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Medicine Boards - Erica > Renal > Flashcards

Renal Flashcards

(51 cards)

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1
Q

Balkan Endemic Nephropathy

A

Tubulointerstitial disease (fibrous) 2/2 aristocholic acid (endemic to Balkans, also in wt loss supplements). Increased risk transitional cell carcinoma of renal pelvis, ureter, bladder

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2
Q

Type 4 RTA etiologies

A

Aldosterone deficiency or resistance
Mild-mod CKD 2/2 diabetic nephropathy
Chronic interstitial nephritis: SLE or AIDS
Acute GN
Meds: NSAIDS, calcinuerin inhibs, ACE inhibitors, heparin, trimethoprim

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3
Q

Type 4 RTA presentation

A

Hyperkalemia
Normal serum AG
Impaired urine acidification (=positive urine AG)
Urine pH

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4
Q

Type 4 RTA w/u

A

Plasma renin activity
Serum aldosterone
Serum cortisol

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5
Q

Type 1 RTA presentation

A

Hypokalemia
Normal serum AG
Impaired urine acidification (=positive urine AG)
Urine pH >5.5

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6
Q

Type 2 RTA presentation

A

Hypokalemia (secondary hyperaldosteronism)
Glycosuria (w normal plasma glucose)
Low molecular weight proteinuria
Phosphaturia
Normal=negative urine AG since urine able to appropriately excrete acid

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7
Q

Thin glomerular basement membrane disease

A

persistent hematuria, normal kidney function, and positive family history of hematuria without kidney failure

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8
Q

Low C3

A 
Post strep GN
Membranoproliferative GN
SLE
Infection related GN
Cryoglobulinemic vasculitis (C4 often low too)
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9
Q

Normal C3

A 
IgA nephropathy
IgA vasculitis (aka Henoch Schonlein purpura)
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10
Q

Age to start doing cystoscopy for hematuria

A

35yo, unless smoker, exposure to cyclophosphamide or analine dye

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11
Q

Cutoff for treatment of hypertension based on ambulatory BP monitoring

A

135/85 awake, 125/75 asleep

Use average BP

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12
Q

When to start combo anti-HTN

A

20/10 above goal BP

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13
Q

Aminoglycoside nephrotoxicity features

A

Onset w/in 5-10d
Non-oliguric
Granular casts in the urine

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14
Q

Gitelman mimics

A

thiazide diuretic

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15
Q

oncogenic osteomalacia

A

2/2 benign soft tissue tumor -> overexpression of FGF-23
bone pain/increased alk phos/osteomalacia/fractures, hypophosphatemia, renal phosphorus wasting, low 1,25-dihydroxy VitD w normal 25-hydroxy Vit D

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16
Q

trimethoprim Cr effect

A

can raise Cr by 0.5 based on change in secretion, not decrease in GFR

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17
Q

FeNa/FeUrea cutoffs for pre-renal

A

FeNa 2% likely ATN

FeUrea

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18
Q

Treatment class IV SLE nephritis

A

IV steroids plus IV MMF or IV cyclophosphamide

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19
Q

Orlistat renal effects

A

Increased intestinal uptake of oxalate -> oxalate nephropathy

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20
Q

Acquired cystic kidney disease

A

increases with time in ESRD/on HD. large number of small bilateral kidney cysts, reduced kidney size, and a markedly increased (30x) risk for developing renal cell carcinoma

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21
Q

5 types of cardiorenal syndrome

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A

1) acute heart failure leading to acute kidney injury (AKI) (CRS1), 2) chronic heart failure leading to chronic kidney disease (CKD), 3) AKI leading to acute heart failure, 4) CKD leading to cardiac dysfunction (heart failure, coronary artery disease, arrhythmias), and 5) systemic conditions leading to simultaneous heart and kidney dysfunction (such as sepsis)

22
Q

HTN prior to 20th week of pregnancy?

23
Q

Gestational HTN

Study These Flashcards
A

Begins after 20th wk of pregnancy and must resolve w/in 12wks postpartum

24
Q

Reset osmostat

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A

stable, mild hypo-osmolar hyponatremia 2/2 downward setting of the level at which sensors of plasma osmolality trigger the release of antidiuretic hormone and is associated with quadriplegia, tuberculosis, advanced age, pregnancy, psychiatric disorders, and chronic malnutrition

25
Metabolic compensation for respiratory acidosis
Increase bicarb by 1-2 for every 10mmHg increase in pCO2. After 24-48hrs, increase bicarb by 3-4 for every 10mmHg increase in pCO2
26
Causes FSGS
chronic hypertension, diabetes mellitus, progressive kidney disease, obesity, sickle cell disease, reflux nephropathy, or after nephrectomy, drugs (pamidronate, interferon), HIV
27
When to screen for intracranial aneurysms in ADPKD
1. family history of aneurysm or subarachnoid hemorrhage 2. previous rupture 3. high-risk occupations in which a rupture would affect the lives of others.
28
Type 1 RTA associated conditions
genetic causes, autoimmune disorders (Sjogren's, AA hepatitis, primary biliary cirrhosis, SLE, RA), nephrocalcinosis/hypercalciuria, dysproteinemias, drugs/toxins (ifosamide, amphotericin B, lithium, ibuprofen), and tubulointerstitial disease
29
Henoch Schonlein purpura AKA
IgA vasculitis
30
Bartter syndrome mimics
Loop diuretic | metabolic alkalosis, hypokalemia, and normal to low blood pressure with mild volume depletion
31
Tx calcium oxalate stones
maintain UOP >2L/d and adequate calcium intake cholestyramine to bind oxalate in the gut to decrease absorption if low urine citrate -> alkalinize with potassium citrate
32
Compensation for respiratory alkalosis
Acute: Decrease HCO3 by 2 for every 10mmHg decrease in pCO2 | Chronic (after 24-48hrs): Decrease HCO3 by 4-5 for every 10mmHg decrease in pCO2
33
Delta delta ratio
delta AG/ delta HCO3 delta AG = AG - 12 (=normal AG) delta HCO3 = 25 - HCO3 if delta delta ratio less than 1 likely combo of anion gap metabolic acidosis plus non anion gap metabolic acidosis if delta delta ratio >2 -> combo of anion gap metabolic acidosis plus metabolic alkalosis
34
Hypophosphatemia symptoms
weakness, myalgia, rhabdomyolysis, arrhythmias, heart failure, respiratory failure (diaphragmatic weakness), seizures, coma, and hemolysis
35
Sx of D lactic acidosis
intermittent confusion, slurred speech, ataxia, and an increased anion gap metabolic acidosis with a normal plasma lactate level
36
Assessment of volume status in metabolic alkalosis
Urine Cl >15: saline-responsive metabolic alkalosis causes include vomiting, remote use of diuretics, and post-hypercapnic metabolic alkalosis
37
Tumor lysis electrolyte findings
Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia
38
Primary vs secondary FSGS
Primary: hypoalbuminemia, extensive foot process effacement on biopsy -> consider immunosuppression Secondary: enlarged glomeruli, minimal edema, rarely full picture of nephrotic syndrome -> ACE/ARB plus treatment of underlying condition
39
Cholesterol embolization AKI
peripheral eosinophilia, hypocomplementemia, inflammation/eosinophiliuria, digital ischemia/infarction, can have livedo reticularis
40
Osmolal gap
Difference between measured osms and calculated osms. If high gap, think methanol, ethylene glycol, sorbitol, mannitol, significantly elevated lipids, paraproteins Calculated osms = 2xNa + urea + glucose + ethanol (optional)
41
Treatment suspected ethylene glycol intoxication
1. fomepizole (competitively inhibits alcohol dehydrogenase) | 2. bicarb if pH
42
Acquired hypokalemic periodic paralysis associated condition
Thyrotoxicosis, esp in men of Asian or Mexican descent | Can also be hertiable
43
Hypokalemic periodic paralysis precipitants
Exercise Carbohydrate rich meal -> sudden intracellular shift of potatssium
44
Goal BP chronic HTN in pregnancy
More liberal: 120-160/80-105 mm Hg | different than in pre ecclampsia
45
Water restriction test
Use: confirm DI, differentiate central vs nephrogenic Procedure: restrict water, measure hourly urine volume, urine osmolality, and plasma sodium concentration Interpretation: if serum Osms don't increase to >600 -> DI Then give desmopression. If central -> serum Osms will increase. If nephrogenic -> serums Osms will not increase
46
Goal HCO3 in CKD
23-29 (reduces risk of progression of CKD)
47
Proteinuria equivalents for pre ecclampsia
thrombocytopenia (platelet count 1.1 or a doubling of the serum creatinine concentration in the absence of other kidney disease) impaired liver function (elevated blood concentrations of liver aminotransferases to twice the normal concentration) pulmonary edema cerebral or visual symptoms
48
Iron study goals ESRD
Transferrin sat >30% Ferritin >500 (KDIGO recommends IV iron)
49
Differentiate primary vs secondary membranous glomerulopathy
antibody to the phospholipase A2 receptor (PLA2R) if positive: more likely primary secondary causes: malignancies (solid organ cancers, especially lung, colon, and breast), autoimmune diseases (such as lupus or mixed connective tissue disease), infections (hepatitis B and C), and medications (penicillamine, gold, and NSAIDs)
50
Treatment calcium-based nephrolithiasis
HCTZ
51
Treatment uric acid nephrolithiasis
maintain UOP >2L/d alkalinize urine w K citrate allopurinol if refractory

Medicine Boards - Erica (11 decks)

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