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Flashcards in Renal Deck (58):
1

Causes of prerenal AKI

Pump: HF, MI
Leaky Vessels: Cirrhosis, nephrosis, gastrosis
Low volume: diarrhea, dehydration, diuresis, hemorrhage
Tubing issue: RAS, FMD

2

Causes of postrenal AKI

Obstruction leading to hydronephrosis
Ureter:Stones, cancer
Bladder: Stones, cancer, neurogenic bladder
Urethra: Stones cancer, neurogenic, BPH, foley clog

3

Causes of renal AKI

Glomerular issue
Tubular issue (ATN)
Intertitial issue (AIN)

4

Glomerulonephritis

RBC casts on UA -- rule out nephrotic syndrome

5

Nephrotic syndrome

>3.5mg protein, edema, increased cholesterol

6

Acute interstitial nephritis

Caused by drugs (beta lactams) or infection. WBC casts, eosinophils, rash, fever.

7

Acute tubular necrosis

Caused by ischemia, drugs/toxins (iv contrast, myoglobin, aminoglycosides). Brown muddy casts

8

Phases of intrarenal pathology

Prodrome with increased creatinine,
oliguric phase with decreased urine,
polyuric phase with increased urine.

9

How to calculate FeNa?

Clearance of Na/GFR

=Urine Na/Plasma Na * Plasma Cr/Urine Cr

10

Lab findings suggestive of prerenal pathology?

BUN:Cr >20
FeNa

11

Normal GFR

>90

12

Stage II CKD and how to treat

GFR between 60 and 90
Aggressively treat comorbidities = BP

13

Stage III CKD and how to treat

30-59
Aggressively treat comorbidities

14

Stage IV CKD and how to treat

GFR 15-29. Put on transplant list, create AV fistula if symptomatic

15

Stage V CKD and how to treat

GFR

16

Indications for acute dialysis

Acidosis
Electrolyte abnormalities (hyper K)
Ingestion of toxins
Overload
Uremia

17

How to decrease risk of contrast induced nephropathy?

IV NS, or use deiodinated contrast.

18

First step in working up hyponatremia?

Calculate vs measured serum osms

19

How to calculate S Osm?

2Na +Glu/18+Bun/2.8

20

Normal S osm?

270-280

21

How to correct Na if hypertonic hyponatremia?

For each 100 BG above 100, add 1.6 to Na.

22

Causes of euvolemic hyponatremia

RATS
RTA IV
Addisons
TSH
SIADH

23

Action of PTH

PTH maintains level of Ca in blood
Increased PTH activates osteoclasts to increse serum ca,
in kidney, PTH will resorb ca, excrete phos, and convert Vit D to active form to absorb more ca and phos.

24

Correction of ca for albumin

99% of calcium is albumin bound. Normal albumin is 4, if albumin reads 3, then need to add 0.8 to Ca.

25

Signs of hypocalcemia

Tetany, chvostek sign (tap facial nerve), trousseau's sign (bp cuff for 3 mins causes tetany), perioral tingling

26

How to work up hypocalcemia

Check albumin. If it corrects because albumin is low, then check ionized calcium level. If that's low, replete with IV calcium

27

Signs of hypercalcemia?

Stones, moans, bones, psychiatric overtones.

28

How to work up hypercalcemia?

Recheck calcium levels, if normal do nothing.
If high, then give IVF, then calcitonin.
Long term hyperca, give bisphosphonates.

Don't give loop diuretics because this has fallen out of favor.

29

Primary, secondary, tertiary hyperparathyroidism

Primary is autonomous PTH adenoma
Secondary is due to early renal failure
Tertiary hyperPTH is due to multple autonomous adenomas.

30

How does patient with hyperPTH present? Lab values?

Bone pain, pathologic fractures, brown tumors. Increased PTH, increased CA, decreased phos. Don't need vitamin D

31

How to determine 1 from 2 and 3 hyper PTH?

Sestomibi scan.

32

How to treat hyperparathyroidism

Resect and cinacalcet to prevent tertiary hyperparathyroidism

33

Hypercalcemia of malignancy

Cancer can cause hyperca from mets or from PTHrp.
Treat with bisphosphonates.

34

Hypervitaminosis D

From granulomas. Increases Ca, decreases PTH, increases phos

35

Hyper Ca of immobilization

Causes Ca and phos to rise, and pth to decrease

36

Familial Hypercalcemic Hypocalciuria

Asymptomatic increase of calcium with decreased urinary calcium

37

HypoPTH

Usually iatrogenic. Decreased PTH, Decreased Ca. Tx with IV Ca

38

PseudohypoPTH

Due to insensitivity to PTH.
Causes increased PTH, but decreased Ca.

39

Vitamin D deficiency.

Decreased Ca and phos, increased PTH, osteopenia.
Dx with 1,25oh D level
Tx with ca and vitamin d or high dose vitamin D

Also treat with bisphosphonates if severely osteopenic.

40

CKD induced hypocalcemia

Decreased Vitamin D conversion causes decreased Ca and Phos, so increased PTH. (2 hyperparathyroidism)

41

Causes of hyperkalemia

Iatrogenic, trauma, hypoaldosteronemia (acei, arb, spironolactone), ESRD, diet

42

How to work up hyperkalemia

Recheck, then get an EKG, if any changes (peaked T waves, long qrs, give ca gluc, will eventually cause torsades.

If no ekg changes, not emergent so give kayexalate or lasix.

43

Treatment options for hyperkalemia

Insulin w/D50, bicarb or albuterol, decreases EC K but no change inTBK
Kayexalate
Diuretics
Dialysis

44

Hypokalemia

From GI losses or renal losses (hyperaldosteronism, diuretics, barters syndrome, gittleman's)
Ekg shows flat T waves and U waves.

Just replete K. PO is better than IV.

If peripheral

45

How to work up kidney stone?

Do a UA first, no blood, no stone.

Then do spiral CT scan or ultrasound if pregnany

46

How to treat kidney stone

Fluid, pain meds, tamsulosin

47

How to treat kidney stone between 5 mm and 3 cm

Lithotripsy

48

How to treat kidney stone >3cm

Surgery, then later, strain urine and type, followed by 24 h urine catch.

49

Types of stones

Ca oxalate (envelope), radioopaque
Struvite (coffin), radioopaque, proteus
Cysteine (hexagon), radiolucent
Uric acid (rhomboid), radiolucent, gout or increased turnover.

50

Simple renal cyst (pt, dx tx)

Patient: asymptomatic, small no loculations.
No need for diagnostic tests or treatment

51

Complex renal cyst

Patient has a flank mass that can cause infection and hematuria. Evaluate with CT, u/s if pregnant. Then biopsy, tx: resection

52

RCC

Flank mass, increased EPO, hematuria. CT scan or us if prenant. DO NOT BIOPSY.

Tx: nephrectomy, ex vivo pathology.

Spreads hematogenously.

53

ARPKD

Infants. Complete renal failure, aneuric. Dx with ux. Radially oriented cysts.

54

ADPKD

Flank mass, infections, bleeds. CT scan. Biopsy. Supportive then transplant.

55

Minimal change disease

Associated with hodgkins, children

56

FSGS

Associated with blacks, aids, heroin use.

57

Membranous

In whites, hep b and c, solid tumors

58

MPGN

Hep B and C, C3 nephritic factor.