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Flashcards in Renal Deck (26):
1

lab findings of analgesic nephropathy

elevated creatinine

hematuria

proteinuria

pyuria w/ WBC casts

microcytic anemia (likely due to GI blood loss from NSAID-induced chroinc gastritis irritation)

2

lab findings of acute glomerulonephritis

elevated creatinine

hypertension

proteinuria

hematuria w/ dysmorphic RBCs

RBC casts

3

38F G3P3 p/w post-void dribbling, followed by dysuria and dyspareunia. PE demonstrates anterior vaginal wall fullness. UA pos for nitrites, leuk esterase, RBCs, and WBCs. History significant for nitrites, leuk esterase, RBCs, WBCs

Diagnosis?

best diagnostic test?

acquired diverticulum of urethra - usually secondary to maternal birth trauma or instrumentation of the urethral tract

(remember the 3D's dribbling, dysuria, dyspareunia)

best test: TVUS 

4

gross hematuria following an acute URI

IgA nephropathy

5

electrolyte abnormality associated with hyperative DTRs

hypoactive DTRs

hyperative DTRs = hypocalcemia

hypoactive DTR = hypomagnesium

6

patient with SLE develops hematuria, proteinuria. WHat is the appropriate next step in management?

how would you monitor disease burn?

get a renal biopsy and start IV methylprednisolone

serum complement or anti-dsDNA

7

management of blood pressure in patients w/ ADPKD

regular BP checks

BP goals < 130/80

ACEi (controls BP and prevents progression to renal failure)

8

most common extra-renal manifestations of ADPKD

hepatic cyst

9

screening modality for asymptomatic family members of a patient w/ ADPKD

Abdominal US

10

long-term risk of kidney donation

gestational complications in female donors of childbearing age (fetal loss, pre-eclampsia, gestational diabetes, gestational HTN)

11

which electrolyte abnormality can cause a paralytic ileus?

k

12

what is the first line intervention for enuresis when behavioral modifications fail?  second line intervention?

which intervention has the best long-term outcome?

1st line: enuresis alarm (best long-term outcome)

2nd line: desmopressin

13

first test to do when patient presents with enuresis

rule out anything that can be causing the enuresis with a UA (specific gravity, glucosuria, infection)

14

Patient comes in with a symptomatic ureteral stone. What are the indications for a urology consult vs discharge?

urology consult: urosepsis, acute renal failure, complete obstruction, stone size >10mm

15

when is contrast induced nephropathy (CIN) typically seen? how long does it last?

within 2-3 days of contrast exposure

lasts 5-7 days

16

Patient w/ chronically elevated serum creatinine - what would be the most important diagnostic step and why?

management?

get UA/urine protein to assess extent of proteinura, as it affects prognosis and treatment in patients with CKD; considered significant beginning at levels of 500-1000mg

BP goal: 130/80, reduce proteinuria to with ACEi/ARB to <500mg/day

17

T/F hypercalcemia is associated with chovstek's sign, hyperpigmentation, seizures, muscle weakness, and hypotension

FALSE - it is HYPOcalcemia that presents w/ these facts.

18

Patient develops HTN after kidney transplant. How can you assess if there is renal artery stenosis in the transplanted kidney?

diagnostic imaging?

give ACEi - can cause marked increase in serum creatinine after initiation of  ACEi

abdominal duplex doppler US

19

when is antibiotic prophylaxis considered in women with urinary tract infections?

for women with:

>2 UTI in 6 months

or

>3 UTI in 1 year

20

diagnostic test if you suspect renal artery stenosis

abdominal duplex doppler US

21

when is a VCUG indicated?

all children <24 months w/ UTI should undergo renal/bladder US to evaluate for anatomic abnormalities that may predispose to UTIs

children w/ abnormal US (hydro, reflux, obstruction) or recurrent UTIs should undergo VCUG

(not indicated for patients with first time UTIs)

22

What is absolutely required prior to treating any sexually active female who presents UTI? 

(doesn't actually happen in real life, only on Step 3)

pregnancy test - it will determine her treatment

TMP-SMX is pregnancy risk category C/D - affects folate metabolism during pregnancy

Cipro - pregnancy category risk C - affects fetal arthropathy

23

what is the preferred UTI treatment for pregnant women?

cephalexin

amoxicillin

nitrofurantoin

you CAN treat pregnant women with these antibiotics!

24

Feeding severe alcoholics is associated with this electrolyte abnormality

HYPO-phosphatemia - patients w/ severe alcoholism often have chronic depletion of phosphate secondary to decreased vitamin D and phosphate intake along with decreased intestinal intake in those with chronic diarrhea

Despite the phosphate depletion, serum levels are maintained (extracellular shift) until IVF w/ glucose is administered. This results in insulin secretion, which causes a shift of phosphate intracellularly. 

Hypophosphatemia can result in rhabdomyolysis and patients often complain of new-onset of weakness. Important to trend CPK

25

how to differentiate between SIADH and polydipsia as a cause of hyponatremia?

check urine osmolality

in SIADH, urine osmolality is very high (aka concentrated, higher than serum osmolality)

in polydipsia, urine osmolality is very low (aka diluted, lower than serum osmolality)

26

patient w/ RCC - how do you determine if patient can undergo partial vs radical nephrectomy?

if the mass is confined within the renal capsule - partial

if the mass extends through the renal capsul but not beyond gerota's fascia - radical