OME - Nephro

Question 1

Respiratory acidosis is a result of what?

D/t what causes?

Answer 1

Hypoventilation

Opiates, COPD, asthma, OSA, muscle weakness (GB)

Question 3

What defines CKD stage IV?
Need to to do what?

V?
Need to do what?

Answer 3

Severe, GFR 15-29
Prepare for dialysis/transplant —> put AV fistula

Kidney failure, GFR < 15
Dialysis or DIE

Question 4

MUDPILES = ?

Answer 4

Methanol
Uremia
DKA
Propylene glycol 
INH/Iron 
Lactic acidosis
Ethylene glycol
Salicylates

Question 5

What are the 3 effects of PTH?

Answer 5

1 - activates osteoclasts to clear bone: Inc Ca, Inc P
2 - directly reabsorbs Ca, excretes P in the kidney
3 - indirectly absorbs Ca and P from the gut via Vit D

Question 6

Acid/Base disturbance question for resp acidosis, what is the 1st step?

2nd?

3a?

3b?

3c?

Answer 6

Check pH, < 7.4 = acidosis

Resp or Metabolic —> look at CO2, normal is 40

Check AG

Acute (.08) or chronic (.04): 7.4 - (dimes *.04/.08) for CO2
1 or 3 for bicarb

Is there metabolic derangement?
24 + (dimes * 1/3) = expected bicarb

Question 8

What does pancreatitis cause in reference to calcium?

Answer 8

Calcium sequestration:

Dec Ca, Inc PTH, Dec PO4

Question 10

At what size will kidney stones pass spontaneously?

What size req medical therapy?
What meds?

What size for lithotripsy?

What size surgery?

Answer 10

0.5 mm

0.7 mm
Amlodipine or Terazosin

< 1.5 cm

> 1.5 cm

Question 13

Best Treatment for hypokalemia?

If treating it and still doesn’t change do what?

Answer 13

PO > IV

Check Mg levels

Question 15

Metabolic acidosis determined, what is the next step?

Then what?

Also have to check what?

Answer 15

AG

Is CO2 appropriate for bicarb: Winter’s formula
Expected CO2 = 1.5*bicarb + 8 +/-2

Another metabolic derangement?
Take AG - 12, then take that number and add it to the # of Bicarb you have. Take that total and then compare it to normal bicarb of 24, (> 24 = alkalosis, < 24 = acidosis)

Question 16

Severe Hypo/hyper natremia has what symptoms?

To fix Hypo do what?

To fix Hyper?

Answer 16

Coma, seizures, death

IV Hypertonic Saline (3%)

IV D5W

Question 18

Hypertonic hyponatremia may occur in diabetics, how must you correct?

Answer 18

Every 100mg/dL of glucose above 100, adult for Na by 1.6 Increase

Ex: 500 bG = 4 x 1.6 Na, add 6.4 Na to given level

Question 19

Multiple adenomas of the parathyroid glands means what?

Due to what?

What lab values?

Answer 19

Tertiary hyperparathyroidism

Chronic RF

Inc PTH
Inc Ca
Dec P

Question 22

What is winter’s formula?

Used for what?

Answer 22

Expected CO2 = 1.5*bicarb + 8 +/-2

Metabolic acidosis derangement + another Respiratory disturbance

Question 24

ADPKD can produce what other symptoms?

What are the extrarenal manifestations?

Answer 24

Pain, hematuria
Malignant HTN d/t activation of RAS

Cirrhosis, pancreatitis, SAH

Question 25

The decision for dialysis is based on what?

Answer 25

AEIOU
Acidosis 
Electrolytes (Na/K)
Ingestion (toxins)
Overload (CHF, edema)
Uremia (pericarditis)

Question 26

What is another name for kayexalate?

Used for what?

Answer 26

Sodium polystyrene sulfonate

Elim K+ in the stool

Question 28

Pt that has euvolemic hyponatremia, what could be the causes?

Answer 28

RATS
RTA
Addison’s
Thyroid
SIADH

Question 29

What is the serum osmolar equation?

Normal is what?

Answer 29

(2xNa) + (glucose/18) + (BUN/2.8)

280

Question 30

Moderate Hypo/hyper natremia has what symptoms?

To fix Hypo do what?

To fix Hyper?

Answer 30

N/V/HA

IV NS

IV NS

Question 31

Secondary hyperparathyroidism due to what?

Lab values:
PTH
Ca
P
Vit D?

Treat how?

Answer 31

Renal Failure, Vit D NOT Made

Inc PTH
Dec Ca
Inc P
Dec Vit D

Cinacalcet

Question 32

What does pseudohypoparathyroidism mean?

Lab values:
PTH
Ca
P

Answer 32

PTH-end organ RESISTANCE

Inc PTH
Dec Ca
Inc P

PTH is not working properly

Question 33

Resp alkalosis, what is the difference bw it and resp acidosis in terms of adjusting?

Answer 33

Find acute/chronic

Then adjust expected bicarb of:
24 - (dimes x 2) acute
24 - (dimes x 4) chronic

Question 34

Pt that has Non-Gap Acidosis w/hypokalemia can only be caused by what?

Answer 34

RTA

Diarrhea

Question 35

What is meloxicam?

What can it cause?

Answer 35

NSAID

AKI

Question 36

Pt w/metabolic acidosis w/NON-AG, what is next step? If + means what? If - means what?

Answer 36

Urine AG RTA Diarrhea

Question 37

What has radially aligned cysts in the kidney? Presents how?

Answer 37

ARPKD At birth w/oliguria/Anuria

Question 38

How to calculate Urine AG?

Answer 38

URINE Na + K - Cl

Question 39

Symptoms of hypercalcemia? Treatment? If need to be very aggressive? BEST long-term tx?

Answer 39

Stones, bones, groans, psychic moans (AMS) LOTS of IVF Calcitonin Bisphosphonates

Question 41

Complex cyst found on US, next step?

Answer 41

Surgery to remove

Question 42

Pt that has a large kidney stone (> 3cm) and rising Cr, what is the next step? Then what?

Answer 42

Nephrostomy tubes to bypass stone Then surgery

Question 43

What causes Familial Hypocalciuric hypercalcemia? Lab values: Ca PTH Diagnose How?

Answer 43

Abnormal CaSR Inc Inc FHx and LOW Urine Ca

Question 46

What causes metabolic alkalosis? Check what next? If low what? High?

Answer 46

High aldosterone Urine Chloride (<10), Pt is volume responsive —> give IVF (>10), not volume, check for HTN —> RAS/Conn’s OR Bartter/Gitelman (if no HTN)

Question 48

What presents w/flank pain, hematuria, and flank mass? 1st step in workup? Next? What may be some additional problems?

Answer 48

RCC UA, then CT/US Renal vein thrombosis, anemia, polycythemia

Question 51

How to confirm Dx of kidney stones? If pregnant?

Answer 51

Non-Con CT US

Question 52

Respiratory alkalosis is a result of what? D/t what causes?

Answer 52

Hyperventilation Pain, anxiety, hypoxemia (PNA, PE, ARDS)

Question 53

How do you account for Ca levels when albumin is below 4?

Answer 53

Every 1 point below 4 add back 0.8 Ca Normal Ca is 10

Question 57

What is the cause of secondary hyperparathyroidism? Lab values of: P? Ca? PTH? Treat how?

Answer 57

Kidney failure —> phosphate retention, Vit D def Inc P Dec Ca Inc PTH Phosphate binders - sevelamer Calcimimetics - cinacalcet

Question 58

Typical pt presentation for kidney stones? Workup starts with what?

Answer 58

Colicky flank pain that radiates to the groin N/V Hematuria UA

Question 65

When do you need 1,25-Vit D to make a diagnosis in parathyroid cases? Will be what? Ca? P? PTH?

Answer 65

Granulomatous disease (Sarcoidosis, TB) High High High Low

Question 67

What are the 3 stages of treatment in HyperK+?

Answer 67

I - stabilize myocardium: give IV Calcium gluconate II - dec serum K: give insulin and glucose III - decrease total body K: Kayexlate or loop diuretics

Question 68

What are the 3 main causes of intrarenal AKI? What distinguishing characteristics of each?

Answer 68

ATN - muddy brown casts AIN - wbc, wbc casts GN - rbc casts (glomerular diseases)

Question 73

What defines CKD stage I? II III?

Answer 73

GFR > 90 Mild, GFR 60-89 Mod, GFR 30-59

Question 76

What SE does EPO have in ESRD pts?

Answer 76

Worsens HTN

Question 83

Post-renal failure caused by what? Results in what? Diagnose how?

Answer 83

Obstruction to outflow Hydroureter/Hydronephrosis US

Question 86

What substances can be dialyzed?

Answer 86

``` SLIME Salicylates Lithium Isopropanol Methanol / Mg Ethylene glycol ```

Question 88

What is the cause of pre-renal AKI? Due to what? What lab values?

Answer 88

Decreased perfusion Dec CO, 3rd spacing, Dec vessel diameter UNa < 10, FeNa < 1%, BUN/Cr > 20

Question 90

What lab values indicate intra-renal AKI?

Answer 90

BUN/Cr < 10 UNa > 20 FeNa > 1%

Question 91

Type 1 RTA has what urine pH? K+ status? Pathology?

Answer 91

> 5.5 Hypokalemia Alpha-intercalated cells canNOT secrete H+

Question 92

Type 2 RTA has what urine pH? K+ status? Path?

Answer 92

< 5.5 Hypokalemia PCT defect of HCO3 reabsorption

Question 93

Type 4 RTA has what urine pH? K+ status? Path?

Answer 93

Urine pH < 5.5 HyperKalemia D/t hypoaldosteronism or CKD (DM pts) Prevents CD from generating NH4+ Will have low bicarbonate