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Flashcards in Renal & GU Deck (236)
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1
Q

best initial test in nephro

A
  • urinalysis
  • BUN
  • Cr
2
Q

urinalysis consists of

A
  1. dipstick if positive

2. microscopic analysis

3
Q

normally excrete which protein

A

Tamm Horsfall (30-50mg/24hrs)

4
Q

transient proteinuria

A

BENIGN, 2-10% of population

5
Q

benign causes of proteinuria

A

exercise

orthostatic proteinuria

6
Q

single protein: creatinine = efficacy to

A

24hr urine collection

7
Q

urine dipstick detects

A

ALBUMIN ONLY

8
Q

normal protein excretion in 24hrs

A

less than 300mg

9
Q

best initial test proteinuria

A

urinalysis

10
Q

most accurate test proteinuria

A

protein:creatinine ratio

11
Q

P/Cr accuracy vs. 24hr urine

A

GREATER ACCURACY– faster and easier

12
Q

finding out cause of proteinuria

A

biopsy

13
Q

microalbuminuria

A

30-300mg/24hrs

14
Q

microalbuminuria can lead to….

A

worsening renal function

15
Q

tx of microalbuminuria in diabetic patient

A

ACEI/ ARB

16
Q

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

A

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

17
Q

WBC’s in urine

A

inflammation– acute interstitial nephritis

infection

18
Q

eosinophils with NSAID induced kidney disease

A

NOOOOOOOPE!!!

19
Q

stains used to detect eosinophils in urine

A

Wright and Hansel stains

20
Q

common cause for mild recurrent haematuria

A

IgA nephropathy

21
Q

False positives for dipstick haematuria

A

Hb or Mb

22
Q

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

A

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
Q

IVP nephro answer

A

ALWAYS WRONG– since slow and renal toxicity with contrast

24
Q

dysmorphic RBC’s

A

glomerulonephritis

25
Q

cystoscopy indications

A
  1. hematuria without infection or trauma
  2. haematuria– without cause on CT/US
  3. hematuria with bladder mass on sonography
26
Q

Diagnostic test for bladder cancer

A

cystoscopy with biopsy

27
Q

hyaline casts

A

DEHYDRATION–tamm horsfall protein

28
Q

mgmt of pre and post-renal azotemia

A

underlying cause; MOST ARE REVERSIBLE

29
Q

obstruction with increasing creatinine

A

need BOTH kidneys to be obstructed for the creatinine to rise

30
Q

weird cause of post-renal azotemia

A

retroperitoneal fibrosis

31
Q

causes of retroperitoneal fibrosis

A

CTX: bleomycin, methylsergide

RTX

32
Q

HYPOtn causes of pre-renal azotemia

A
  • sepsis
  • anaphylaxis
  • bleeding
  • dehydration
33
Q

HYPOvol causes of pre-renal azotemia

A
  • diuretics
  • burns
  • pancreatitis
  • decrease pump function: CHF/ constrictive pericarditis/tamponade
  • low albumin
  • cirrhosis
34
Q

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

A

renal artery stenosis

35
Q

ATN causes toxins

A
  • NSAIDs
  • aminoglycosides
  • amphotericin
  • cisplatin
  • cyclosporine
36
Q

miscellaneous causes of intrinsic renal azotemia

A
  • rhabdomyolysis
  • hyperuricaemia
  • crystals
  • contrast
  • BJ proteins
  • Post-strep infection
  • heavy metals
  • ethylene glycol
37
Q

immediate increase in Cr cause

A

contrast induced nephropathy, within 1 day

38
Q

2 days post CTX with cisplatin cause of increase Cr

A

tumor lysis syndrome

39
Q

5-10 days, get increase in Cr

A

DRUGS– cisplatin, ahminoglycosides etc.

40
Q

PC AKI early

A
  • N/V

- malaise

41
Q

PC AKI SEVERE

A
  • confusion

- pericarditis

42
Q

Pre-Renal Azotemia

A

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

43
Q

Intra-Renal Azotemia

A

BUN:CR 20
FeNa: >1%
UOsm:

44
Q

bladder distended and get a MASSIVE RELEASE of urine after catheter

A

POST-renal azotemia (Since obstruction now being relieved)

45
Q

if AKI cause is not clear, NEXT BEST STEP

A

URINALYSIS

46
Q

sickle cell trait AVOID

A

DEHYDRATION– since get stuck in renal medulla, can’t concentrate

47
Q

Contrast induced nephropathy

A

HYDRATION—- both BEFORE and DURING contrast study

48
Q

LABS in contrast induced nephropathy

A

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
Q

how to prevent tumor lysis syndrome

A
  • allopurinol
  • rasburicase
  • hydration

BEFORE CTX

50
Q

ethylene glycol

A

calcium oxalate stones– thus LOW CALCIUM

51
Q

methanol ingestion…

A

INFLAMMATION OF RETINA

52
Q

calcium levels with NSAID ingestion

A

NO CHANGE

53
Q

toxins are more likely to develop ATN if…

A

HYPO perfusion of kidney and if there is..

UNDERLYING RENAL INSUFF

54
Q

risk of ATN with age

A

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

55
Q

what may increase risk of amino glycoside or cisplatin toxicity

A

LOW MAGNESIUM

56
Q

causes of rhabdomyolysis

A
  1. trauma
  2. crush injuries
  3. immobility
57
Q

initial test rhabdomyolysis

A
  • positive urine dipstick for blood, NO cells
58
Q

most accurate test rhabdomyolysis

A

urine test for myoglobin

59
Q

labs in rhabdomyolysis

A

INCREASE CPK
hyperuricaemia
hyperkalaemia
hypocalcemia

60
Q

tx of rhabdomyolysis

A
  1. saline
  2. mannitol
  3. bicarb
61
Q

need to tx hypocalcemia in rhabdomyolysis

A

NOOOOO– it will correct itself

62
Q

at risk of what with rhabdomyolysis

A

HYPERKALAEMIA–> LIFE THREATENING ARRHYTHMIA– thus do an EKG

63
Q

any proven therapy to benefit ATN

A

NOOOO, just have to correct the underlying cause

64
Q

use of diuretics in ATN

A

DO NOT change the overall outcome

65
Q

wrong answers for tx of ATN

A
  • low dose dopamine
  • diuretics
  • mannitol
  • steroids
66
Q

indications for dialysis when…

A

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

67
Q

hypocalcemia an indication for dialysis?

A

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

68
Q

ototoxicity with furosemide based on

A

TOTAL DOSE and

HOW FAST its injected

69
Q

prerenal azotemia + cirrhosis

A

= hepatorenal syndrome

70
Q

blue toe syndrome and lived reticularis

A

atheroemboli

71
Q

scenario where you would get atheroemboli

A

catherization– causes the cholesterol plaques to be broken off

72
Q

urine findings for atheroemboli

A

EOSINOPHILURIA

73
Q

EOSINOPHILURIA seen in…

A
  • acute (allergic) interstitial nephritis– EXCEPT NSAID

- atheroemboli

74
Q

most accurate diagnostic test for atheroemboli

A

BIOPSY

75
Q

tx for atheroemboli

A

NONE– the biopsy doesn’t change the management

76
Q

pulses with atheroemboli

A

NORMAL– because the emboli are too small to occlude vessels

77
Q

tx of acute interstitial nephritis

A

usually resolves SPONTANEOUSLY with stopping the drug or controlling the infection

78
Q

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

A

glucocorticoids

79
Q

analgesic nephropathy causes..

A
  • ATN
  • AIN
  • membranous glomerulonephritis
  • vascular insufficiency
  • papilary necrosis
80
Q

triad of symptoms in acute interstitial nephritis

A

rash
fever
eosinophiluria

81
Q

TWO MAIN symptoms in papillary necrosis

A

flank pain

gross hematuria

82
Q

most accurate test in diagnosis of papillary necrosis

A

CT scan– shows bumpy contour of interior

83
Q

description of urine in papillary necrosis

A

necrotic material in urine VISIBLY

84
Q

tx of papillary necrosis

A

NO TREATMENT

85
Q

MAIN difference between nephrotic and nephritic syndrome

A

AMOUNT OF PROTEINURIA

86
Q

best initial test for good pastures

A

anti-GBM ab’s

87
Q

most accurate dx for good pastures

A

BIOPSY

88
Q

tx of good pastures

A
  • plasmapharesis

- steroids

89
Q

gross hematuria 1-2 days after URTI

A

synpharyngitis—berger disease/ IgA nephropathy

90
Q

gross hematuria 1-2 WEEKS after URTI

A

PSGN

91
Q

most accurate test for berger disease

A

kidney biopsy

92
Q

tx of berger disease

A

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

93
Q

tx of proteinuria in berger disease

A

ACE inhibitors and steroids

94
Q

biopsy for PSGN

A

NOOOTTTT routineyl done

95
Q

supportive tx for PSGN

A

antibiotics and diuretics

96
Q

tx of alports

A

NOOO specific tx to reverse collagen defect

97
Q

skin findings of PAN

A

livedo reticular and gangrene

98
Q

MI in young person, or stroke in young person

A

PAN

99
Q

ANCA in PAN

A

NOT present in most cases

100
Q

best initial test for PAN

A

angiography

101
Q

most accurate test for PAN

A

biopsy

102
Q

tx of PAN

A
  • prednisone

- cyclophosphamide

103
Q

biopsy in lupus

A

NOT for dx of lupus, it’s to check severity– FOCUS TREATMENT

104
Q

mild lupus nephritis

A

steroids

105
Q

severe lupus nephritis

A

steroids + mycophenolate OR cyclophosphamide

106
Q

tx of renal amyloidosis

A

melphalan and prednisone

107
Q

Ddx LARGE KIDNEYS

A
  • amyloid
  • HIV nephropathy
  • PCKD
108
Q

nephrotic syndrome based on….

A

SEVERITY> cause

109
Q

edema in nephrotic vs. CHF

A

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

110
Q

best initial test for nephrotic syndrome

A

urinalysis– NOT sufficiently accurate

albumin:Cr ratio, 5.4:1= 5.4g excreted over 24hrs

111
Q

most accurate test for nephrotic syndrome

A

RENAL BIOPSY

112
Q

initial tx of nephrotic syndrome

A

steroids

113
Q

unresponsive to steroids for nephrotic syndrome….

A

cyclophosphamide

114
Q

control proteinuria in nephrotic syndrome with..

A

ACE inhibitors/ ARBs

115
Q

edema mgmt in nephrotic syndrome

A
  • salt restriction and diuretics
116
Q

uremia defined as

A
  • met acidosis
  • fluid overload
  • encephalopathy
  • hyperKalaemia
  • pericarditis
117
Q

efficacy of peritoneal and hemodialysis

A

EQUALLY as effective

118
Q

accelerated what in ESKD

A

atherosclerosis and HTN

119
Q

endocrinopathy in ESKD

A

anovulatory women

low testosterone men– erectile dysfunction

120
Q

death in ESKD

A

CARDIAC DISEASE X3> mortality than infection

121
Q

tx bleeding in ESKD

A

DDAVP

122
Q

tx of pruritus in ESKD

A

UV light and dialysis

123
Q

tx hyperphosphatemia in ESKD

A
  • calcium carbonate/ citrate
  • sevelamer
  • lanthanum
124
Q

tx of hyperMg in ESKD

A

RESTRICT– high Mg foods, laxatives, antacids

125
Q

tx of atherosclerosis in ESKD

A

dialysis

126
Q

endocrinopathy tx in ESKD

A

dialysis

replace– estrogen and testosterone

127
Q

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

A

HIGH calcium levels, secondary to giving patient vit D

128
Q

aluminum phosphate binders

A

NEVER NEVER NEVER USED–since cause DEMENTIA

129
Q

living related kidney donor

A

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

130
Q

hLA matched kidneys last for

A

24 YEARS

131
Q

deceased kidney donor

A

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

132
Q

dialysis alone survival

A

1 and 3 year= variable

5 year= 30-40%

133
Q

dialysis + DIABETIC survival

A

1 and 3 year= variable

5 year= 20%

134
Q

HUS E.coli tx

A

RESOLVES SPONTANEOUSLY

135
Q

what two things don’t work in TTP

A

platelet transfusion (Worsens it) and steroids

136
Q

simple cyst

A

echo free
smooth, thin
sharp demarcation
good through to back

137
Q

complex–potentially malignant cyst

A

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

138
Q

mcc death in ADPCKD

A

RENAL FAILURE

139
Q

causes of nephrogenic DI

A
  • lithium
  • demecloycyline
  • chronic kidney disease
  • HYPOkalaemia
  • HYPERcalcemia
140
Q

nocturia….. first clue to

A

diabetes insipidus

141
Q

sodium disorders—>

A

NEURO symptoms

142
Q

potassium disorders–>

A

MUSCLE/ HEART symptoms

143
Q

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

A

diabetes insipidus

144
Q

water deprivation test in diabetes insipidus

A

urine osmolality stays low

urine volume stays high

145
Q

response to ADH CDI

A

yes

146
Q

response to ADH NDI

A

no

147
Q

ADH level in CDI

A

low

148
Q

ADH level in NDI

A

high

149
Q

tx of hypernatremia

A
  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
Q

severe hypernatremia tx

A

0.9% saline

151
Q

mild hypernatremia tx

A

glucose or 0.45% saline

152
Q

causes of hyponatremia divided into

A
  1. hypervolemia
  2. hypovolemia
  3. euvolemia
153
Q

hypervolemia causes of hyponatremia

A

CHF
cirrhosis
nephrotic syndrome

154
Q

hypovolaemia causes of hyponatremia

A

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
Q

euvolaemia causes of hyponatremia

A
  • psychogenic polydipsia
  • hyperglycemia
  • hypothyroidism
  • SIADH
156
Q

slow loss of sodium

A

asymptomatic

157
Q

quick loss of sodium

A

seizures

158
Q

SIADH– urine osmolality

A

HIGH urine osmolality

159
Q

SIADH–urine sodium

A

HIGH urine sodium

160
Q

SIADH vs. primary polydipsia

A

primary polydipsia: low sodium urine, urine osmolality

161
Q

mild hyponatremia

A

asymptomatic– restrict fluids

162
Q

moderate hyponatremia

A

minimal confusion– saline AND loops

163
Q

severe hyponatremia

A

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

164
Q

conivaptan, tolvaptan

A

ADH antagonists

165
Q

SIADH given saline AND….

A

LOOPS– must give with loops

166
Q

chronic SIADH tx

A

demecloycline– ADH antagonist in kidneys

167
Q

causes of hyperkalaemia divided into…

A
  1. pseudohyperk
  2. decreased excretion
  3. cellular shifts
168
Q
  1. pseudohyperkalaemia
A
  • hemolysis
  • repeated fist clenching with tourniquet
  • thrombocytosis or leukocytosis
169
Q
  1. decreased excretion of K+
A
  • renal failure
  • aldosterone decrease:
    ACE, RTA 4, K+ sparing drugs, Addisons
170
Q
  1. cellular shift of K+–> hyperkalaemia
A
  • tissue destruction: rhabdomyolyis, tumor lysis
  • decreased insulin
  • beta blockers
  • digoxin
  • acidosis
  • heparin
171
Q

PC hyperkaelamia

A

paralysis– severe

  • ileus
  • weakness
  • cardiac rhythm disorders
172
Q

most urgent test in severe hyper K

A

ECG

173
Q

ECG findings of hyperK

A
  • PEAKED T WAVES
  • prolonged Pr
  • wide QRS
174
Q

acronym for tx of hyperk

A

C-BIG-K

175
Q

abnormal ECG/ life threatening hyperK tx

A
CBIG
- calcium chloride or gluconate (protective for heart only)
- bicarb-- esp. if acidosis caused it
- insulin and glucose
[consider dialysis]
176
Q

hyperK tx without abnormal ECG

A
  • kayexalate

- loops

177
Q

kayexalate

A

removes potassium from body via bowel

178
Q

general causes of hypoK

A

shift into cells
GI loss
renal loss

179
Q

shift into cells– hypoK

A
  • insulin
  • beta 2 agonists
  • alkalosis
180
Q

GI losses of K

A
  • diarrhea
  • chronic laxative abuse
  • vomiting, NG suction
181
Q

renal losses of K

A
  • loops
  • increased aldosterone
  • hypoMg
  • RTA proximal and distal
182
Q

increased aldosterone

A
  • Conns
  • volume depletion
  • cushings
  • bartters
  • licorice
183
Q

EKG findings of hypoK

A

U waves, and flat T

184
Q

tx of hypoK

A

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

185
Q

causes of type 1 RTA

A

amphotericin

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

186
Q

risk of what with type 1 RTA

A

kidney stones and nephrocalcinosis

187
Q

tx of type 1 RTA

A

replace bicarb

188
Q

urine pH in type 2 RTA

A

variabel
early: >5.5
later:

189
Q

tx of type 2 RTA

A

thiazides–> volume depletion–> enhance bicarb reabsorption

190
Q

mcc of type 4 RTA

A

diabetes

191
Q

tx of type 4 RTA

A

fludrocortisone

192
Q

RTA vs. diarrhea normal anion gap?

A

UAG= Na- Cl

193
Q

UAG for RTA

A

positive

194
Q

UAG for diarrhea

A

negative

195
Q

normal AG levels

A

6-12

196
Q

elevated AG levels

A

greater than 12

197
Q

cause of lactic acidosis

A

hypotension

hypoperfusion

198
Q

tx of lactic acidosis

A

tx of the hypoperfusion

199
Q

cause of ketacidosis

A

DKA/ starvation

200
Q

test for ketoacidosis

A

acetone level

201
Q

tx of ketoacidosis

A

insulin and fluids

202
Q

cause of oxalic acid increase

A

ethylene glycol OD

203
Q

test for oxalic acid

A

urinalysis– crystals

204
Q

tx of oxalic acid increase

A

fomepizole

dialysis

205
Q

cause of formic acid increase

A

methanol ingestion

206
Q

test for formic acid

A

inflamed retina

207
Q

tx of formic acid

A

fomepizole

dialysis

208
Q

what is more precise than respiratory rate

A

minute ventilation= RR x TV

209
Q

analgesia used in nephrolithiasis

A

ketorolac= nSAID

210
Q

best imaging for nephrolithiasis

A

non-contrast CT

211
Q

stone passes spontaneously

A

less than 5mm

212
Q

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

A

nifedepine and tamsulosin

213
Q

fat malabsorption and kidneys…

A

INCREASE stone formation

214
Q

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

A

lithotripsy– upper half of the ureters

215
Q

stone is LARGE and obstructing

A

stent placement

216
Q

lower half of the ureters

A

basket

217
Q

long term tx for nephrolithiasis

A

THIAZIDES– hypercalcemia– thus remove calcium from urine

218
Q

tx for urge incontinence

A
  • bladder training
  • local anticholinergic: oxybutinin, tolterodine, solifenacin, dariferancin
  • surgical tightening of urethra
219
Q

goal blood pressure in diabetic

A

140/90mmHg

220
Q

goal blood pressure if over 60yo

A

150/90

221
Q

routine HTN screening for asymptomatic

A
  • CAD
  • CVD
  • PAD
  • CHF
  • visual disturbance
  • renal insufficiency
222
Q

bruit in the flank

A

hypertension

223
Q

PC of HTN if symptomatic

A
  • bruit in flank

- coarctation of aorta: UL> LL

224
Q

number one/ FIRST tx for HTN

A

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

225
Q

best initial tx for HTN

A
D-ABC
diuretics= thiazides
----
ACE/arb
Beta blocker
CCB
226
Q

90% of HTN patients treated with…

A

2 medications

227
Q

pregnancy and HTN

A

1st= beta blockers

  • CCB
  • hydralazine
  • alpha methyldopa
228
Q

CAD and HTN

A

beta blocker

ACE/ARB

229
Q

BPH and HTN

A

alpha blockers

230
Q

depression and asthma with HTN

A

NOOOOOOOOOOOOOO beta blockers

231
Q

hyperthyroidism and HTN

A

beta blockers

232
Q

osteoporosis and HTN

A

thiazides

233
Q

hypertensive crisis

A

HTN+ end organ damage

234
Q

best initial tx for htn crisis

A

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

235
Q

LOWERING BP IN HTN CRISIS

A

NOOOOOOOOTTTTTT to normal– since can provoke a stroke

236
Q

causes of type 2 RTA

A
  • multiple myeloma
  • amyloidosis
  • fanconi syndrome
  • heavy metals
  • acetazolamide