Renal Flashcards
(139 cards)
1
Q
What are the 6 D’s of hypernatremia?
A
Diuresis Dehydration DI Docs (iatrogenic) Diarrhea Disease
2
Q
What is the treatment for hypernatremia if hypovolemic with hemodynamic instability?
A
NS
3
Q
What is the equation for free water deficit?
A
total body water x ([serum Na/140] - 1)
4
Q
What fluids should be used to replace free water deficits with hypernatremia?
A
D5W or PO water
5
Q
What is the rate of free water replacement with hypernatremia? Over how long?
A
0.5 mEq/hr over 48-72 hours
6
Q
What is the diagnosis for hypernatremia with:
-Urine osmolality less than 100
A
Central DI
7
Q
What is the diagnosis for hypernatremia with:
-urine osmolality 100-300
A
Nephrogenic DI
8
Q
What is the ddx for hypernatremia with:
-High urine osmolality (over 600)
A
Extrarenal losses (v/d) Na gain (hypertonic saline)
9
Q
What is the calculation for serum osmolality?
A
2[Na] + glucose/18 + bun/2.8
10
Q
What is the general treatment for hypervolemic and euvolemic hyponatremia?
A
Water restriction +- diuretics
11
Q
How fast should hyponatremia be corrected in a day?
A
No more than 8 mEq/L/day
12
Q
Correcting hyponatremia too fast can cause what?
A
Central pontine myelinolysis
13
Q
When is hypertonic saline always indicated for the treatment of hyponatremia?
A
If seizing and below 120
14
Q
What are the causes of isotonic hyponatremia? (4 substances)
A
Hyperlipidemia
Hyperproteinemia
Glucose
Mannitol
15
Q
What are the causes of hypertonic hyponatremia? (3 substances)
A
Glucose
Mannitol
Contrast agents
16
Q
What are causes of hypovolemic hyponatremia when U[Na] is LESS than 10?
A
Loss of water
- v/d/NG suction
- Skin losses
- 3rd spacing
17
Q
What are causes of hypovolemic hyponatremia when U[Na] is MORE than 10?
A
Inappropriate loss of free water (Na follows water)
- Diuretics
- Urinary obstruction
- Addison’s
- Bicarbonaturia
18
Q
What are causes of isovolemic hyponatremia when urine osmolality is over 100? (4)
A
Producing concentrated urine inappropriately
- SIADH
- Drugs
- Hypothyroidism
- Glucocorticoid deficiency
19
Q
What are causes of isovolemic hyponatremia when urine osmolality is under 100? (2)
A
Excreting excess free water
- Psychogenic polydipsia
- Beer potomania
20
Q
What are causes of hypervolemic hyponatremia when U[Na] is LESS than 10? (3)
A
too much water, and holding onto too much water
- CHF
- Cirrhosis
- nephrotic syndrome
21
Q
What are causes of hypervolemic hyponatremia when U[Na] is MORE than 10? (3)
A
Too much volume, not holding onto electrolytes
- AKI
- CKD
22
Q
Which type of RTA causes hyperkalemia?
A
III
23
Q
Which HTN drug (besides diuretics) can cause hyperkalemia?
A
beta blockers
24
Q
What are the three major, non-specific s/sx of hyperkalemia?
A
- Areflexia
- Weakness
- Intestinal colic
25
What are the ECG changes associated with hyperkalemia?
Tall, peaked T waves
Wide QRS
PR prolongation
26
Over what level does hyperkalemia require emergent treatment?
6.5 mEq/L
27
What are the components of the C BIG K mnemonic for the treatment of hyperkalemia?
- Calcium gluconate
- Bicarb / beta-2 agonists
- Insulin
- Glucose
- Kayexalate
28
What other mineral deficiency needs to be corrected prior to correcting K?
Mg
29
What are the non-specific s/sx of hypokalemia?
- Muscle weakness
- Ileus
- Hyporeflexia
30
What are the ECG manifestations of hypokalemia?
- T wave flattening
- U waves
- ST segment depression
31
What are the components of the CHIMPANZEES mnemonic for causes of hypercalcemia?
- Ca supplementation
- hyperPTH or hyperthyroidism
- Iatrogenic
- Milk-alkali syndrome
- Paget's disease
- Adrenal insufficiency
- Neoplasm
- ZE syndrome
- excess vit A
- excess vit D
- Sarcoid
32
What is the the effect of loop diuretics on Ca levels?
Lose calcium
33
What are symptoms of hypercalcemia?
- stones
- Bones
- Abdominal groans
- Psychiatric overtones
34
What are the ECG findings associated with hypercalcemia?
Short QT
35
What is the treatment for hypercalcemia? What is 2/2 granulomatous diseases?
- IV hydration
| - Steroids for granulomatous diseases
36
What are the s/sx of hypocalcemia?
- Abdominal cramps
- Tetany
- Perioral and acral paresthesias
37
Chvostek and Trousseau's sign are seen with what derangement of calcium (high or low)?
HypOcalcemia (O face)
38
What two tests are the most fruitful for the workup of hypocalcemia?
PTH
| Ionized Ca
39
What are the ECG manifestations of hypocalcemia?
Prolonged QT
40
What is the treatment for hypocalcemia, besides "treating the underlying disorder"?
Mg and Ca supplements
41
What are the three major causes of hypomagnesemia?
- Decreased intake (short bowel syndrome, TPN)
- INcreased loss (diarrhea, alcoholism)
- DKA
42
What is the formula for correcting Ca levels for hypoalbuminemia?
Corrected = total serum + 0.8*(4-serum albumin)
43
What are the components of the MUDPILERS mnemonic for the causes of anion gap metabolic acidosis? What is the treatment for each?
- Methanol: fomepizole
- Uremia: dialysis
- DKA: insulin/fluids
- Paraldehyde/phenformin
- Iron, INH: lavage, charcoal
- Lactic acidosis: IVF
- Ethylene glycol: fomepizole
- Rhabdo: IVFs
- Salicylates: alkalinize urine (Na bicarb)
44
Hypomagnesemia will not allow for correction of what metabolic disorders?
Hypokalemia
| Hypocalcemia
45
Urine Ca oxalate crystals are nearly pathognomonic for what intoxication?
Ethylene glycol
46
What will a fundoscopic exam show with methanol poisoning?
Optic disc hyperemia
47
What is renal tubular acidosis?
Decrease in H+ secretion or HCO3 reabsorption by the kidneys, leading to a non-anion gap metabolic acidosis
48
What is the definition of AKI?
Abrupt decrease in renal function (elevation in Cr), and decreased urine output
49
What is Winters formula (both mathematically, and conceptually)?
PaCO2 = 1.5(HCO3) + 6 +/-2
| Used in metabolic acidosis to determine if there is more than one acid/base disorder present
50
What are the following value with RTA type II:
- Defect
- Serum K
- Urinary pH
- Etiologies
- Treatment
- Complications
- Defect = cannot secrete H+
- Serum K = low
- Urinary pH = over 5.3
- Etiologies = AUtoimmune disorders
- Treatment = replace HCO3
- Complications = nephrolithiasis
51
What are the following value with RTA type I:
- Defect
- Serum K
- Urinary pH
- Etiologies
- Treatment
- Complications
- Defect = Cannot absorb HCO3
- Serum K = Low
- Urinary pH = 5.3 initially, but lower once serum is acidic
- Etiologies = multiple Myeloma, amyloidosis
- Treatment = Thiazides,
- Complications = rickets, osteomalacia
52
What are the following value with RTA type IV:
- Defect
- Serum K
- Urinary pH
- Etiologies
- Treatment
- Defect = aldosterone deficiency or resistance
- Serum K = High
- Urinary pH = Less than 5.3
- Etiologies = Hyporeninemic, hypoaldosteronism
- Treatment = Furosemide, mineralocorticoid replacement
53
What are the components of the AEIOU for indications for urgent dialysis?
- Acidosis
- Electrolyte abnormalities
- Ingestions
- Overload
- Uremic symptoms
54
What is the definition of CKD?
More than 3 months of GFR less than 60 mL/min
55
What is the treatment that has been shown to prevent progression of CKD?
ACEIs/ARBs
56
What is the treatment for abnormal bleeding 2/2 CKD?
Desmopressin (DDAVP)
57
What is the treatment for hyperphosphatemia and hypocalcemia in CKD respectively?
- Hyperphosphatemia = sevelamer (phosphate binder)
| - Hypocalcemia = calcinet (or Ca)
58
How long does creatinine take to spike following contrast use? Drug use?
- Contrast = 5-10 days
| - Drugs = 24 hours
59
A postvoid residual of how much is characteristic of postrenal azotemia?
More than 50 mL
60
What is the FeNa with pre, post, and intra renal?
```
Pre = less than 1%
Intra = Over 2%
Post = 1-2%
```
61
What is the urine sodium for pre, intra, and post renal?
```
Pre = Less than 20 mEq/L
Intra = over 40
Post = over 40
```
62
What is the urine osm for pre, intra, and post?
```
Pre = Over 500
Intra = less than 350
Post = less than 350
```
63
What urine sediment findings are characteristic or prerenal, and intrarenal etiologies of AKI?
```
Pre = Hyaline casts
Intra = eosinophils for interstitial, muddy brown casts for ATN
```
64
What is the treatment for prerenal, intrarenal, and postrenal AKI?
```
Pre = fluids AEIOU
Intra = IVF or d/c offending meds
Post = Cath
```
65
Postinfectious glomerulonephritis presents how soon after infection? What serum findings?
2-6 weeks
| Low C3
66
What are the C3 levels with IgA nephropathy? How soon after infection?
Few days after infection, normal C3
67
What are the classic symptoms of the following disorders:
- Granulomatosis with polyangiitis (Wegener's)
- Microscopic polyangiitis
- Churg strauss
- Granulomatosis with polyangiitis (Wegener's) = kidney, lung and sinuses
- Microscopic polyangiitis = Kidney and lung
- Churg strauss = kidney and asthma
68
What happens to H+ reabsorption with CAIs?
Increased
69
What are the major side effects of CAIs?
- Hyperchloremic metabolic acidosis
| - sulfa allergy
70
What are the loop diuretics? (4)
- Furosemide
- Ethacrynic acid
- Bumetanide
- Torsemide
71
Which loop diuretic is NOT a sulfa drug?
Ethacrynic acid
72
Which diuretics are ototoxic?
Loops
73
Which diuretics cause hyperuricemia?
Loops
74
Which diuretics can raise blood glucose levels?
Thiazides
75
Which diuretics can cause a metabolic acidosis? Alkalosis? (2 for each)
```
Acidosis = K sparing, CAIs
Alkalosis = thiazides and loops
```
76
What are the three major K sparing diuretics?
- Spironolactone
- Triamterene
- Amiloride
77
What is the ddx of nephrotic syndrome with low C3 levels? (3)
Postinfectious
Membranoproliferative
Lupus nephritis
78
Palpable purpura + arthralgias + nephritic/nephrotic syndrome, low C3, and + HCV = ?
Mixed cryoglobulinemia
79
What causes the hypercoagulable state with nephrotic syndrome?
Loss of antithrombin III
80
What is the treatment for poststreptococcal (postinfectious) glomerulonephritis?
SUpportive
81
What is the treatment for IgA nephropathy?
Glucocorticoids for select pts
| ACEIs in pts with proteinuria
82
What is the classic triad of HSP?
Palpable purpura
Arthralgias
Abdominal pain
83
What are the s/sx of granulomatosis with polyangiitis (Wegener's granulomatosis')?
- granulomatous inflammation of the respiratory tract with hemoptysis
- *nasopharyngeal involvement*
- Necrotizing vasculitis of the kidney
84
What is the antibody that is present with granulomatosis with polyangiitis?
c-ANCA
85
What is the treatment for granulomatosis with polyangiitis? (3)
HIgh dose corticosteroids
cytotoxic agents
Rituximab
86
What is microscopic polyangiitis? s/sx? Antibody? Treatment?
- Small vessel vasculitis similar to GPA, but NO granulomas
- Similar to GPA, but NO nasopharyngeal involvement
- p-ANCA
- Glucocorticoids
87
What is eosinophilic granulomatosis with polyangiitis (Churg-strauss)? S/sx (4)? Antibodies present? Treatment?
- Small vessel vasculitis
- Asthma, sinusitis, skin nodules, neuropathy
- p-ANCA, IgE
- Glucocorticoids
88
What are the s/sx of Goodpasture syndrome?
- Hemoptysis
| - NO URI involvement
89
What is the treatment for Goodpasture?
- Plasma exchange therapy
| - Pulsed steroids
90
What are the histologic findings of Goodpasture? CXR?
- Linear anti-GBM deposits
- Hemosiderin filled macrophages in sputum
- CXR with infiltrates
91
What level of proteinuria is diagnostic of nephrotic syndrome? What is the best way to detect this?
More than 3.5 g/day
| Use spot protein-to-creatinine ratio
92
What is the treatment for nephrotic syndrome, in general?
Protein and salt restriction
DIuretics
ACEIs
93
What vaccine should be administered to pts with nephrotic syndrome?
PPV23
94
Review Pathoma nephrotic syndromes
And nephritic syndromes
95
Spike and dome appearance on kidney bx = ?
Membranous
96
Tram track appearance on kidney bx = ?
membranoproliferative
97
Nephritic syndrome in a HIV positive african american man with a h/o sickle cell disease and heroin use =?
FSGS
98
Which nephrotic syndromes are associated with HBV/HCV, SLE?
Type I membranoproliferative glomerulonephropathy
| Membranous nephropathy
99
What size of kidney stones can be treated with ESWL?
0.5 - 3 mm
100
What is the only radiolucent kidney stone?
Uric acid
101
What sort of urinary pH predisposes to calcium phosphate vs calcium oxalate stones?
```
Phosphate = high pH
Oxalate = Low pH
```
102
Why is lowering calcium intake not recommended for the treatment of calcium oxalate stones?
Leads to hyperoxaluria, which pulls Ca into urine. Thus want to INCREASE Ca.
103
What is the treatment for uric acid stones?
Hydration,
| Alkalinize the urine with citrate
104
What are the amino acids that are lost with cystinuria?
Cystine
Ornithine
Arginine
Lysine
105
What urinary pH predisposes to uric acid stones? Cystine?
Uric acid = lower pH
| Cystine - Low pH
106
What are the extrarenal manifestations of ARPKD?
Liver fibrosis
Portal HTN
Cysts in pancreas, liver
107
What are the extrarenal manifestations of ADPKD?
*cerebral aneurysms*
| Cysts in pancreas, liver
108
What are the s/sx of polycystic kidney disease?
Pain and hematuria
HTN
Hepatic cysts
109
What is the treatment for PKD?
Prevent complications and decrease the rate of progression to ESRD
110
What are the GFRs for stages 1-5 of ESRD?
```
1 = over 90 mL/min
2 = 60-90
3 = 30-60
4 = 15-30
5 = less than 15
```
111
What are the two major painless etiologies of scrotal swelling?
Hydrocele
| Varicocele
112
What are the two major painful etiologies of scrotal swelling?
epididymitis
| Testicular torsion
113
What is the Prehn sign? What does it indicate?
Decrease pain with elevation of the testicle
| Indicative of epididymitis, and not torsion
114
When should a hydrocele resolve by/when is surgery indicated?
By 1 year
115
What are the medications that can cause ED?
- beta blockers
- SSRIs
- TCAs
- Diuretics
116
What are the accompanying signs of neurologic causes of ED?
- No anal tone
| - Loss of lower extremity sensation
117
What are the labs that should be obtained with ED?
- Testosterone and gonadotropin
| - Prolactin
118
What are the top four causes of cancer death in men, in order?
1. Lung cancer
2. Prostate
3. Colorectal
4. Pancreatic
119
What sort of bone lesions does prostate cancer cause?
Osteoblastic
120
What is the treatment for prostate cancer?
- Watchful waiting if old
| - Radical prostatectomy or brachytherapy
121
What are the components of the I PEE RBCS for the ddx of hematuria?
```
Infection
PKD
Exercise
External trauma
Renal glomerular disease
BPH
CA
Stones
```
122
What are the two major risk factors for bladder cancer?
- smoking
| - Aniline dyes
123
How do you diagnose bladder cancer?
Cystoscopy with bx
124
What is the diagnosis that should be suspected in a middle smoker with a left-sided varicocele?
RCC
125
What is the treatment for bladder carcinoma in situ?
Intravesical chemo
126
What is the treatment for superficial bladder cancer?
COmplete transurethral resection of intravesical chemo with HCG
127
What is the treatment for invasive bladder cancer with mets?
Chemo
128
What is the treatment for RCC?
Surgical resection
129
beta-hCG in men = what cancer?
Choriocarcinoma
130
What genetic abnormality is associated with testicular cancer?
Klinefelter
131
What is the most common testicular cancer between 15-30?
Seminomas
132
Which type of testicular cancers respond extremely well to chemo?
Seminomas
133
What is the tumor marker for: seminomas?
Placental ALP
134
What is the tumor marker for: Yolk sac tumors
AFP
135
What is the tumor marker for: choriocarcinoma
beta-hCG
136
What is the tumor marker for: testicular teratomas
AFP and/or beta hCG
137
What is the tumor marker for: Leydig cell tumors
Testosterone and estrogen
138
What is the tumor marker for: sertoli cell tumors
None
139
What is the tumor marker for: testicular lymphomas
None
