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Flashcards in Renal & GU Deck (236):
1

best initial test in nephro

- urinalysis
- BUN
- Cr

2

urinalysis consists of

1. dipstick if positive
2. microscopic analysis

3

normally excrete which protein

Tamm Horsfall (30-50mg/24hrs)

4

transient proteinuria

BENIGN, 2-10% of population

5

benign causes of proteinuria

exercise
orthostatic proteinuria

6

single protein: creatinine = efficacy to

24hr urine collection

7

urine dipstick detects

ALBUMIN ONLY

8

normal protein excretion in 24hrs

less than 300mg

9

best initial test proteinuria

urinalysis

10

most accurate test proteinuria

protein:creatinine ratio

11

P/Cr accuracy vs. 24hr urine

GREATER ACCURACY-- faster and easier

12

finding out cause of proteinuria

biopsy

13

microalbuminuria

30-300mg/24hrs

14

microalbuminuria can lead to....

worsening renal function

15

tx of microalbuminuria in diabetic patient

ACEI/ ARB

16

diabetic patient with kidney disease, do BIOPSY when there is...

NO OPHTHALMIC DISEASE (recall what's going on in the kidneys, reflects what's going on in the eyes of a diabetic)

17

WBC's in urine

inflammation-- acute interstitial nephritis
infection

18

eosinophils with NSAID induced kidney disease

NOOOOOOOPE!!!

19

stains used to detect eosinophils in urine

Wright and Hansel stains

20

common cause for mild recurrent haematuria

IgA nephropathy

21

False positives for dipstick haematuria

Hb or Mb

22

patient presents with trauma to kidneys and dark urine... what next

microscopic exam of urine-- to detect if Hb/Mb present (Cannot tell the difference between the two, but can tell if its present or not)

23

IVP nephro answer

ALWAYS WRONG-- since slow and renal toxicity with contrast

24

dysmorphic RBC's

glomerulonephritis

25

cystoscopy indications

1. hematuria without infection or trauma
2. haematuria-- without cause on CT/US
3. hematuria with bladder mass on sonography

26

Diagnostic test for bladder cancer

cystoscopy with biopsy

27

hyaline casts

DEHYDRATION--tamm horsfall protein

28

mgmt of pre and post-renal azotemia

underlying cause; MOST ARE REVERSIBLE

29

obstruction with increasing creatinine

need BOTH kidneys to be obstructed for the creatinine to rise

30

weird cause of post-renal azotemia

retroperitoneal fibrosis

31

causes of retroperitoneal fibrosis

CTX: bleomycin, methylsergide
RTX

32

HYPOtn causes of pre-renal azotemia

- sepsis
- anaphylaxis
- bleeding
- dehydration

33

HYPOvol causes of pre-renal azotemia

- diuretics
- burns
- pancreatitis
- decrease pump function: CHF/ constrictive pericarditis/tamponade
- low albumin
- cirrhosis

34

one other cause of pre-renal azotemia-- non-hypoTN/VOL

renal artery stenosis

35

ATN causes toxins

- NSAIDs
- aminoglycosides
- amphotericin
- cisplatin
- cyclosporine

36

miscellaneous causes of intrinsic renal azotemia

- rhabdomyolysis
- hyperuricaemia
- crystals
- contrast
- BJ proteins
- Post-strep infection
- heavy metals
- ethylene glycol

37

immediate increase in Cr cause

contrast induced nephropathy, within 1 day

38

2 days post CTX with cisplatin cause of increase Cr

tumor lysis syndrome

39

5-10 days, get increase in Cr

DRUGS-- cisplatin, ahminoglycosides etc.

40

PC AKI early

- N/V
- malaise

41

PC AKI SEVERE

- confusion
- pericarditis

42

Pre-Renal Azotemia

BUN:Cr >20:1
UNa: 500mOsm/kg, = HIGH specific gravity

43

Intra-Renal Azotemia

BUN:CR 20
FeNa: >1%
UOsm:

44

bladder distended and get a MASSIVE RELEASE of urine after catheter

POST-renal azotemia (Since obstruction now being relieved)

45

if AKI cause is not clear, NEXT BEST STEP

URINALYSIS

46

sickle cell trait AVOID

DEHYDRATION-- since get stuck in renal medulla, can't concentrate

47

Contrast induced nephropathy

HYDRATION---- both BEFORE and DURING contrast study

48

LABS in contrast induced nephropathy

YES IT'S ATN, BUT...contrast causes spasm of the afferent arteriole-- thus get BIG reabsorption water and Na thus...
UNa 500= HIGH specific gravity

49

how to prevent tumor lysis syndrome

- allopurinol
- rasburicase
- hydration

BEFORE CTX

50

ethylene glycol

calcium oxalate stones-- thus LOW CALCIUM

51

methanol ingestion...

INFLAMMATION OF RETINA

52

calcium levels with NSAID ingestion

NO CHANGE

53

toxins are more likely to develop ATN if...

HYPO perfusion of kidney and if there is..
UNDERLYING RENAL INSUFF

54

risk of ATN with age

INCREASES with age-- body loses 1% of renal function for every year past 40yo

55

what may increase risk of amino glycoside or cisplatin toxicity

LOW MAGNESIUM

56

causes of rhabdomyolysis

1. trauma
2. crush injuries
3. immobility

57

initial test rhabdomyolysis

- positive urine dipstick for blood, NO cells

58

most accurate test rhabdomyolysis

urine test for myoglobin

59

labs in rhabdomyolysis

INCREASE CPK
hyperuricaemia
hyperkalaemia
hypocalcemia

60

tx of rhabdomyolysis

1. saline
2. mannitol
3. bicarb

61

need to tx hypocalcemia in rhabdomyolysis

NOOOOO-- it will correct itself

62

at risk of what with rhabdomyolysis

HYPERKALAEMIA--> LIFE THREATENING ARRHYTHMIA-- thus do an EKG

63

any proven therapy to benefit ATN

NOOOO, just have to correct the underlying cause

64

use of diuretics in ATN

DO NOT change the overall outcome

65

wrong answers for tx of ATN

- low dose dopamine
- diuretics
- mannitol
- steroids

66

indications for dialysis when...

RISK OF LIFE THREATENING condition which CANNOT be corrected any other way

67

hypocalcemia an indication for dialysis?

NOOOO-- because it can be corrected with calcium and it D

68

ototoxicity with furosemide based on

TOTAL DOSE and
HOW FAST its injected

69

prerenal azotemia + cirrhosis

= hepatorenal syndrome

70

blue toe syndrome and lived reticularis

atheroemboli

71

scenario where you would get atheroemboli

catherization-- causes the cholesterol plaques to be broken off

72

urine findings for atheroemboli

EOSINOPHILURIA

73

EOSINOPHILURIA seen in...

- acute (allergic) interstitial nephritis-- EXCEPT NSAID
- atheroemboli

74

most accurate diagnostic test for atheroemboli

BIOPSY

75

tx for atheroemboli

NONE-- the biopsy doesn't change the management

76

pulses with atheroemboli

NORMAL-- because the emboli are too small to occlude vessels

77

tx of acute interstitial nephritis

usually resolves SPONTANEOUSLY with stopping the drug or controlling the infection

78

if creatinine continues to rise after stopping drug for AIN give...

glucocorticoids

79

analgesic nephropathy causes..

- ATN
- AIN
- membranous glomerulonephritis
- vascular insufficiency
- papilary necrosis

80

triad of symptoms in acute interstitial nephritis

rash
fever
eosinophiluria

81

TWO MAIN symptoms in papillary necrosis

flank pain
gross hematuria

82

most accurate test in diagnosis of papillary necrosis

CT scan-- shows bumpy contour of interior

83

description of urine in papillary necrosis

necrotic material in urine VISIBLY

84

tx of papillary necrosis

NO TREATMENT

85

MAIN difference between nephrotic and nephritic syndrome

AMOUNT OF PROTEINURIA

86

best initial test for good pastures

anti-GBM ab's

87

most accurate dx for good pastures

BIOPSY

88

tx of good pastures

- plasmapharesis
- steroids

89

gross hematuria 1-2 days after URTI

synpharyngitis---berger disease/ IgA nephropathy

90

gross hematuria 1-2 WEEKS after URTI

PSGN

91

most accurate test for berger disease

kidney biopsy

92

tx of berger disease

NO TREATMENT PROVEN-- 30% resolve, 40-50%--> ESKD

93

tx of proteinuria in berger disease

ACE inhibitors and steroids

94

biopsy for PSGN

NOOOTTTT routineyl done

95

supportive tx for PSGN

antibiotics and diuretics

96

tx of alports

NOOO specific tx to reverse collagen defect

97

skin findings of PAN

livedo reticular and gangrene

98

MI in young person, or stroke in young person

PAN

99

ANCA in PAN

NOT present in most cases

100

best initial test for PAN

angiography

101

most accurate test for PAN

biopsy

102

tx of PAN

- prednisone
- cyclophosphamide

103

biopsy in lupus

NOT for dx of lupus, it's to check severity-- FOCUS TREATMENT

104

mild lupus nephritis

steroids

105

severe lupus nephritis

steroids + mycophenolate OR cyclophosphamide

106

tx of renal amyloidosis

melphalan and prednisone

107

Ddx LARGE KIDNEYS

- amyloid
- HIV nephropathy
- PCKD

108

nephrotic syndrome based on....

SEVERITY> cause

109

edema in nephrotic vs. CHF

nephrotic= EVERYWHERE SWOLLEN; where as CHD goes to legs mainly

110

best initial test for nephrotic syndrome

urinalysis-- NOT sufficiently accurate
albumin:Cr ratio, 5.4:1= 5.4g excreted over 24hrs

111

most accurate test for nephrotic syndrome

RENAL BIOPSY

112

initial tx of nephrotic syndrome

steroids

113

unresponsive to steroids for nephrotic syndrome....

cyclophosphamide

114

control proteinuria in nephrotic syndrome with..

ACE inhibitors/ ARBs

115

edema mgmt in nephrotic syndrome

- salt restriction and diuretics

116

uremia defined as

- met acidosis
- fluid overload
- encephalopathy
- hyperKalaemia
- pericarditis

117

efficacy of peritoneal and hemodialysis

EQUALLY as effective

118

accelerated what in ESKD

atherosclerosis and HTN

119

endocrinopathy in ESKD

anovulatory women
low testosterone men-- erectile dysfunction

120

death in ESKD

CARDIAC DISEASE X3> mortality than infection

121

tx bleeding in ESKD

DDAVP

122

tx of pruritus in ESKD

UV light and dialysis

123

tx hyperphosphatemia in ESKD

- calcium carbonate/ citrate
- sevelamer
- lanthanum

124

tx of hyperMg in ESKD

RESTRICT-- high Mg foods, laxatives, antacids

125

tx of atherosclerosis in ESKD

dialysis

126

endocrinopathy tx in ESKD

dialysis
replace-- estrogen and testosterone

127

with what calcium levels do you want to add sevelamer and lanthanum?

HIGH calcium levels, secondary to giving patient vit D

128

aluminum phosphate binders

NEVER NEVER NEVER USED--since cause DEMENTIA

129

living related kidney donor

95% 1 year survival
88% 3 year survival
72% 5 year survival

130

hLA matched kidneys last for

24 YEARS

131

deceased kidney donor

90% 1 ear survival
78% 3 year survival
58% 5 year survival

132

dialysis alone survival

1 and 3 year= variable
5 year= 30-40%

133

dialysis + DIABETIC survival

1 and 3 year= variable
5 year= 20%

134

HUS E.coli tx

RESOLVES SPONTANEOUSLY

135

what two things don't work in TTP

platelet transfusion (Worsens it) and steroids

136

simple cyst

echo free
smooth, thin
sharp demarcation
good through to back

137

complex--potentially malignant cyst

mixed echogeneticity
irregular thick walls
lower density on back wall
debris in cyst

138

mcc death in ADPCKD

RENAL FAILURE

139

causes of nephrogenic DI

- lithium
- demecloycyline
- chronic kidney disease
- HYPOkalaemia
- HYPERcalcemia

140

nocturia..... first clue to

diabetes insipidus

141

sodium disorders--->

NEURO symptoms

142

potassium disorders-->

MUSCLE/ HEART symptoms

143

hyper-osmolar blood (high Na)
hypo-osmotic urine
hypo-Na urine

diabetes insipidus

144

water deprivation test in diabetes insipidus

urine osmolality stays low
urine volume stays high

145

response to ADH CDI

yes

146

response to ADH NDI

no

147

ADH level in CDI

low

148

ADH level in NDI

high

149

tx of hypernatremia

1. correct underlying cause of fluid loss
2. CDI: replace ADH= vasopressin= DDAVP
3. NDI: correct K/Ca; STOP Li/demeclo, give thiazide or NSAID if above didn't work

150

severe hypernatremia tx

0.9% saline

151

mild hypernatremia tx

glucose or 0.45% saline

152

causes of hyponatremia divided into

1. hypervolemia
2. hypovolemia
3. euvolemia

153

hypervolemia causes of hyponatremia

CHF
cirrhosis
nephrotic syndrome

154

hypovolaemia causes of hyponatremia

sweating/burns/ pneumonia/ diuretics/diarrhea etc.
BECAUSE-- will be treating with chronic replacement of free water-- thus a little sodium and a lot of water are lost in urine over time-- thus decreasing sodium

ADDISONS

155

euvolaemia causes of hyponatremia

- psychogenic polydipsia
- hyperglycemia
- hypothyroidism
- SIADH

156

slow loss of sodium

asymptomatic

157

quick loss of sodium

seizures

158

SIADH-- urine osmolality

HIGH urine osmolality

159

SIADH--urine sodium

HIGH urine sodium

160

SIADH vs. primary polydipsia

primary polydipsia: low sodium urine, urine osmolality

161

mild hyponatremia

asymptomatic-- restrict fluids

162

moderate hyponatremia

minimal confusion-- saline AND loops

163

severe hyponatremia

lethargy, seizures, coma-- hypertonic saline AND conivaptan, tolvaptan

164

conivaptan, tolvaptan

ADH antagonists

165

SIADH given saline AND....

LOOPS-- must give with loops

166

chronic SIADH tx

demecloycline-- ADH antagonist in kidneys

167

causes of hyperkalaemia divided into...

1. pseudohyperk
2. decreased excretion
3. cellular shifts

168

1. pseudohyperkalaemia

- hemolysis
- repeated fist clenching with tourniquet
- thrombocytosis or leukocytosis

169

2. decreased excretion of K+

- renal failure
- aldosterone decrease:
ACE, RTA 4, K+ sparing drugs, Addisons

170

3. cellular shift of K+--> hyperkalaemia

- tissue destruction: rhabdomyolyis, tumor lysis
- decreased insulin
- beta blockers
- digoxin
- acidosis
- heparin

171

PC hyperkaelamia

paralysis-- severe
- ileus
- weakness
- cardiac rhythm disorders

172

most urgent test in severe hyper K

ECG

173

ECG findings of hyperK

- PEAKED T WAVES
- prolonged Pr
- wide QRS

174

acronym for tx of hyperk

C-BIG-K

175

abnormal ECG/ life threatening hyperK tx

CBIG
- calcium chloride or gluconate (protective for heart only)
- bicarb-- esp. if acidosis caused it
- insulin and glucose
[consider dialysis]

176

hyperK tx without abnormal ECG

- kayexalate
- loops

177

kayexalate

removes potassium from body via bowel

178

general causes of hypoK

shift into cells
GI loss
renal loss

179

shift into cells-- hypoK

- insulin
- beta 2 agonists
- alkalosis

180

GI losses of K

- diarrhea
- chronic laxative abuse
- vomiting, NG suction

181

renal losses of K

- loops
- increased aldosterone
- hypoMg
- RTA proximal and distal

182

increased aldosterone

- Conns
- volume depletion
- cushings
- bartters
- licorice

183

EKG findings of hypoK

U waves, and flat T

184

tx of hypoK

oral or IV K (be careful with IV--> may lead to fatal arrhythmia)

185

causes of type 1 RTA

amphotericin
autoimmune diseases-- SLE or Sjogrens (since can damage the kidneys)

186

risk of what with type 1 RTA

kidney stones and nephrocalcinosis

187

tx of type 1 RTA

replace bicarb

188

urine pH in type 2 RTA

variabel
early: >5.5
later:

189

tx of type 2 RTA

thiazides--> volume depletion--> enhance bicarb reabsorption

190

mcc of type 4 RTA

diabetes

191

tx of type 4 RTA

fludrocortisone

192

RTA vs. diarrhea normal anion gap?

UAG= Na- Cl

193

UAG for RTA

positive

194

UAG for diarrhea

negative

195

normal AG levels

6-12

196

elevated AG levels

greater than 12

197

cause of lactic acidosis

hypotension
hypoperfusion

198

tx of lactic acidosis

tx of the hypoperfusion

199

cause of ketacidosis

DKA/ starvation

200

test for ketoacidosis

acetone level

201

tx of ketoacidosis

insulin and fluids

202

cause of oxalic acid increase

ethylene glycol OD

203

test for oxalic acid

urinalysis-- crystals

204

tx of oxalic acid increase

fomepizole
dialysis

205

cause of formic acid increase

methanol ingestion

206

test for formic acid

inflamed retina

207

tx of formic acid

fomepizole
dialysis

208

what is more precise than respiratory rate

minute ventilation= RR x TV

209

analgesia used in nephrolithiasis

ketorolac= nSAID

210

best imaging for nephrolithiasis

non-contrast CT

211

stone passes spontaneously

less than 5mm

212

stone is 5-7mm what to use, to help them pass

nifedepine and tamsulosin

213

fat malabsorption and kidneys...

INCREASE stone formation

214

stone is between 0.5cm- 2cm, non-obstructive

lithotripsy-- upper half of the ureters

215

stone is LARGE and obstructing

stent placement

216

lower half of the ureters

basket

217

long term tx for nephrolithiasis

THIAZIDES-- hypercalcemia-- thus remove calcium from urine

218

tx for urge incontinence

- bladder training
- local anticholinergic: oxybutinin, tolterodine, solifenacin, dariferancin
- surgical tightening of urethra

219

goal blood pressure in diabetic

140/90mmHg

220

goal blood pressure if over 60yo

150/90

221

routine HTN screening for asymptomatic

- CAD
- CVD
- PAD
- CHF
- visual disturbance
- renal insufficiency

222

bruit in the flank

hypertension

223

PC of HTN if symptomatic

- bruit in flank
- coarctation of aorta: UL> LL

224

number one/ FIRST tx for HTN

WEIGHT LOSS-- life style modifications for 3-6months before starting on anti-HTN

225

best initial tx for HTN

D-ABC
diuretics= thiazides
----
ACE/arb
Beta blocker
CCB

226

90% of HTN patients treated with...

2 medications

227

pregnancy and HTN

1st= beta blockers
- CCB
- hydralazine
- alpha methyldopa

228

CAD and HTN

beta blocker
ACE/ARB

229

BPH and HTN

alpha blockers

230

depression and asthma with HTN

NOOOOOOOOOOOOOO beta blockers

231

hyperthyroidism and HTN

beta blockers

232

osteoporosis and HTN

thiazides

233

hypertensive crisis

HTN+ end organ damage

234

best initial tx for htn crisis

FIRST= LABETALOL...... then nitroprusside (because needs arterial line, thus never FIRST)

235

LOWERING BP IN HTN CRISIS

NOOOOOOOOTTTTTT to normal-- since can provoke a stroke

236

causes of type 2 RTA

- multiple myeloma
- amyloidosis
- fanconi syndrome
- heavy metals
- acetazolamide