Renal Step UP Flashcards
(139 cards)
1
Q
What improves the prognosis of CRF patients?
A
Protein restriction and the use of ACE inhibitors
2
Q
When do ACE inhibitors actually hurt CRF?
A
When the Cr is >3-3.5
3
Q
Captopril is a….
A
ACE inhibitor
4
Q
What doesn’t affect CRF prognosis?
A
Salt restriction and potassium restriction
5
Q
HIV kidney damage is
A
Collapsing focal and segmental glomerulosclerosis
6
Q
Typical presentation of focal segmental glomerulosclerosis
A
Nephritic range proteinuria, azotemia, and normal sized kidneys
7
Q
Nitrites signify what
A
The presence of Enterobacteriaceae
8
Q
Elderly patient with bone pain, renal failure, and hypercalcemia has
A
Multiple myeloma until proven otherwise
9
Q
Initial hematuria
A
Urethral damage
10
Q
Terminal hematuria
A
Bladder/Prostatic damage
11
Q
Total hematuria
A
Kidney/Ureter damages
12
Q
Clots and kidney disease
A
Not seen
13
Q
BPH starts where in the prostate
A
Center
14
Q
Prostate cancer starts where in the prostate
A
Peripheral
15
Q
Metformin is bad for what
A
RF, hepatic failure or sepsis, it causes Lactic Acidosis! which RF and HF already make worse
16
Q
Nephritic syndrome presents with
A
Dependent edema, HTN, hematuria (dysmorphic RBCs and red cell casts). May also see Rash, low-grade fever, and proteinuria.
17
Q
Workup of BPH starts with
A
Serum Cr and UA
18
Q
Signs of dehydration
A
Dry Mucosa, higher values for Hct and serum electrolytes, BUN/Cr >20. Use crystalloid
19
Q
What to do for testing in an old person with irritative voiding symptoms and negative urine culture
A
R/o bladder cancer: e.g. urinary cytology and cystoscopy
20
Q
Treating recurrent hypercalciuric renal stones
A
Increased fluid intake, sodium restriction, and a thiazide.
21
Q
Cystinuria presents with
A
H/o recurrent kidney stones from childhood and positive FH. Stones are radiopaque, hexagonal.
22
Q
Test for cystinuria
A
Urinary cyanide nitroprusside test positive
23
Q
Most common kidney stones?
A
Calcium oxalate 75-90%
24
Q
Small bowel disease, surgical resection, or chronic diarrhea can lead to what
A
Calcium oxalate stones from malabsorption of fatty acids and bile salts….???
25
Acyclovir and the kidney
Can precipitate in renal tubules and cause ARF. Prevent with adequate hydration.
26
Acute pyelonephritis: UCx/BCx or Abx first
UCx/BCx before starting Abx
27
Hodgkin's lymphoma causes what
Minimal change disease: nephrotic syndrome
28
Most common nephropathy associated with cancer
Membranous nephropathy
29
Renal vein thrombosis and what condition connected
Membranous glomerulonephritis: nephrotic syndrome
30
Most common nephrotic syndrome
Membranous glomerulonephritis in adults
31
Contrast-induced nephropathy risk factors
Patients with diabetes and elevated baseline Cr
32
How to prevent contrast damage
IV hydration with isotonic bicarb and acetylcysteine
33
Most common nephrotic syndrome in blacks
FSGS
34
Nephrotic syndrome in HIV and IV drug abuse
FSGS
35
Fibromuscular disease can present in children?
Yes with a bruit or venous hum at CVA. Angiogram reveals string of beads sign.
36
Signs of diabetic nephropathy
Glomerular hyperfiltration is the earliest sign, which also causes the glomerular injury.
37
The first sign of diabetic nephropathy that can be quantitated
Thickening of the glomerular basement membrane
38
Presence of hematuria in a patient with irritative voiding...
Bladder cancer
39
BPH and hematuria
Not related, neither is suprapubic pain and systemic complaints
40
Most common cause of overflow incontinence in old males
Enlarged prostate
41
What to do when you have isolated proteinuria
Dipstick on at least two other occasions
42
Most common causes of interstitial nephritis
Cephalosporins, penicillins, sulfonamides, lasix, NSAIDs, rifampin, phenytoin, allopurinol.
43
Treatment for drug induced interstitial nephritis
Discontinue the drug
44
Medullary cystic disease presents with
Recurrent UTI, renal stones, and contrast filled cysts demonstrated by IVP
45
Old patients with poor oral intake and NSAIDs, ACEIs, and diuretics can have
Prerenal azotemia due to intravascular volume depletion and poor renal perfusion
46
Causes of acute pericarditis
Viral infection (most common), bacterial infections, connective tissue diseases, uremia
47
How to treat patients with pericarditis and RF
Hemodialysis to get rid of the uremia that is causing the pericarditis
48
Indications for hemodialysis
Refractory hyperkalemia, volume overload not responding to diuretics, refractory metabolic acidosis (pH<7.2), uremic pericarditis, uremic encephalopathy or neuropathy, coagulopathy due to renal failure
49
Treating pericarditis
NSAIDs can help, but they are bad in RF
50
Most common glomerulonephritis
IgA nephropathy
51
IgA Nephropathy presents with
Episodes of gross hematuria, beginning 1-3 days after an upper respiratory infection. Serum complement levels are normal.
52
What to do first in complicated acute pyelonephritis
Start empiric antibiotics
53
Signs of drug induced interstitial nephritis
Eosinophiluria, rash, arthralgias, renal failure
54
MOA of cyclosporine
Calcineurin inhibitor
55
Most common SE of cyclosporine
Nephrotoxicity. Most serious as well.
56
MOA of tacrolimus
Calcineurin inhibitor, same as cyclosporine
57
Other SEs of cyclosporine
Nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hirsutism, and tremor.
58
Tacrolimus SEs
Nephrotoxicity, hyperkalemia, HTN, and tremor
59
Major toxicity of azathioprine
Dose-related diarrhea, leukopenia, and hepatotoxicity
60
Major toxicity of mycophenolate
bone Marrow suppression
61
Meds that cause hyperkalemia
ACEIs, NSAIDs, potassium-sparing diuretics
62
Potassium-sparing diuretics
Spironolactone and amiloride
63
Cholesterol embolization
Follows surgical or interventional manipulation of the arterial tree. Renal failure, livedo reticularis, systemic eosionphilia, and low complement levels should make you think of cholesterol embolism.
64
Tx of cholesterol embolization
Conservative, stop anticoagulation to allow healing of ruptured plaques, steroids don't help.
65
Tx of contrast-induced nephropathy
Hydration, low-osmolality contrast (non-ionic too), limiting amount of contrast. With borderline RF, use prophylactic N-acetylcysteine and fenoldopam (dilates vessels).
66
DM nephropathy and eosinophils
NOPE!
67
DM nephopathy time course
Takes a long time, rapid decline over months is not diabetes
68
Post-strep glomerulonephritis
Nephritic syndrome with strep throat or skin infections. Low complement.
69
Acute Allergic Interstitial Nephropathy signs
Rash, RF, eosinophilia, eosinophiliuria (Hansel stain)
70
most common causes of Acute allergic interstitial nephropathy
Antibiotics, NSAIDs, Thiazides, Phenytoin, Allopurinol
71
High protein diet and stones
Increased risk of calcium stones
72
Recommendations for patients with renal calculi
1. Decreased dietary protein and oxalate.
2. Decreased sodium intake
3. increased fluid intake
4. Increased dietary sodium
73
Tx for uric acid stones
Alkalinize the urine with Oral Sodium Bicarb or Sodium Citrate to dissolve the stones
74
Classic triad of Renal cell carcinoma
Flank pain, hematuria, and a palpable abdominal renal mass (rare triad tho)
75
Persistent varicocele should make you worry about....
RCC
76
RCC can produce what
Paraneoplastic conditions like too much erythropoetin.
77
tx of BPH
Finasteride or alpha-1 blockers.
78
Finasteride MOA
5-alpha reductase inhibitors, acts on epithelial hyperplasia
79
Terazosin MOA
Alpha-1 antagonist: Acts on smooth muscle hyperplasia in BPH
80
Collagen predominance in BPH
Neither finasteride or alpha-1 blockers work
81
Most common causes of rhabdo
1. Alcoholism. 2. Cocaine use, electrolyte abnormalities (e.g. hypokalemia, hypophosphatemia)
82
signs of rhabdo
Positive dipstick blood, no RBCs. Disproportionate elevation of Cr compared to BUN.
83
Tx rhabdo
IV hydration and alkalinize the urine, possible osmotic diuresis
84
Rhabdo histology
Acute Tubular Necrosis. measure serum CK
85
Cryoglobulinemia presentation
Palpable purpura, glomerulonephritis, non-specific systemic symptoms, arthralgias, hepatosplenomegaly, peripheral neuropathy, and hypocomplementemia.
86
What dz makes you think of Cryoglobulinemia
Hep C
87
Henoch-Schonlein purpura
Childhood, palpable purpura on butt, abd. pain, arthalgias, proteinuria, and hematuria with RBC casts on UA. normal serum complement. No HCV connection.
88
Microscopic Polyangiitis presentation
Constitutional symptoms of fever and malaise. Abd. pain, hematuria, with active urinary sediment and purpura. Positive ANCAs. Normal serum complement, serology usually negative.
89
Membranoproliferative glomerulonephritis
Nephrotic-range proteinuria and hematuria.
90
Membranoproliferative glomerulonephritis histology
Dense intramembranous deposits that stain for C3.
91
Membranoproliferative glomerulonephritis type 2 cause
IgG against C3 taht leads to persistent complement activation and kidney damage
92
Goodpasture's syndrome big sign
Anti-GBM antibodies
93
What diseases have immune-complex mediated
SLE, post-streptococcal glomerulonephritis
94
cause of idiopathic crescentic glomerulonephritis
Cell-mediated injury
95
Definition of Nephrotic syndrome
Proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipiedmia, and lipiduria
96
Most common Nephrotic syndrome in adults and kids
Adults: Membranous glomerulopathy
Kids: Minimal Change disease
97
Complications of Adult Polycystic Kidney Disease
Rupture of brain aneurysm and AAA
98
Pulmonary hemorrhage in what disease
Goodpastures and Wegeners
99
Nephrotic syndrome and blood clotting
Hypercoagulable: watch for venous or arterial thrombosis
100
Classic findings of amyloidosis
Renal amyloid deposits that show apple-green birefringence under polarized light after congo red staining
101
Most common cause of painless hematuria in adults
Bladder tumors
102
Post-streptococcal glomerulonephritis presentation
hematuria, HTN, red cell casts, and mild proteinuria
103
Goodpasture's syndrome tx
Emergency plasmapharesis
104
Wegener's granulomatosis tx
Cyclophosphamide and steroids
105
Simple renal cysts tx
Benign and require no further evaluation. They look very simple and cyst like, anything that looks a little different than a thinly walled globe needs more evaluation.
106
What to do for pyelonephritis that doesn't respond after 48-72 hrs of appropriate Abx
U/S or imaging
107
Pathology of DM nephropathy
nodular glomerulosclerosis but diffuse glomerulosclerosis is more common
108
Tx for serious-gram negative infections
Aminoglycosides like amikacin which are nephrotoxic
109
Most common cause of priapism
Prazosin, but think of trazodone
110
Most common cause of acute epididymitis in young vs. old men
Chlamydia and gonorrhea in young men. Gram-negative rods in Older men
111
Non-inflammatory chronic prostatitis presentation
Afebrile and irritative voiding
112
Most common cause of abnormal hemostasis in CRF
Platelet dysfunction due to uremia
113
Treating uremic coagulopathy
DDAVP to release factor VII von Willebrand factor
114
Anemia and ESRD
Deficiency of erythropoeitein. Normocytic/normochromic. Most common side effect of giving erythropoetin is HTN, HA, and flu like symptoms
115
HTN nephropathy pathology
Arterioslecrotic lesions of afferent and efferent renal arterioles and glomerula capillary tufts
116
Diabetes nephorpathy pathology
Increased extracellular matrix, BM thickening, mesangial expansion, and fibrosis
117
How to treat fibromuscular dysplasia
percutaneous angioplasty with stent placement.
118
Cause of hepatorenal syndrome
Renal vasoconstriction
119
Hepatorenal syndrome tx
liver transplantation
120
Analgesic nephropathy presentation
Woman with chronic headaches with painless hematuria caused by papillary necrosis.
121
Analgesic nephropathy cause
Chronic tubulointerstial damage leading to papillary necrosis
122
Tx acute rejection
IV steroids
123
Most common cause of death in dialysis patients
CV dz
124
Alport's syndrome presentation
Familial disorder with recurrent gross hematuria and proteinuria. Sensorineural deafness too.
125
Alport's syndrome pathology
Alternating areas of thinned and thickened capillary loops with splitting of the GBM
126
When to suspect Alport's syndrome?
Recurrent hematuria, sensorineural deafness, and FH of RF
127
Preferred treatment for UTIs
Oral Bactrim for uncomplicated cystitis
128
UCx for uncomplicated cystitis?
Not done
129
Muddy brown granular casts are from
ATN
130
RBC casts
Glomerulonephritis
131
WBC casts
interstitial nephritis and pyelonephritis
132
Fatty casts
Nephrotic syndrome
133
Broad and wazy casts
Chronic renal Failure
134
What causes diabetic glomerulosclerosis
Diabetic microangiopathy
135
Young black male with painless hematuria is
Sickle Cell Trait
136
ADPKD signs
HTN, hepatic cysts, intracranial berry aneurysms.
137
Hep B infection and nephrotic syndrome
Membranous glomerulonephritis
138
Why wouldn't you be able to pee if you have BPH and pain
You can't valsalva
139
Most common cause of acute bacterial prostatitis in old men
e.coli
