Renal 2 Flashcards
(105 cards)
1
Q
MCC of painless hematuria (evaluation)
A
bladder cancer
if older than 35 –> CT and cytoscopy
2
Q
gross hematuria - prostate?
A
BPH
not cancer
3
Q
hematuria - best initial test
A
urinalysis to rule out and confirm microhematuria (more than 3 RBCs)
4
Q
reccomendations for patient with renal calculi
A
- increased fluids
- low sodium
- normal calcium
5
Q
medication that cause urinary retention (and manegment)
A
anticholinergics
stop them + cathetirization
6
Q
osmolar gap?
A
measured serum osm - calculated serum osm
7
Q
causes of combination of osmolar gap and and high anion gap met acidosis
A
acute ethanol (MC)
methanol
ethylen glycol
8
Q
methanol toxicity
A
blindness
9
Q
oliguria means
A
less than 250 ml in 12 hours
10
Q
management of acute oliguria
A
bedside bladder scan to assess for urinary retention
- retention (MORE THAN 300 ml) –> catheter to decompress –> serum + urine bioch +/- image –> treat underling
- no retention –> serum + urine bioch +/- image:
a. pre-renal (IV fluids or treat underling)
b. renal cause -> treat underling
11
Q
hepaternal vs pre-renal
A
hepatorenal does not respond to fluids
12
Q
hepatorenal syndrome treatment
A
- address precipitating factor
- splachninc vasoconstrictor
- liver transplantation
13
Q
MCC of death in dyalisis patients
A
Cardiovascular
14
Q
MCC of death in patients with renal transplantation
A
cardiovascular
15
Q
MC extrarenal manifestation of ADPKD
A
hepatic cysts
16
Q
GI complication of ADPKD
A
colonic diverticula
17
Q
aspirin intoxitation - ph
A
normal
18
Q
GI symptoms of ureteral colic
A
vagal reaction –> ileus
19
Q
medication to fascilate stone passage
A
a1 blocker (tamsulosin) –> act on distal ureter
20
Q
bladder cancer screening
A
not recommended (even if RFs)
21
Q
management of ureteral stones
A
symptomatic relief –> urosepsis, acute renal failure or complete obstructiion?
yes –> urology consult
no –> stone siize:
less than 10 mm –> hydration pain control, a blocker
bigger than 10 –> urology consult
uncontrolled pain or no stone passage in 4-6 weeks –> urology consult
22
Q
MC nephrotic syndrome associated with thromboembolism
A
membranous nephropathy
23
Q
lithium - hemodialysis?
A
if more than 4, or more than 2.5 with signs of toxicities
24
Q
simple vs malignant renal cyst in contrast CT
A
only malignant has enhancement
25
causes of asterixis
1. Hepatic encephalopathy
2. Uremic encephalopathy
3. CO2 retention
26
SIADH - management
fluid restriction +/- salt tablets
if severe: hypertonic (3%) saline
if refractory --> demeclocycline
27
GI loses - K+
both vomiting and diarrhea causes hypokelamia
28
medications that can cause hyperkalemia
1. β-blockers
2. ACEi
3. K+ sparing diuretics
4. digitalis
5. cyclosporin
6. heparin
7. NSAID
8. succinylcholine
9 . Trimethorpime
29
NSAID mediated hyperkalemia - mechanism
decreases renal perfusion --> decreased K delivery to the collecting ducts
30
Heparin mediated hyperkalemia - mechanism
blocks aldosterone production
31
Cyclosporine mediated hyperkalemia - mechanism
blocks aldosterone activity
32
Trimethoprime mediated hyperkalemia - mechanism
blockage of epithelium Na2+ channel in the collecting ducts --> also blocks the creatinine secretion (artificially), without affecting the GFR
33
causes of edema in nephritis
FLUID RETENTION
34
urinary retention due to anticholinergics
detrusor hypocotractility
35
medications that causes SIADH
SSRI, carbamazepine, Cyclophosphamide, NSAID
36
psychiatric disorder associated with 1ry polydipsia
schizophrenia
37
nephrotic syndrome can cause accelerated atherosclerosis - mechanism
1. loss of anthothrombin III
2. due to low albumin, liver overproduce lipid proteins
affects veins more (esp renal veins)
38
severe hyperkalemia - best initial step
calcium gluconate --> then insulin, glucose, HCO3-, β-agonists
39
hyperkalemia - ECG
- tall peaked T waves with short QT
- PR prolongation + QRS widening
- No P waves
- conduction block, ectopy, or sine wave pattern
40
metabolic acidodis - give HCO3-?
if ph less than 7.1
41
hypokalemia in alcohoics is refractory - why
hypogmagnesemia (removal of inhibition of renal excretion)
42
stones - best initial test
U/S (NOT URINALYSIS)
43
best options for renal transplantation
in order
1. living related donor
2. living unrelated
3. cadaveric
44
drug induced intestitial nephritis - treatment
stop the related drug (not steroids)
45
glomerular vs non glomerulal hematuria regarding type
- glomerular usually microscopic, also proteins and casts adn dysmorphic RBCs
- nonglomerular usually gross
46
SE of acyclovir on kidneys (treatment)
crystaluria --> renal tubular obstruction
| administer fluids with the drug
47
etiology of crystal induced acute kidney injury
```
acyclovir
sulfonamides
MTX
ethylene glycol
protease inh
Uric acid
```
48
clinical presentation of crystal induced acute kidney injury
usually asymptomatic
AKI in less than 7 days from the starting drug
hematuria, pyuria, crystals
49
treatment of crystal induced induced acute kidney injury
stop medication
fluids
loop duretics
50
urinalysis - blood?
cannot distinguish Hb from myoglobin
51
post-void redidual volume in obstruction
more than 50 ml in men and 150 in women
52
renal transplantation - treatment if signs of rejection
IV steroids
53
renal transplant dysfunction - causes
1. utreteral obstruction (U/S to rule out)
2. cyclosporine toxicity (drug level)
3. vascular obstruction (renal biopsy)
4. acute tubular necrosis
acute rejection is treated with IV steroids
54
treatment of hypernatriemia
hypovolemic: O.9% saline (but if mild can give 5% dextrose in 0.45 saline)
euvolemic: hypotonic
correction no more than 1 meq/L/h
55
MCC of renal artery stenosis
HTN
56
cocaine - acute renal failure?
due to rhabdomyolisis (CPK causes ARF if more than 20.000)
57
the quickest way to low the K+
insulin
58
evaluation of met alkalosis
urine chloride
low --> vomiting / NG aspiration, prior diuretics (SALINE RESPONSIVE)
high --> hypervolemia (aldosterone) (SALINE UNRESPONSIVE)
hypovolemia/evolemia: current diuretics (SALINE RESPONSIVE) Barrter, gitelman (SALINE UNRESPONSIVE)
59
Most sensitive screen for nephropathy
RANDOM urine for microalbumin/creatinine ratio
| 24h is more accurate but it is inconvenience
60
advantages of renal transplantation over dyalysis
1. better survival + quality
2. autonomic neuropathy stabilzes or improves in diabetics
3. return to normal endocrine, sexual and reproductive functions
2. anemia, bone disease and hypertension better control
61
evaluation of hyponatremia
serum osm more than 290?
yes --> marked hypogl / advanced renal failure
no --> urine osm less than 100?:
- yes (polydipsia, malnutriotion)
- no --> check urine sodium
if if less than 25 --> SIADH, adrenal ins, hypoth
if it is more than 25 --> vloume depltion, cirrhosis, CHF
62
how to correct low Na+
3% salide solution
| not exceed 0.5 mEg/L/hr to
63
characteristic of varicoceles due to underlying mass pathology
unilateral varicoceles that fail to empty when a patient s recumbent
64
mechanism of hepatorenal syndrome
splanchnic arterial dilation, decreaesd vascular resistance, local renal vasocnstriction with decreased perfusion
65
postictal lactic acidosis
anion gap metab acidosis following a tonic clonic seizure --> resolves in 90 mins without treatment
66
post-streptoc vs IgA nephropathy regarding complement
low C3 in post-strept
| normal in IgA
67
reduce Ca intake - stones
reduce ca intake increases oxalate absorption
68
GFR in DM
increases in the beginning (hyperfiltration)
| then goes down
69
recommendations for blood tranfusion
under 7: always
7-8: if cardiac surgery, HF, oncology patients in treatment
8-10: symptomatic anemia, noncardiac surgery, ongoing bleeding, ACS
70
indications for urgent dialysis
1. refractory acidosis with ph under 7.1
2. volume overload refractory to diuretics
3. symptomatic uremia (bleeding, encephalopathy, pericarditis
4. ingestion: toxic alcohols, salicylate, lithium, sodium valproate, carbamazepine
5. elect abnormalities: severe or symptomatic hyperkalemia refractory to medications
71
skin in cyanide toxicity
cherry red flashing, cyanosis comes later
72
treatment of hypertension and renal artery stenosis
ACI are indicated for iniitlay therapy
renal artery stenting or surgical revasculization is resewed for patients with resistant HTN or recurrent flash pulm endam and/or refractory HF due to severe hypertension
BE VERY CAREFUL IF BILATERAL
73
MCC of abnormal hemostasis in patients with chronic renal failure / characteristics / treatment
platelet dysfunction
BT in elevated. PT and PTT are normal
desmoprasin is the treatment
(no transfusion)
74
nephrotic syndrome - anemia?
iron resistant microcytic hypochromic anemia
| DUE TO TRANSFERRIN LOSS
75
Most frequent vessel manifestation of nephrotic syndrome
venous thrombosis
76
asymptomatic or mild hypercalcemia
no immediate treatment required
| avoid thiazide, lithium, volume depletion + prolonged bed rest
77
moderate hypercalcemia - treatment
usually no immediate treatment required unless symptomatic
| - similar to severe
78
severe hypercalcemia - treatment
```
short term (immediate) treatment
- normal saline + calcitonin
- avoid loop diuretics unless volume overload
Long term
- bisphosphonate
```
79
pyelonephritis treatment
- outpatient: fluoroquinolones
- inpatient: IV antibiotics (fluoroquinolone, aminoglycoside +/- ampicillin)
- urine culture prior to treatment
80
uncomplicated cystitis - treatment
- Nitrofurantoin for 5 fays (avoid if pyelonephritis or Cr clearance less than 60)
- TMP - sxm for 3 days
- fosfomycin (single dose)
- fluoroquinolones (2nd option)
- Culture only if initial treatment fails
81
complicated cystitis - treatment
- fluoroquinolones (5-14d),
- extended spectrum antibiotics (ampicillin/gentamycin) for for severe
- culture before
82
when is complicated cystitis
DM, kidney disease, pregnancy immunocompromised, urinary tract obstruction, hopsital acquired, assoiacetd with procedure, indwelling foreign body
83
treatment of uric acid stones
1. hydration
2. alkalinization of urine (POTASSIUM CITRATE)
3. low-purine
diet
4. allopurinol if resistant
84
how to alkalinize urine in uric acid stones
potassium citrate
85
grades of hypercalcemia - grade
severe (more than 14) or symptomatic)
moderate: 12-14
mild or asymptomatic (less than 12)
86
amiloride mediated hyperkalemia - next step
change the medication
| low diet K+ does not change anything
87
analgesic nephroapathy
MC form of drug induced chronic renal failure
| Papillay necrosis + chronic tubulointestitial nephritis are the MC pathologies seen
88
bladder outlet obstruction (eg. from BPH) - next step
renal U/S to assess function and check for hydronephrosis
89
Interstitial cystisis (bladder pain syndrome) - epidimiology
- More common in women
| - associaed with psychiatric + pain disorders (eg. fibromyalgia)
90
interstitial cystitis (bladder pain syndrome) - clinical presentation
1. bladder pain with filling, releif with voiding
2. urinary frequency + urgency
3. Dyspareunia
91
interstitial cystitis (bladder pain syndrome) - diagnosis
- bladder pain with no other cause for 6 or more weeks
| - normal urinalysis
92
interstitial cystitis (bladder pain syndrome) - treatment
1. not curative: focus to improve quality of lide
2. behavioral modification, avoid triggers, physical therapy
3. TCA, pentosan polysulfate sodium
4. Analgesics for acute exacerbations
93
which 2 lab values provide the best picture for acid-base status
pH + pCO2
| HCO3- can be calculated fro henderson hesselbach equation
94
acute kidney injury causes acidosis - anion or non anion gap
both:
anion gap: uremic toxins
non-anion gap: impaired acid excretion
95
Obstructive uropathy - presentation
1. flank pain
2. low-volume voids iwth or without occasonal high-volume voids
3. if bilateral: renal dysfunction
96
Genitourinary manifestations of diabetic autonomic neuropathy
1. erectile dysfunction + retrogratde ejaculation in men, decreased libio + dyspareunia in owmen
2. decreased ability to sense full bladder leading to incomplete emptying + decreased urination
3. eventu`al reccurent UTI and /or overflow incontinence (dribbling, porr urinary streem
97
urate stones shape
needle
98
how to evaluate uric acid stones
CT or U/S or IV pyelography
99
hyperakalemia - acute therapy if
1. more than 7
2. ECG changes
3. rapid rising
100
renal stones - high volume urination?
intermittent episodes of high volume urination can occur when obstruction is overcome by a large volume of reatained urine (post-obstructive) --> can lead to potassium wasting and dehydration --> weakness
101
postoperative oliguria with inconclusive scan - next step
folley
102
postoperative oliguria means
less than 0.5ml/kg/hr
103
suspect renal ca - next step
CT
104
IGA nephropathy - when is the resp infection
concurrent
105
aspirin ph - process
resp alkalosis early --> metabolic acidosis later
