Quiz 2 - Nephropathies Flashcards Preview

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Flashcards in Quiz 2 - Nephropathies Deck (39)
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1
Q

Diabetic nephropathy pathophy

A

1) glycosylation of proteins damage GBM (thickening)

2) Hemodynamic changes leads to glomerular hypertrophy (sclerosis)

2
Q

Diabetic nephropathy RFs

A

family hx, advanced age, concurrent HTN, poor glycemic control (>6.5%
HbA1c levels), ethnicity (blacks, Mexican-Americans, Pima Indians—often due to socioeconomic factors) obesity, smoking, oral contraceptives

3
Q

Diabetic nephro ssxs

A

albuminuria, occ hematurra

4
Q

Diabetic nephropathy monitoring

A

**Microalbumin (random am sample or 24 hr collection)

Normal: 0-30 mg/d
Microalbuminuria: 30-300mg/d
Macroalbuminuria > 300 mg/d

**HbA1c

**ophthalmic + podiatry exams

5
Q

Target values for DM pts

HbA1c
FPG
peak PPG
BP
lipids
A
A1C≤ 6.5%
FPG <110 mg/dl
peak postprandial PG <140 mg/dl
BP < 130/80mmHg
 Lipids LDL <100, <70 mg/dl

in pts with CAD, HDL: >40 mg/dl men, >50 mg/dl women, TG: <150 mg/dl

6
Q

Diabetic nephropathy natural TX

A
Ginkgo—protective against damage to glomerulus
Flax and pumpkin seed
Curcumin—antioxidant, renal protective
Guggul
Chromium 
Alpha lipoic acid, Vaccinium
7
Q

Renovascular HTN secondary to

A

atheroscleorosis (secondary to HTN)

8
Q

Renovascular HTN pathophys

A

Reduced blood flow causes affected kidney(s) to secrete renin, retain NaCl and H2O – inc BP

9
Q

Renovascular HTN ssxs

A

HTN ssxs

PE: Abdominal bruit over renal A

10
Q

Renovascular HTN complications:

A

left ventricular hypertrophy, hypertensive retinopathy

11
Q

Labs Renovascular HTN

A

Severe HTN with progressive renal insufficiency, refractory to aggressive therapy, malignant HTN, elev creatinine

12
Q

Captopril challenge test

A

administer ACE-i to watch effect on plasma renin

13
Q

Tx Renovascular HTN

A

1) Control BP with meds:
2) Percutaneous angioplasty w stent
3) Surgical reconstruction of damaged artery
4) Surgical bypass of renal arteries
5) Treat atherosclerosis: guggal, garlic, EFAs, B vits
6) Vascular protectants: bioflavonoids, vaccinium

14
Q

Benign hypertensive nephrosclerosis cause

A

chronic HTN

15
Q

Renal artery occlusion/ thromboembolism

A

Leads to flank pain, abdominal pain, fever, N&V
Hematuria. Acute renal failure may develop
Seen on CT angiography

16
Q

Renal vein thrombosis causes

A

hypercoagulability, nephrotic syndrome, amyloidosis, estrogen therapy, pregnancy, SLE
Seen on US and MR venography

17
Q

NEPHROPTOSIS RFs

A

excessive weight loss, frequent intense physical activity

18
Q

Nephroptosis Ssxs

A

severe abdominal, costovertebral, flank pain and vomiting in upright position from

1) acute hydronephrosis kinked proximal ureter
2) renal vessel lumen narrowing and resultant ischemia
3) visceral nerve stimulation from traction

19
Q

Dietl Crisis

A

severe colicky flank pain, nausea, vomiting, chills, tachycardia, oliguria, hematuria and proteinuria
Pain relieved with upward movement of kidney, supine position

20
Q

Nephroptosis work-up

A

US, IV urography

21
Q

Nephroptosis Tx

A

surgical nephropexy, wear truss

22
Q

Simple cysts ssxs

A

Flank or back pain, intermittent and dull; Fever and malaise if infected
Abdominal mass, may be palpable or percussed, tender if infected

23
Q

Simple cysts Tx

A

Leave alone
If infected: antimicrobial tx, may need percutaneous drainage
Surgical excision if obstructing ureter

24
Q

ADPKD SSx:

A

Pain over both kidneys due to infection, obstruction, hemorrhage, “drag” from heaviness
Gross or microscopic hematuria; nocturia
HTN (retinopathy can develop)
Palpable, nodular kidney(s)
Developing renal insufficiency: HA, N&V, weight loss
If infected: fever, chills, tender kidney(s)

25
Q

ADPKD Imaging

A
  1. US Most cost effective``
  2. CT
  3. MRI can differentiate RCC from cysts
26
Q

ADPKD complications

A
Gross hematuria
Nephrolithiasis (20%)
Hypertension
ESRF
Increasing, intractable pain
Other possible findings in this population
27
Q

ADPKD Tx

A

Low protein diet – 0.5-0.75 g/kg/d
Force fluids to 3000 ml or more per day (to suppress plasma vasopressin)
Restrict caffeine
Flax oil
Reasonable physical activity – avoid strenuous activity or contact sports
reat uremia, stones, infection when present
Screen for and treat HTN.
Poss tx: dialysis, renal transplantation
cystic decompression (for pain)
Constitutional HP: tumors, cystic—Baryta carb, Calc carb, Phos
Constitutional hydro
Conventional drug trials: somatostatin, everolimus (mTOR inhibitor)

28
Q

ADPKD prognosis kids

A

poor.

29
Q

ARPKD assoc with

A

biliary dysgenesis. Leads to hepatomegaly and portal hypertension in most cases

30
Q

ARPKD severity

A

may lead to death in newborn

may lead to ESRD and the need for Ki transplant by age 10 or 15.

31
Q

Von-Hippel Lindau syndrome

A

Autosomal Dominant

retinal angiomas, hemangioblastomas, pheochromocytoma, islet cell tumors, renal cysts, epididymal cysts

32
Q

Tuberous sclerosis

A

CNS + heart, skin, lung lesions

seizures, mental retardation, adenoma sebacum

33
Q

Renal Cell Carcinoms RFs

A

Cigarette smoking
Hypertension
Chronic analgesic use
Obesity:
Toxin exposure (Cd, asbestos, Pb, gasoline and petroleum products, PAHs)
Cytotoxic chemotherapy use in children (for malignancy, autoimmune dz)
HCV
Sickle cell disease
itrites in diet, prior radiation therapy, use of oral contraceptives
High coffee intake, animal fat diet, dialysis, hysterectomy, contrast IV

34
Q

RCC mets to…

A

lung

also, bones, LNs, adrenals, kidney

35
Q

RCC ssxs “classic triad”

A

gross hematuria, flank pain, palpable abd mass

ssxs of paraneoplastic syndrome

36
Q

RCC Tx

A

1) Partial or Radical nephrectomy for localized stage I & II (<4cm tumor size)
2) Chemo and radiation —not proven effective
3) Biologic response modulators, eg interleukin-2 therapy, interferon alpha
4) Molecularly Targeted Therapies:
5) Pre- and post-surgical support tissue healing nutrients, modified citrus pectin
6) Adjuvant naturopathic care—health, nutrition optimization
8) Note: Clinical trials underway for RCC vaccination: TroVax

37
Q

Nephroblastoma

A

“Wilm’s Tumor”

mixed malignant. Seen in children 3-4 yrs

38
Q

Neohroblastoma ssxs

A

Presents as abdominal swelling, abd pain, hypertension, N&V, constipation,
Loss of appetite, SOB

39
Q

mets to kidney from…

A

lung, breast, stomach, renal