Renal exam - clinical Flashcards
(163 cards)
1
Q
recommendation for BP in elevated range
A
nonpharmacologic therapy with reassessment in 3-6 months
2
Q
recommendation for stage 1 HTN and ASCVD risk < 10%
A
nonpharmacologic therapy with reassessment
3
Q
recommendation for stage 1 HTN and ASCVD risk > 10%
A
start meds
4
Q
recommendation for stage 2 HTN
A
start meds
5
Q
1st line HTN drug categories
A
thiazides, CCBs, ACEIs, ARBs
6
Q
thiazide prototype
A
HCTZ, chlorthalidone
7
Q
CCB prototypes
A
amlodipine, clevidipine
8
Q
ACEI prototype
A
captopril
9
Q
ARB prototype
A
losartan
10
Q
thiazides mechanism
A
block Na/Cl cotransporter in DCT
11
Q
thiazides side effects
A
hypokalemia, increase in glucose, lipids, uricemia, calcium.
12
Q
ACEI/ARB side effects
A
cough (ACE only), angioedema, teratogen, increased creatinine, hyperkalemia, hypotension (CATCHH)
13
Q
special ACEI/ARB indication
A
first choice for patients with DM, CKD, CHF
14
Q
drugs for HTN in pregnancy
A
Nifedipine, methyldopa, labetalol, hydralazine (new moms love hugs)
15
Q
drugs for HTN with heart failure
A
diuretics, ACEIs/ARBs, beta blockers, aldosterone antagonists
16
Q
drugs for HTN with DM
A
ACEIs/ARBs, CCBs, thiazides, beta blockers
17
Q
consideration of BBs in DM
A
BBs can mask ssx of hypoglycemia
18
Q
specific drug for HTN with CHF
A
vaslartan-sacubitril
19
Q
prototype alpha-1 blocker
A
prazosin
20
Q
prototype alpha-2 agonist
A
clonidine
21
Q
mechanism of beta blockers
A
decrease cardiac output and renin release. Also decrease peripheral resistance if combined with vasodilating agent (labetalol)
22
Q
mechanism of alpha 2 agonists
A
sensitize brainstem to inhibition by baroreceptor reflexes
23
Q
hypertensive urgency
A
asymptomatic, >180/>120
24
Q
hypertensive emergency
A
severe HTN associated with end-organ damage
25
treatment for hypertensive urgency
gradual decrease with oral meds
26
treatment for hypertensive emergency
IV meds, decrease BP by 25% in 1-2 hours then get to 160/100 within 2-6 hours
27
AKI definition
increase of Cr of >0.3 mg/dl within 48 hours
28
2 forces opposing glomerular filtration
oncotic pressure, capsule hydrostatic pressure
29
1 force driving glomerular filtration
glomerular hydrostatic pressure
30
most common type of outpatient AKI
prerenal
31
most common type of inpatient AKI
intrinsic
32
prerenal AKI mechanism
lack of bloodflow that overwhelms autoregulation (hypovolemia or loss of afferent vasodilation or loss of efferent vasoconstriction)
33
why do ACEI/ARBs drop GFR
loss of angiotensin II effects means loss of efferent arteriolar vasonstriction leading to reduced GFR
34
why do NSAIDs drop GFR
loss of prostaglandins leads to loss of afferent arteriole dilation
35
tests for AKI
BUN/Cr ratio, fractional excretion of Na, fraction excretion of urea
36
AKI BUN/Cr ratio
>20
37
normal BUN/Cr ratio
<10
38
interfering factors with BUN/Cr ratio
malnutrition can cause lower Cr, GI bleeds can cause higher BUN, low protein intake can cause low BUN
39
interfering factors with fractional excretion of Na
CHF, cirrhosis, contrast nephropathy can all cause low FENa
40
causes of prerenal AKI
anything that decreases BP, anything causing afferent arteriole vasoconstriction (hypercalcemia, NSAIDs, pressors) or efferent arteriole vasodilation (ACEI/ARBS)
41
treatment of prerenal AKI
d/c offending meds, maintain MAP>65
42
causes of intrarenal AKI
acute tubular necrosis, atheroembolic renal disease, glomerulonephritis, acute interstitial injury
43
acute tubular necrosis location
proximal tubule
44
muddy brown cellular casts
acute tubular necrosis
45
causes of acute tubular necrosis
ischemic injury (shock), exogenous toxin (abx, chemo, contast, etc), endogenous toxin (cytokines, myoglobin, tumor lysis syndrome, bilirubin, etc)
46
how to differentiate AKI from prerenal
AKI is a severe and prolonged prerenal, with or without superimposed nephrotoxin
47
why oliguria in acute tubular necrosis
protective mechanism via tubuloglomerular feedback
48
treatment of acute tubular necrosis
maintain MAP, loop diuretics for fluid overload (but does not fix ATN), may use dialysis for refractory cases
49
indications for dialysis
```
Acidosis
Electrolyte imbalances (refractory)
Intoxication
Overload of volume
Uremia
```
50
uremia ssx
CNS irritation, GI (N/V/anorexia), pericardial effusion, uremic bleeding (platelet dysfunction)
51
causes of acute interstitial nephritis
Meds (especially abx, PPIs, loop diuretcs), infections (CMV, HIV, EBV), autoimmune, hypercalcemia
52
what is acute interstitial nephritis
hypersensitivity reaction that spares glomeruli
53
ssx of AIN
asymptomatic, constitutional symptoms, bilateral flank pain
54
AIN triad
fever, rash, eosinophilia (only seen in 10%)
55
AIN urine findings
no proteinuria or hematuria, may find WBCs or casts
56
how is AIN diagnosed
usually clinical based on new drugs, unexplained Cr rise, findings of urine WBCs and casts
57
RPGN causes
ANCA vasculitis, lupus nephritis, Goodpasture's disease
58
Glomerulonephritis injury from immune complexes damages ____ and leads to _____, with _____ urine findings
capillaries, nephritic syndrome, hematuria
59
glomerulonephritis injury from autoantibodies damages ____ and leads to ____, with ____ urine findings
podocyte filtration barrier, nephrotic syndrome, proteinuria
60
nephrotic or nephritic? massive edema
nephrotic
61
causes of nephrotic syndrome
membranous nephropathy, minimal change disease, diabetic nephropathy
62
causes of nephritic syndrome
lupus nephritis, ANCA vasculitis, IgA nephropathy
63
nephrotic or nephritic causes dysmorphic RBCs
nephritic
64
tests for glomerulonephritis
ANA, complement, hepatitis, HIV, anti-GBM titer
65
treatment of glomerulonephritis
if mild, ACE/ARB, immunosuppression if nephrotic proteinuria or rapid decline in renal function (for several years)
66
causes of postrenal AKI
bilateral uretral obstruction, neurogenic bladder, bladder neck obstruction from BPH
67
diagnosis of postrenal AKI
renal US/CT, bedside bladder scan with post voice residual volume (>100)
68
treatment of postrenal AKI
relieve obstruction, d/c offending meds - may be reversible if not too prolonged
69
what is common after postrenal AKI
postobstructive diuresis (due to high BUN/Na+/H2O accumulated during obstruction or decreased Na+ reabsorption capacity)
70
carbonic anhydrase inhibitor prototype
acetazolamide
71
osmotic diuretic prototype
mannitol
72
carbonic anhydrase inhibitor mechanism
inhibition of carbonic anhydrase in proximal convoluted tubule
73
osmotic diuretic mechanism
high osmolarity prompts fluid shift from ICF to ECF
74
loop diuretic mechanism
Inhibition of Na/K/2CL symporter in ascending limb of loop of Henle
75
thiazide diuretic mechanism
inhibition of Na+/Cl- cotransporter in DCT
76
uses of carbonic anhydrase inhibitors
metabolic alkalosis, mountain sickness
77
uses of osmotic diuretics
reduce intracranial pressure, acute renal failure
78
uses of loop diuretics
edematous states, acute renal failure, HTN, hypercalcemia, hyperkalemia
79
uses of thiazide diuretics
HTN, CHF, nephrolithiasis, diabetes insipidus, osteoporosis
80
ADH antagonist uses
SIADH, HF, polycystic kidney disease
81
adverse effects of carbonic anhydrase inhibitors
non AG metabolic acidosis, hypokalemia, sulfa allergy, nephrolithiasis
82
adverse effects of osmotic diuretics
initial volume expansion with subsequent dehydration
83
adverse effects of loop diuretics
ototoxicity, hypokalemia, hypocalcemia, hypomagnesemia, alkalosis, hyperglycemia, hyperlipidemia, gout
84
adverse effects of thaizide diuretics
hyponatremia/kalemia/magnesemia, hyperglycemia, uremia, hyperlipidemia, sulfa allergy, gout
85
adverse effects of potassium-sparing diuretics
hyperkalemic metabolic acidosis, gynecomastia (spironolactone)
86
prototype of potassium-sparing diuretics
amiloride, spironolactone
87
adverse effects of ADH antagonists
nephrogenic diabetes insipidus
88
most common cause of CKD in US
Diabetic nephropathy
89
first treatment of hyperkalemia in CKD
calcium gluconate (stabilize cell membrane)
90
2nd treatment of hyperkalemia in CKD
push K into cells (insulin/glucose, beta agonist, sodium bicarb)
91
3rd treatment of hyperkalemia in CKD
eliminate K from body (lasix, dialysis)
92
what is CKD contraindication to metformin
GFR<30
93
meds associated with hyperkalemia
NSAIDs, metformin, ACEI/ARB, aldosterone antagonists, beta blockers, dig, potassium-sparing diuretics
94
lab findings in secondary hyperparathyroidism
low-normal Ca, low-high Ph, low vit D, high PTH
95
phos binder prototypes
sevelamer, calcium carbonate
96
how to treat elevated PTH in secondary hyperparathyroidism
calcitriol (1,25 vit D-OH)
97
poorly controlled secondary hyperparathyroidism can lead to
osteitis fibrosa
98
overtreatment of Vit D analogs or chronic disease can lead to
adynamic bone disease due to low bone turnover (low PTH levels)
99
what does acute rise in creatinine after ACEI use suggest
bilateral renal artery stenosis
100
"string of pearls" appearance on renal angiography is suggestive of
fibromuscular dysplasia as cause of renal artery stenosis
101
what is responsible for voiding bladder
parasympathetics from S2-S3 pelvic nerve
102
what is responsible for storing urine
sympathetics: hypogastric T11-L2
103
voluntary control of bladder
pudendal nerve
104
inhibitory process to parasympathetics at baseline (to keep people from peeing everywhere all the time)
pontine micturition center at baseline
105
failure to store forms of incontinence
urge/stress
106
failure to empty forms of incontinence
overflow
107
causes of urge incontinence
overactive bladder, decreased bladder compliance
108
causes of stress incontinence
intrinsic sphincter dysfunction, pelvic floor laxity. Childbirth, age, obesity
109
causes of overflow incontinence
bladder won't contract, protastatic or urethral obstruction
110
symptoms of stress incontinence
incontinence with increasing abdominal pressure (sneezing, coughing etc)
111
cause of overactive bladder
detrusor muscle contracts when it shouldn't
112
symptoms of urge incontinence
urgency, frequency, nocturia
113
total incontinence cause
surgery, neuropathy
114
symptoms of overflow incontinence
frequency, nocturia, distended bladder on exam, incomplete empyting
115
medical treatment for urge incontinence
muscarininc antagonists (anticholinergics): oxybutynin
116
medical treatment for prostate enlargement
alpha antagonists (tamsulosin)
117
4 most common types of kidney stones
calcium based, uric acid, struvite, cystine
118
risk factors for calcium based stones
low urine volume, abnormal urine pH, high dietary sodium/animal protein consumption
119
types of calcium based stones
calcium oxalate and calcium phosphate
120
causes of calcium oxalate stones
hypercalciuria: increased absorption from intestine, primary hyperparathyroidism, impaired resoprtion of Ca from tubules
121
treatment of calcium based stones
high fluid intake, adequate Ca, limit Na/animal protein intake, thiazides, potassium citrate
122
primary cause of uric acid stones
low urinary pH, associated with DM and insulin resistance
123
treatment of uric acid stones
increase fluid intake, alkalinize the urine with potassium citrate, allopurinol
124
struvite stones made of
ammonium/magnesium/phosphate
125
cause of struvite stones
UTI with proteus, klebsiella, staph
126
treatment of struvite stones
urease inhibitor
127
cause of cystine stones
autosomal recessive defect in proximal tubule
128
treatment of cystine stones
decrease sodium intake, alkalinize urine, cystine binder
129
3 most common types of bladder malignancy
transitional cell, squamous cell, adenocarcinoma
130
most common type of bladder cancer
transitional cell carcinoma
131
risk factors of transitional cell carcinoma
smoking, hair dye, cyclophosphamide, industrial solvents
132
treatment of transitional cell carcinoma
if nonmuscle invasive: transurethral resection
| if muscle invasive: radical cystectomy
133
location of bladder adenocarcinoma
dome of bladder or urachus
134
squamous cell carcinoma risk factors
chronic inflammatory conditions
135
autoantibodies seen in SLE
Anti-double stranded DNA, anti-Smith, ANA
136
post-strep GN is nephrotic or nephritic
nephritic
137
what is lupus nephritis
glomerulonephritis caused by immune complex deposits
138
causes of acute pyelonephritis
ascending bacteria from urethra/bladder (more common) - usually E coli, proteus, klebsiella. OR hematogenous spread from bloodstream (less common)
139
risk factors for acute pyelonephritis
reduced urine flow (obstruction, bladder dysfunction, vesico-ureteral reflux)
140
acute pyelonephritis urinalysis
neutrophils with white cell casts
141
complications of acute pyelonephritis
papillary necrosis, pyelonephrosis, perinephric abscess, sepsis, chronic inflammation with scarring
142
clinical picture of nephrotic syndrome
insidious onset, massive proteinuria, hypoalbuminemia, edema, hyperlipidemia
143
clinical picture of nephritic syndrome
hematuria, azotemia (increased creatinine and BUN), oliguria, acute onset, HTN
144
clinical picture of membranoproliferative glomerulonephritis
young people with a slowly progressive nephritic syndrome that is unresponsive to immunosuppressants
145
secondary MPGN is due to
SLE, hep B, hep C
146
ANCA disease clinical picture
adult with nephritic syndrome and possible acute renal failure treated with high dose steroids and cyclophosphamide
147
2nd leading bacteria causing UTI in sexually active women
staph saprophyticus
148
causes of sterile pyuria that mimics UTI
chlamydia, gonorrhea
149
why is urine yellow
urobilin
150
specific gravity < 1.01
hydration
151
specific gravity >1.03
dehydration
152
causes of alkaline urine
(with UTI) struvite stone, RTA
153
what type of casts can be normal in UA
hyaline
154
what do nitrites in urine indicate
UTI with gram-negative bacteria
155
red cell casts indicate
glomerular disease
156
white cell casts indicate
AIN, chronic pyelo
157
fatty casts indicate
nephrotic syndrome
158
renal tubular epithelial casts indicate
acute tubular necrosis
159
granular casts indicate
chronic renal failure
160
waxy casts indicate
chronic renal failure
161
most common cause of intrarenal AKI
acute tubular necrosis
162
what is acute tubular necrosis
damage to tubules due to ischemia or exposure to nephrotoxins
163
glomerular disease is type of
intrarenal AKI
