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STEP 2 AG > Renal > Flashcards

Renal Flashcards

(57 cards)

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1
Q

Hematuria where’s the blood coming from

A 
Kidney/ureter = blood the whole time
Bladder = blood at the end
Urethra = blood at the beginning
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2
Q

Urethral stricture

A

Obstructive sx slow urine stream, dribbling, spraying, large postvoid residual, NO UTI SX, cause often unknown

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3
Q

Membranous nephropathy

A

Hep B

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4
Q

Why do we treat pregnant women w asx bacteriuria

A

Prevent pyelo (ureteral smooth muscle relaxes higher risk asc infx), ARDs preterm labor

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5
Q

Stones

A

Don’t see on XR: (SUCCX)

  • Struvite (urease-prod bact)
  • Uric acid (tx K citrate alk urine)
  • Ca 1-3mm (envelope crystals)
  • Cysteine (SIXteen=hexagonal crystals, genetic, COLA, cyanide nitroprusside test)
  • Xanthine

Radiopaque:
- Ca oxalate >3mm

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6
Q

AKI

A

Def=<600mL/24h, Cr inc >50%

Prerenal BUN/Cr>20, UNa<20 appropriately low (kidneys are working), nl UA:

  • hypovolemia (sepsis, DIURETICS)
  • maybe CHF

Intrarenal BUN/Cr 10-15, UNa>40:

  • acyclovir crystals direct damage to tubules 24-48h
  • AIN rx (blactams other abx, PPI >7 days after start the rx) OR systemic dz, WBC casts
  • ATN ischemic injury, can be 2/2 hypovolemia, Uosm >300, UNa >20, FeNa >2% (kidneys suck), give fluids MUDDY BROWN CASTS
  • Glomerulonephritis RBC CASTS (+/- few WBC)

Postrenal hydronephrosis:

  • BPH
  • cancer
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7
Q

Blunt abd trauma, pelvic injury PERITONITIS

A

Bladder dome rupture (ant wall and neck of bladder are extraperitoneal)

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8
Q

W/u for recurrent UTIs in kids

A 
US:
<2 yo
2+ UTIs
Family hx renal dz
Abx don’t work

Voiding cystourethrogram:
Newborn <1 mo
2+ UTIs
Not E. coli

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9
Q

Diabetic glomerulosclerosis course

A

1 Glomerular hyperfiltration —> intraglom hypertension ACEi reduce htn
2 BM thickening
3 mesangial expansion
4 nodular sclerosis

DM nephropathy Screening check microalbumin (dipstick detects protein >300, in DM have protein 30-300)

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10
Q

Nocturnal enuresis

A

> 5 yo, lifestyle, alarm, desmopressin

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11
Q

Indications to remove a stone

A

Time >1mo
Size >1cm
Stuck (complete obstruction)
Sick (AKI, sepsis, PAIN)

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12
Q

Sickle cell TRAIT kidney stuff

A

Hypostenuria (kidney can’t concentrate the urine)
Renal papillary necrosis (hematuria)
Rhabdo

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13
Q

SSRI

A

SIADH!

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14
Q

Posterior urethral injury

A

Pelvic fx, blood in urethral meatus, perineal hematoma, inability to urinate, high-riding prostate, dx retrograde urethrography

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15
Q

Proteinuria in a preggo

A

Physiologic = trace, dec Cr, hypotens

Diabetic nephropathy = >300 or 1+ protein, inc Cr, hypertension, if <20w likely preexisting

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16
Q

Polycystic kidney disease

A

AD
B/l masses, berry aneurysms, hepatic cysts, INTERMITTENT recurrent b/l flank pain (w/ gardening) +/- hematuria, early onset HTN

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17
Q

HYPERKALEMIA!! Treatment

A

IF >7 or EKG changes —> Give calcium gluconate or chloride NOT CARBONATE, insulin + glucose, inhaledB2 agonists

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18
Q

Drug to help pass a kidney stone

A

Tamsulosin a1 antagonist
Bethanechol cholinergic tx for retention
Oxybutinin antichol tx for OAB

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19
Q

Drugs that cause hyperK

A

Notoriously Bad Potassium
NSAIDs
BP drugs (ACEi, ARB, amiloride, Bb, spironolactone)

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20
Q

Symptomatic hyponatremia (encephalopathy)

A

6-8 per 24h, if iatrogenic from hypotonic fluids can give hypertonic

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21
Q

Interstitial cystitis

A

Clean UA, pain, tx supportive

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22
Q

Mixed acid-base disorders compensatory

A

Metabolic acidosis, CO2 should be lower to compensate—> CO2=1.5(HCO3) + 8 +-2
Metabolic alkalosis—> CO2 INC 0.7/1 HCO3 >28
Respiratory acidosis—> bicarb INC 1/10 acute, 4/10 chronic
Respiratory alkalosis—> bicarb DEC 2/10 acute, 5/10 chronic

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23
Q

Nephrotic syndrome increases risk of

Study These Flashcards
A

Atherosclerosis

24
Q

Renal artery stenosis

Study These Flashcards
A

ACEi, ARB, no stent

25
Bladder cancer
Unilateral hydronephrosis w/o a stone
26
Electrolyte changes w vomiting
Low K, H, Cl | Increased bicarb —> metabolic alkalosis
27
Calciphylaxis (calcifications uremic arteriolopathy)
ESRD on HD, kidney transplant Hyperphosphatemia, hyper-PTH, hyper/normal Ca Calc of arterioles and soft tissue —> ischemia and necrosis
28
Hypernatremia
IF HYPOVOLEMIC, give NS (0.9%) saline until euvolemic, then hypotonic (0.45% saline or D5)
29
Dx of pyelonephritis or renal abscess in kids
Abd US (not CT, rad)
30
RCC
Flank pain, hematuria, abd mass L sided varicocele that DOES NOT reduce w recumbancy Paraneoplastic (thrombocytosis, polycythemia/anemia)
31
Von Hippel-Lindau
RCC, CNS hemangioblastomas (cerebellum, retina), pheo | AD
32
Main risk factor for UTI in women vs men
Shorter urethra
33
Hyperventilation acid-base stuff
Low CO2 —> decreased bicarb, decreased H+ in urine —> alkaline urine
34
Hepatic cyst benign vs malignant
Benign —> homogenous, non-enhancing, non-septated, no loculation, asx, usually incidental, provide reassurance
35
Coagulopathy in ESRD patients
Platelet dysfxn, prolonged BT, DDAVP inc VIII:vWF multimer release from endothelial cells
36
SIADH tx
Na <120 = severe, +symptoms —> hypertonic saline (3%) | Not severe —> fluid restriction +/- salt tabs
37
DM nephropathy, amyloidosis, membranous nephropathy, MCD, membranoproliferative glomerulonephritis, FSGS, IgA
DAMMM you FIne DM nephropathy: hyalinosis af+ef arterioles Amyloidosis: abnl proteins/inflamm (RA) vs lambda light chains (MM Waldenstrom) congo red apple green birefringence MCD: kids>adults NSAIDs Hodgkin lymphoma MN: cancer (breast, lung) hep B, NSAIDs, SLE MPGN: Hep B/C, lipodystrophy (type 2=anti-C3 convertase IgG) FSGS: HIV, heroin, obesity, race AA or Hispanic IgA: URI granular deposits
38
Familial hypocalciuric hypercalcemia
High serum Ca, normal-high PTH, low urine Ca/Cr clearance <0.01 Ddx hyperPTH, will have urine Ca >0.02
39
Tx for recurrent calcium stones
Low sodium, low protein, fluids, NORMAL Ca, thiazide
40
Tx hypercalcemia
>14 +/- sx—> NS + calcitonin, if can’t get fluids (CHF, RF) HD, bisphos later (MM, but worry about that LATER)
41
MC cause of potter sequence
Posterior urethral valves
42
Ethylene glycol vs methanol
Both: AG gap + osmolal gap met acidosis (2xNa + glucose/18 + BUN/2.8, nl <10), tx fomepizole Ethylene glycol kidneys (Ca oxalate crystals in UA, hypoCa) Methanol eyes
43
Farmer
Organophosphate poisoning
44
DKA/HHS
Often precipitated by infx (UTI) 30-40%, dehydration 2/2 osmotic diuresis, Na may be normal IT CAN STILL BE DKA IF GLUCOSE IS 250, iso saline bolus 10mL/kg x 1h, ins + K <5.2 gluc <200
45
Na correction hyperglycemia
+2 for every 100>100
46
Hyponatremia
sOsm <275, hypovolemic GI (UNa<40) OR renal (UNa>40), euvolemic psychogenic (uOsm<100) OR SIADH (uOsm>100, UNa>40), hypervolemic CHF sOsm >295 hyperglycemia, mannitol, lipids
47
Nephrogenic diabetes insipidus
Criteria: UOsm<300, >50mL/kg/d, urine spec grav <0.01 Etiology: kidneys don't respond to ADH Sx: nl-high Na
48
Renal infarct
wedge-shaped lesion on CT, flank pain, n/v (+/- fever), hematuria + protein no casts
49
Lithium toxicity
GI, tremor, ataxia, sz, Rx NSAIDs, metronidazole ACEi, tetracyclines HCTZ Prenatal: Ebstein's anomaly (enlarged RV, ASD)
50
Renal vein thrombosis
Pt w cancer, ***COMPLICATION OF NEPHROTIC SYNDROME*** enlarged kidney, UA isolated hematuria, LDH, causes hypercoagulability (loss of protein C, S), AC or AKI surg thrombolytics
51
Kidney stone w/u
US, CT NO CONTRAST
52
Renal tplant complications
ROCA BUM rejection, occlusion (vascular, ureteral), cyclosporine, ATN Bx, US, MRI tx for rejection = steroids
53
MUDPILES
``` Methanol Uremia DKA Propylene glycol Iron/Isoniazid Lactic acidosis Ethylene glycol Salicylate (tinnitus) ```
54
Iron poisoning
<6yo GI losses=hypovolemic shock corrosive hematemesis, radiopaque XR tx deferoxamine
55
Alport syndrome
Type IV collagen, kidney probs + SN hearing loss
56
PSGN
1-4w, immune complexes (vs IgA during or days after illness)
57
Normal lactate
<1 (<2 if critically ill)

STEP 2 AG (16 decks)

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