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CB Internal Medicine > Renal > Flashcards

Renal Flashcards

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1
Q

Renal tubular acidosis associated with:

abnormal H+ secretion and nephrolithiasis

A

Type 1 (distal) RTA

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2
Q

Renal tubular acidosis associated with:

abnormal HCO3- reabsorption and rickets

A

Type II (proximal) RTA

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3
Q

Renal tubular acidosis associated with:

low aldosterone state

A

Type IV (distal) RTA

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4
Q

What is the treatment of hypernatremia?

A

NS if unstable vital signs

D5W or 1/2 NS to replace free-water loss

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5
Q

What is the differential diagnosis of hypotonic, hypervolemic hyponatremia?

A

1) Cirrhosis
2) CHF
3) Nephrotic syndrome
4) Acute kidney injury (AKI)
5) Chronic kidney disease (CKD)

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6
Q

Chvostek and Trousseau signs present in what electrolyte imbalance?

A

Hypercalcemia

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7
Q

What is the 2 most common causes of hypercalcemia?

A

1) Malignancy

2) Hyperparathyroidism

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8
Q

What electrolyte imbalance presents with T-wave flattening and U waves on ECG?

A

Hypokalemia

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9
Q

What electrolyte imbalance presents with peaked T waves and widened QRS on ECG?

A

Hyperkalemia

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10
Q

What is the treatment of hyperkalemia?

A

C BIG K

Calcium glutinate; bicarb; insulin; glucose; kayexalate

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11
Q

What is the first-line treatment for moderate hypercalemia?

A

IV hydration

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12
Q

Type of AKI in a patient with FeNA < 1%

A

Pre renal

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13
Q

A 49 year old man presents with acute-onset flank pain and hematuria. What is the diagnosis?

A

Nephrolithiasis

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14
Q

What is the most common type of nephrolithiasis?

A

Calcium oxalate

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15
Q

What is the test of choice for nephrolithiasis?

A

Non contrast CT

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16
Q

Ultrasonography shows bilateral enlarged kidneys with cysts. What is the associated brain anomaly?

A

Cerebral berry aneurysms

autosomal dominant polycystic kidney disease, PCKD

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17
Q

What condition presents with:

hematuria, hypertension, oliguria

A

Nephritic syndrome

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18
Q

What condition presents with:

proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema

A

Nephrotic syndrome

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19
Q

What is the most common form of nephrotic syndrome in adults?

A

Focal segmental glomerulosclerosis

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20
Q

What kind of nephritic syndrome presents 3 days after URI (*normal C3)?

A

IgA nephropathy (Beger disease)

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21
Q

What condition presents with:

palpable purpura, arthralgias, abdominal pain

A

Henoch-Schonlein purpura

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22
Q

What condition presents with:

glomerulonephritis with deafness

A

Alport syndrome

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23
Q

What condition presents with:

glomerulonephritis with hemoptysis

A

Granulomatosis with polyangiitis and Goodpasture syndrome

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24
Q

What condition presents with:

red cell casts in urine sediment

A

Glomerulonephritis/ nephritic syndrome

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25
What condition presents with: | eosinophils in urine sediment
Allergic interstitial nephritis
26
What condition presents with: | waxy casts in urine sediment and Maltese crosses (seen with lipiduria)
Nephrotic syndrome
27
What condition presents with: | muddy brown casts
Acute tubular necrosis
28
What condition presents with: | drowsiness, asterixis, nausea, and a pericardial friction rub
Uremic syndrome seen in patients with renal failure
29
Salicylate ingestion occurs in what type of acid-base disorder?
Anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation
30
What acid-base disturbance is commonly seen in pregnant women?
Respiratory alkalosis
31
What complication can occur if you correct hyponatremia too rapidly?
Central pontine myelinolysis
32
What labs will you order for HTN workup?
Urinalysis (protein) Electrolytes (check K+) Cr Fasting blood glucose/ HBA1C Lipid profile 12-lead ECG (looking for end organ involvement)
33
Pt with high blood pressure and low potassium
Hyperaldosteronism
34
Renovascular HTN should be suspected in patients presenting with what? (Renal artery stenosis)
1. Sudden onset worsening of HTN and age <30 or >55 2. Abdominal bruit 3. HTN resistant to 3 or more drugs 4. Rise in Cr of 30% or more with use of ACE or ARB 5. Other atherosclerotic vascular disease (pt smoke, dyslipidemia) 6. Recurrent pulmonary edema associated with HTN surges
35
What do you order if you suspect DM with HTN?
urinary protein excretion
36
What do you order if you suspect renovascular HTN?
renal ultrasound, catopril renal scan, MRA/ CTA
37
What do you order if you suspect endocrine causes?
``` plasma aldosterone (will be high) plasma renin (will be low) or 24hr urine aldosterone if plasma tests not available ```
38
What do you order if you suspect pheochromocytoma?
24h urine for metanephrines and creatinine then CT abdomen
39
What exogenous factors induce HTN?
``` NSAIDs Steroids OCPs Decongestants Calcineurin inhib MAOIs, SSRIs, SNRIs Cocaine Salt Liquorice root Alcohol ```
40
What test can you use to confirm primary aldosteronism?
Saline loading test
41
How do you treat hyper aldosteronism?
Surgery Spironolactone (aldosterone blocker) Triamterene
42
Pigmented granular casts
Acute tubular necrosis
43
How can you differentiate Prerenal AKI from ATN AKI?
FeNa > 1% (ex, 5%) is ATN FeNa < 1% is prerenal (holding onto sodium)
44
What is the urea:creatinine ratio in pre renal azotemia?
2:1
45
Most common cause of nephrotic syndrome in kids
Minimal change
46
Hallmark of nephrotic syndrome
24 urine protein > 3.5g
47
How do you screen for diabetic nephropathy?
Urine albumin to creatinine ratio ACR > 2.8mg/mmol (female), ACR > 2.0mg/mmol (male) consistent with microalbuminuria
48
Is minimal change disease nephritic or nephrotic syndrome?
NEPHROTIC | damage to glomuerli - give steroids
49
Features of nephrotic syndrome ("HELP")
Hypoalbuminemia Edema Lipid abnormalities Proteinuria
50
Features of nephritic syndrome ("PHAROH")
``` Proteinuria Hematuria Azotemia RBC casts Oliguria HTN ```
51
Work up of hematuria
PURE hematuria (vs blood + protein) think urology causes UTI stone bladder tumor RCC (>60yrs) etc Need CBC, urinalysis, ultrasound, cystoscopy, maybe imaging for stones (CT)
52
What is the most common type of primary glomerular disease worldwide?
IgA nephropathy (Bergers Disease) - post URTI - it's actually a nephritic syndrome - compliment level will be normal
53
Difference between IgA nephroparthy and Post-infectious GN?
``` IgA = normal C3 Post-Ifxn = low C3 ```
54
Hallmark of rapidly progressive glomerulonephritis
Fibrous crescents on renal histopathology | also in Goodpastures
55
Rapidly progressive glomerular nephritis type 1 with hemoptysis and dyspnea
Goodpastures Syndrome
56
Purport on buttock and legs, abode pain, arthralgia, fever | IgA and C3 staining of mesangium
HSP | Henoch-Schonlein Purpura
57
c-ANCA is associated with what clinical picture
granulomatosis with polyangiitis | Wegeners
58
p-ANCA is associated with what clinical picture
microscopic polyangiitis
59
patient presents with purpura, fever, Raynaud's phenomenon, arthalgias and Hep C
cryoblobulinemia
60
How will HIV-associated renal disease present?
FOCAL SEGMENTAL GLOMERULONEPHRITIS
61
child who received an antibiotic, now presenting with flank pain, WBC casts in urine and eosinophils in urine
ACUTE tubulointerstitial nephritis
62
patient in ICU who is being treated for sepsis, is hypotensive, with abrupt decline in renal function despite lots of fluids with high FE Na+ and pigmented granular casts
Acute Tubular Necrosis
63
what can you give patients with chronic renal disease who require radiographic contrast? (to prevent ATN)
N-acetylcysteine fay before and day of procedure | IV NaHCO3
64
what is the definition of chronic renal failure
GFR < 60 for >3 months
65
what are the most common causes of chronic renal disease?
1) DM 2) HTN 3) glomerular nephritis
66
what do you have to worry about in adults with polycystic kidney disease?
cerebral aneurysms (causing subarachnoid hemorrhage)
67
what is the best way to reverse uremic signs and symptoms in chronic kidney disease?
renal transplant
68
where is a renal transplant placed anatomically?
iliac fossa (renal artery of kidney goes to recipient external iliac artery)
69
significant benefits in quality of life can occur if dialysis is started before what CrCl?
CrCl < 15 mL/min

CB Internal Medicine (12 decks)

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