Renal Part 1 Flashcards by Kolbie Chancellor

Pre-Renal AKIs are caused by renal hypo-perfusion. What will the levels of BUN:Cr, Urine Na and FeNa be?

BUN:Cr > 20
Urine Na < 20
FeNa < 1%

How well did you know this?

Not at all

Perfectly

Pre-Renal AKIs are caused by renal hypo-perfusion. What will the levels of BUN:Cr, Urine Na and FeNa be?

BUN:Cr > 20
Urine Na < 20
FeNa < 1%

How well did you know this?

Not at all

Perfectly

Post-Renal AKIs are caused by an obstruction distal to the kidneys. What diagnostics should be pursued?

US or CT to assess etiology

How well did you know this?

Not at all

Perfectly

If a Glomerulonephritis is causing the AKI, what casts will be seen in the urine?

RBC casts

How well did you know this?

Not at all

Perfectly

What things cause AIN (acute interstitial nephritis)?

Infection
Drugs - TMP/SMX, Penicillin, Cephalosporins, NSAIDs, PPIs

How well did you know this?

Not at all

Perfectly

If AIN is causing the AKI, what casts will be seen in the urine?

WBC casts

How well did you know this?

Not at all

Perfectly

If AIN is causing the AKI, what casts will be seen in the urine?

WBC casts

How well did you know this?

Not at all

Perfectly

In addition to WBC casts, what specific immune cell may or may not be seen in the urine if AIN is causing the AKI?

Eosinophils

How well did you know this?

Not at all

Perfectly

What things can cause ATN (acute tubular necrosis)?

Ischemia
IV contrast

How well did you know this?

Not at all

Perfectly

If ATN is causing the AKI, what casts may be seen in the urine?

Muddy brown casts

How well did you know this?

Not at all

Perfectly

How will a patient present with nephrolithiasis?

Unilateral flank pain that radiates to the groin
Hematuria

How well did you know this?

Not at all

Perfectly

For a regular patient with kidney stones, what is the diagnostic of choice?

NON-contrast CT

How well did you know this?

Not at all

Perfectly

In what patients should you consider an US/KUB to assess for kidney stones?

Children or pregnant patients

How well did you know this?

Not at all

Perfectly

A majority of kidney stones are radiopaque. What type if radio-lucent?

Uric acid

How well did you know this?

Not at all

Perfectly

Calcium Oxalate stones are due to HIGH levels of?

Calcium
Oxalate
Citrate

How well did you know this?

Not at all

Perfectly

Lowering dietary _____ can prevent Calcium Oxalate stones (not obvious)

Sodium

How well did you know this?

Not at all

Perfectly

What causes Struvite kidney stones?

UTI with organisms such as Proteus Mirabilis

How well did you know this?

Not at all

Perfectly

If you have a Uric Acid stone, what can be given in order to dissolve the stone?

K+ Citrate

How well did you know this?

Not at all

Perfectly

Stones < ____ will likely pass on their own

< 5mm

How well did you know this?

Not at all

Perfectly

Stones > ____ need surgery. Stones less than this but larger than 5 mm will need ____

> 3cm = surgery
In between 5 mm - 3 cm = Lithotripsy!

How well did you know this?

Not at all

Perfectly

If Metabolic Acidosis is present, you will need to calculate the anion gap using what formula?

Na - (Cl + HCO3)

What level of the anion gap is considered NON-anion gap metabolic acidosis?

Anion gap < 12

What level of anion gap is considered (+) anion gap metabolic acidosis and what is the pneumonic?

Anion gap > 12
MUDPILES

MUDPILES

Methanol
Uremia
DKA
Propylene glycol
Isopropyl alcohol
Lactic acidosis
Ethylene glycol
Salicylates

MUDPILES

Methanol Uremia DKA Propylene glycol Isopropyl alcohol Lactic acidosis Ethylene glycol Salicylates

With what etiology of anion gap metabolic acidosis will there be enveloped urine crystals?

Ethylene glycol

With what etiology of anion gap metabolic acidosis can there also be a respiratory alkalosis?

Salicylates

RTA type 1 is due to?

LOW H+ secretion

Urine pH with RTA 1?

-- due to low H+ secretion = HIGH pH

RTA type 2 is due to?

LOW HCO3 reabsorption

Urine pH with RTA 2?

-- due to low HCO3 reabsorption = LOW pH

RTA type 3 is due to?

LOW Aldosterone

What metabolic change may be present with RTA 4?

HIGH K+ -- due to low aldosterone

Hypernatremia is usually due to free water loss. What is the treatment?

0.9% NaCl (normal saline)

If you correct Hypernatremia too quickly, what may result?

Cerebral edema

What are some things that can cause Hyponatremia?

HIGH ADH Primary polydipsia Excess solutes Starvation

Treatment of Hyponatremia depends on volume status. State treatment for hypovolemic and hypervolemic?

Hypovolemic = Normal saline Hypervolemic = Diuresis

When and only when do you use HYPERTONIC saline (3% NaCl) to treat Hyponatremia?

SYMPTOMATIC -- seizures/etc.

If you correct the hyponatremia too quickly, what may result?

Osmotic demyelination

With Hyperkalemia, what EKG changes will be present? With Hypokalemia?

Hyperkalemia = Peaked T waves and widened QRS Hypokalemia = U waves following T waves

What is the treatment options for Hypokalemia?

Replace K+ -- oral or IV

What is the treatment options for Hyperkalemia?

- Calcium to stabilize heart - Insulin + Glucose; Beta agonists; Na+ Bicarb. - Kayexalate; Loop diuretics

What is the treatment options for Hyperkalemia?

- Calcium to stabilize heart - Insulin + glucose; beta agonists; Na+ bicarb. - Kayexalate; loop diuretics

If low potassium levels or calcium levels are not responding to treatment, what should be checked?

Magnesium

List PTH effects at bone, kidney and gut

Bone: (+) osteoclasts to raise Ca and P Kidney: (+) Ca reabsorption and P excretion Gut: (+) Vitamin D to reabsorb Ca and P

How may Hypocalceima present?

Chvostek or Trousseau sign Tetany Perioral tingling

Treatment for Hypocalcemia?

IV calcium

How may Hypercalcemia present?

"stones bones groans moans" - Kidney stones - Painful bones - Abdominal groans (constipation) - Psychiatric groans

How may Hypercalcemia present?

- Kidney stones - Painful bones - Abdominal groans (constipation) - Psychiatric groans

What is the treatment for Hypercalcemia?

IV fluids + bisphosphonates OR calcitonin