonephritis

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11
Q

what WBC casts mean

A

pyelo

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12
Q

what muddy brown casts mean

A

ATN

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13
Q

what waxy urine casts mean

A

CKD

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14
Q

what hyaline casts in urine mean

A

nothing

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15
Q

post-renal failure path

A

obstruction: stone, cancer, BPH, neurogenic bladder

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16
Q

post-renal failure pt

A

abdominal pain and renal failure

distended or palpable bladder

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17
Q

post-renal failure dx

A

Foley catheter = large residuals

u/s = hydronephrosis

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18
Q

post-renal failure tx

A

catheter (relieves bladder outlet)

nephrostomy (relieves ureteral obstruction)

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19
Q

ATN path

A

tubules slough off, die
toxins: contrast, rhabdo
low flow: shock kidney

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20
Q

ATN pt

A

one of the above pathologies

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21
Q

ATN dx

A

u/a = waxy brown casts

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22
Q

ATN tx

A

oliguric phase: dialysis

polyuric phase: IVF

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23
Q

ATN ppx

A

vigorous hydration, reduce time in contact with toxin

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24
Q

indications for dialysis

A 
AEIOU
Acidosis
Electrolytes (Na/K)
Ingestion (toxins)
Overload (CHF, edema)
Uremia (pericarditis)
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25
chronic kidney disease - hyperparathyroidism
cinacalcet
26
ckd - hyperphosphatemia
sevelamer
27
ckd - HTN
CCB ACE-I BB Clonidine
28
ckd - vit D
Ca + vit D3
29
ckd - dialysis
hemodialysis TiW | peritoneal qHS
30
nephrotic syndrome
HTN nephrotic range proteinuria edema hypercholesterolemia
31
nephritic syndrome
hematuria HTN oliguria
32
treatment of mild HypoNa
po
33
treatment of moderate HypoNa
IVF = NS
34
treatment of severe HypoNa
3% NaCl
35
treatment of mild hyperNa
po
36
treatment of moderate hyperNa
IVF = NS
37
treatment of severe HyperNa
IV = D5W
38
symptoms of mild hyper/hypoNa
asymptomatic
39
symptoms of moderate hyper/hypoNa
in between
40
symptoms of severe hyper/hypoNa
coma | seizures
41
sodium correction
no faster than 0.25mEq/hr | except if seizing or in a coma
42
osmotic demyelination syndrome path
rapid correction of sodium
43
osmotic demyelination syndrome pt
spastic quadriplegic (irreversible)
44
osmotic demyelination syndrome
central pontine myelinolysis
45
osmotic demyelination syndrome dx
clinical, sodium rises too fast
46
osmotic demyelination syndrome tx
none, prevention only
47
work-up for sodium
serum osm urine Na urine Osm
48
hypertonic serum osm
EtOH, glucose
49
isotonic serum osm
fats and proteins
50
hypotonic serum osm
continue
51
urine Na
surrogate for aldosterone
52
urine osm
surrogate for ADH
53
if hypervolemic + sodium dysfunction
give diuresis
54
if hypovolemic + sodium dysfunction
give fluids
55
if euvolemic + sodium dysfunction
TSH cortisol renal electrolytes SIADH is dx of exclusion
56
SIADH path
hypothyroidism - TSH looks like ADH lung lesions (small cell, pneumonia) brain lesions water, but not all, is retained -> decreased tonicity
57
SIADH pt
hyponatremia
58
SIADH dx
diagnosis of exclusion U Na should be high (aldo off) U osm should be high (ADH on)
59
SIADH tx
volume restrict | correct underlying disorder
60
symptomatic hyperCa pt
stones, bones, groans, and moans
61
symptomatic hyperCa dx
calcium and albumin
62
symptomatic hyperCa tx
IVF bisphosphonates calcitonin adjunct
63
hyperparathyroidism path
primary: adenoma secondary: early CKD, physiologic response tertiary: multiple adenomas from secondary
64
hyperPTH pt
hyperCa pathologic fracture, decrease density brown tumors
65
hyperPTH dx
``` calcium labs - very increased PTH - increase Ca - decrease PO4 sestamibi scan - primary: single adenoma - tertiary: multiple adenomas ```
66
hyperPTH tx
parathyroidectomy
67
hyperPTH f/u
``` hypocalcemia post-op - Perioral tingling - Chvostek's sign - Trousseau's sign decrease tertiary hyperPTH with calcimetics - cinacalcet ```
68
hyperCa of malignancy path
mets cause bone destruction | increase Ca -> decrease PTH
69
hyperCa of malignancy pt
malignancy with elevated Ca
70
hyperCa of malignancy dx
calcium labs - very increased calcium - decreased PTH - increase PO4 - decrease PTH-rp
71
hyperCa of malignancy tx
tx underlying cancer
72
hyperCa of malignancy PTH-rp path
squamous cell carcinoma of the lung | increase PTH-rp -> increase Ca -> decrease PTH
73
hyperCa of malignancy PTH-rp pt
malignancy and elevated calcium
74
hyperCa of malignancy PTH-rp dx
``` calcium labs - increase PTH-rp - decrease PTH - decrease PO4 increase Ca ```
75
hypervitaminosis D path
granulomatous disease
76
hypervitaminosis D pt
hypercalcemia, chest lesion (TB, sarcoid)
77
hypervitaminosis D dx
calcium labs - increase Ca - decrease PTH - increase PO4 - increase 1,25-vitD
78
hypervitaminosis D tx
treat granulomatous disease
79
hyperCa of immobilization path
old people in nursing homes
80
hyperCa of immobilization pt
old person in nursing home | debility, bed-bound, or post-op
81
hyperCa of immobilization dx
increase Ca decrease PTH increase PO4
82
hyperCa of immobilization tx
mobilization
83
familial hypercalcemia hypocalciuria path
higher set point of calcium
84
familial hypercalcemia hypocalciuria pt
asymptomatic | family history of high Ca
85
familial hypercalcemia hypocalciuria dx
``` calcium labs - increase Ca (11-12) - normal PTH - normal PO4 urine calcium decrease ```
86
familial hypercalcemia hypocalciuria tx
none
87
vitamin D labs and treatment - 25-VitD (D2)
``` lab = CKD med = osteoporosis ```
88
vitamin D labs and treatment - 1,25 VitD (D3)
``` lab = granulomatous disease med = ckd ```
89
hypoPTH path
iatrogenic (thyroidectomy is an error, PTH is physiologic)
90
hypoPTH pt
tetany, Chvostek's sign | perioral tingling, trousseau's sign
91
hypoPTH dx
decrease PTH decrease Ca neutral PO4
92
hypoPTH tx
IV calcium
93
pseudo-hypoPTH hormone path
PTH-insensitivity
94
pseudo-hypoPTH hormone pt
asymptomatic
95
pseudo-hypoPTH hormone dx
increase PTH decrease Ca increase PO4
96
vitamin D deficiency path
dairy | sunshine
97
vitamin D deficiency pt
osteopenia | Dexa scan -2.0
98
vitamin D deficiency dx
25-VitD
99
vitamin D deficiency tx
Ca + vit D Vit D2 (25-VitD) 50000 q Week bisphosphonates (osteoporosis)
100
CKD path
kidney's can't win because they are dead
101
CKD pt
frequent monitoring of electrolytes
102
CKD dx
increase PTH decrease Ca decrease Phos
103
CKD tx
calcimimetics - cinacalcet phosphate binders - sevelamer Ca + VitD3
104
HyperK path
``` hypoaldo (ACE, ARB, spironolactone) artifact iatrogenic ESRD ingestion + CKD ```
105
hyperK pt
asymptomatic
106
hyperK dx
potassium level | EKG = peaked t-waves, wide QRS
107
hyperK tx
if EKG changes -> stabilize, temporize, and eliminate | if no EKG changes -> eliminate
108
treatment of hyperK stabilize
IV calcium - no change in serum K or total K
109
treatment of hyper K temporize
NaHCO3, D50+insulin | - decrease serum K, no change total K
110
treatment of hyperK eliminate
kayexalate, diuretics, dialysis | - decrease serum K and total K
111
hypoK path
``` GI loss - vomiting or diarrhea renal loss - hyperaldosteronism - diuretics (loops) - large volume infusion ```
112
hypoK pt
weakness, paralysis, loss of reflexes or asymptomatic
113
hypoK dx
potassium level | EKG = U waves
114
hypoK tx
``` replete K PO > IV 10mEq increase serum K by 0.1mEq 10mEq/hr by PIV 20mEq/hr by central line ```
115
kidney stones pt
hematuria colicky flank pain that radiates to groin no fever or leukocytosis
116
kidney stones dx
1st: U/A best: non-contrast CT other: U/s if pregnant, KUB if tracking disease
117
kidney stones tx
If < 5mm: IVF + analgesia if < 7mm: MET (CCB, α blocker) if <1.5cm: lithotripsy (proximal), ureteroscopy (distal) if >1.5cm: surgery sepsis: nephrostomy (proximal), stent (distal)
118
kidney stones f/u
strain and analyze stone | 24hr urine for Ca, PO4, urate, oxalate
119
calcium oxalate stone radio
opaque
120
calcium oxalate stone risk
increase Ca - vit D, PTH increase oxalate - decrease red meat, increase fruits & vegetables, increase vitC
121
Mg ammonium phosphate (struvite) stone radio
opaque
122
struvite stone risk
``` pH increase (alkalotic urine) proteus -> urea splitting ```
123
uric acid stone radio
lucent
124
uric acid stone risk
gout, tumor lysis - allopurinol (before) - rasburicase (after)
125
cystine stone radio
lucent
126
cystine stone risk
genetic disorder
127
simple cyst pt
incidental - another test | small, no loculations, no septations
128
simple cyst tx
none
129
complex cyst pt
``` flank mass peel pain hematuria + loculations + septations ```
130
complex cyst dx
CT scan or u/s (pregnant) | biopsy (only if suspicion of cancer is low)
131
complex cyst tx
resection
132
renal cell carcinoma pt
flank mass, flank pain, hematuria cancer (decrease Hgb) paraneoplastic (increase Hgb, EPO) hematogenous spread of mets
133
renal cell carcinoma dx
CT scan or U/s (pregnant)
134
renal cell carcinoma tx
nephrectomy (excisional biopsy)
135
AD polycystic kidney disease path
adults, autosomal dominant
136
ADPKD pt
cysts -> flank mass infection -> pyelo bleed -> hematuria
137
ADPKD dx
CT scan or U/s (pregnant) | biopsy
138
ADPKD tx
supportive -> dialysis or transplant
139
ADPKD f/u
pancreases -> pancreatitis liver -> hepatitis brain = SAH - MRI, CTA
140
AR polycystic kidney disease path
autosomal recessive | entire kidney replaced by cysts
141
ARPKD pt
renal failure day 1 of life flank mass anuric
142
ARPKD dx
u/s | biopsy = radially oriented cysts
143
ARPKD tx
supportive -> death | transplant
144
respiratory acidosis path
hypoventilation
145
respiratory acidosis pt
opiates -> pinpoint pupils, track marks Asthma/COPD -> wheezing OSA -> fat, daytime somnolence
146
respiratory acidosis dx
decrease pH, increase pCO2
147
respiratory acidosis tx
no next step
148
respiratory alkalosis path
hyperventilation
149
respiratory alkalosis pt
pain, anxiety hypoxemia fast RR
150
respiratory alkalosis dx
increase pH, decrease pCO2
151
respiratory alkalosis tx
no next step
152
metabolic alkalosis path
hyperaldosteronism
153
metabolic alkalosis pt
``` volume deplete (diuresis, dehydration, NG tube suction, emesis) other (chloride non-responsive) ```
154
metabolic alkalosis dx
increase pH, increase pCO2
155
metabolic alkalosis tx
urine chloride - UCL < 10 -> fluids - UCL >10 - -HTN: RAS, Conn's - -no HTN: Bartter, Gitelman
156
metabolic acidosis path
gap vs. nonGap
157
metabolic acidosis pt
noncontributory
158
metabolic acidosis dx
decrease pH, decrease pCO2
159
metabolic acidosis tx
AG >12 -> + anion gap - MUDPILES: Methanol, Uremia, DKA, Propylene glycol, Iron/isoniazid, Lactic acid, Ethanol, Salicylates AG <12 -> no anion gap - urine AG: + -> renal tubular; negative -> diarrhea

Online Med Ed (18 decks)

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