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Flashcards in Renal step Up Deck (135):
1

adverse of acetazolamide

mild metabolic acidosis, hypoK
nephrolithiasis

2

adverse of osmotic diuretics

no effect on Na excretion, hyponatremia followed by hyper

3

side effects of loops

ototoxicity, hyperuricemia, hypoK and hypoCa

4

side effects thiazides

hypoK
hypoNa
hyperuricemia
hypercalcemia

5

side effects K sparind diuretics

hyperkalemia, gynecomastia, menstrual irregularty

6

what scenarios do you use aldosterone antagonists

hyperaldosteronism, CHF
post MI
cirrhosis
acne and PCOS(spironolactone only)

7

cause of calcium oxalate stones

idiopathic hypercalciuria

8

cause of struvite stones

UTI(urease + bacteria)
more common in women
staghorn

9

what cuases Ca phosphate kidney stones

hyper PTH and RTA

10

what causes uric acid stones

chemo drugs, gout

11

what causes cystine kidney stones

cystinuria and aa transport defects

12

what are the radiolucent stones

uric acid

13

what occurs in those with polycystic kidney disease

subarachnoid

14

Tx ADPKD

ADH antagonists, amiloride
Tx HTN
pain control'dialysis or transplant

15

complications of polyscystic kidney disease

ESRD, heptic cysts, intracranial aneurysms, subarachnoid hemorrhage, MVP

16

What malignancies cause increased EPO

RCC
hepatocellular carcinoma
pheo
hemangioblastoma

17

what is risk factor for RCC

tobacco smoking, cadmium exposure and asbestos exposure

18

labs in renal cell carcinoma

polycytehmia from increased EPO
UA shows hematuris

19

Tx RCC

surgicallyr esect

20

Acute interstitial nephritis

damage to renal tubules or parenchyma

21

what meds can cause acute interstitial nephritis

beta lactams, sulfonamides, aminoglycosides, NSAIDs, allopurinol, PPIs, diuretics

22

signs Sx for acute interstitial nephritis

nausea, vomitnig, malaise and fever and rash

23

labs in acute interstitial nephritis

increased Cr. UA show granular or epithelial casts.

24

What is Acute tubular necrosis

progressive damage or renal tubules, acute or chronic renal failure, renal papillary necrosis, eSRD

25

Post infectious glomerulonephritis cause and Sx

GAS
recent infection, oligouria, edema, brown urine and HTN

26

labs for POst strep glomerulonephritis

hematuria, proteinuria
high ASO
subepithelial humps of IgG and C3 on BM

27

Tx psot strep gloemrulonephritis

supportive. dec edema and HTN

28

Sx IgA nephropathy

hematuria, flank pain, low grade fever

29

labs in AgA nephropathy

increased IgA, mesangial cell prolifeation

30

Tx IgA nephroapthy

ACEI and statins for proteinuria
corticosteroid if have nephrotic syndrome

31

signs goodpastures

dyspnea, hemopthysis, myalgias, hematuria

32

labs in goodpastures

serum IgG anti BM Ab, anemia, pulm infiltrates
linear IgG Ab on glomeruli

33

Tx goodpastures

plasmapheresis, corticosteroids, immunosuppressants

34

signs of alport syndrome

hematuria, Sx renal failure, hearing los s(high freq)
cataracts, lenticonus

35

labs in alport

RBC casts, hematuria, proteinuria and pyuria
split basement membrane

36

Sx of rapidly progressive crescenteric glomerulonephrtiis

sudden renal failure, weakness, nausea, weight loss, dyspnea, hemoptysis, myalgias, fever, oliguria

37

labs in RPGN

inflammatory cells deposition and fibrous material in bowman capsule
crescent formation
ANCA +

38

Sx lupus nephritis

HTN, renal failure
nephrotic syndrome

39

labs in lupus nephritis

ANA, anti DNA Ab
hematuria and possible proteinuria

40

cANCA

wegeners

41

minimal change disease Sx

HTN, increased infections.
in children

42

labs in minimal change

hyperlipidemia, hypoalbuminemia, proteinuria
flattening BM from loss of foot processes

43

Tx minmal change

corticosteroids and cytotoxic agents

44

Sx focal segmental glomerular sclerosis

HTN
common in blacks and latinos in US(most common cause of nephrotic syndrome)

45

labs in FSGS

hyperlipidemia, hypoalbuminemia, hematuria, high proteinuria
sclerotic changes

46

Sx membranous nephropathy

edema, dyspnea Hx infection or medication use
assoc with Hep B and C

47

labs in membranous nephropathy

hyperlipidemia, hypoalbuminemia, proteinuria
spike and dome on BM thickening

48

which renal pathology requires anticoagulation sometimes

membranous nephropathy when cause renal vein thrombosis

49

what are Sx membranoproliferative GN

edema
HTN
Hx infeciton or autoimmune
gradual prgression to renal failure

50

labs in MPGN

hyperlipidemia, hypoalbuminemia, hypoclomentemia, proteinuria and hematuria
IgG deposits
BM with train track double layer

51

labs in diabetic nephropathy

kimmelstiel wilson nodules (in nodular type)

52

labs of amyloidosis causing renal issues

elevated Cr
proteinuria
congo red stain show apple green birefringence

53

Fractional excretion Na

prerenal

54

BUN/Cr >20

pre renal

55

Sx signs of chronic kidney disease

gradual development or peripheral neuropathy, brownish skin
changes in mental status, HTN, pericarditis, anorexia, nausea vomiting, GI bleeding

56

labs in chronic kidney disease

increased K
low Na
increased phosphate
decreased Ca
anemia
metabolic acidosis
increased BUN and Cr
urine osmolality similar to serum

57

complications CKD

ESRD
renal osteodystrophy from low serum Ca
encephalopathy
severe anemia (dec epo)

58

indications for dialysis

severe hyperK, severe metabolic acidosis, fluid overload
uremic syndrome
Cr>12 and BUN >100

59

Renal tubular acidosis has what anion gap

no anion gap!!! trick question

60

type I RTA

distal
impaired H secretion causing secondayr hyperaldosteronisms

61

what causes type I RTA

idiopathic, autoimmune, drugs, chronic infeciton, nephrocalcinosis, cirrhosis, SLE, obstructive nephropathy

62

labs in type I RTA

urine pH >5.3
low K in serum with variable HCO3
possible stones

63

type II RTA

HCO reabsorption problem in proximal tubule

64

cause of type II RTA

idiopathic, MM, fanconi, wilson, amyloid, vit D def, autoimmune

65

labs in type II RTA

66

Type IV RTA

low renin/aldosterone from primary or secondary hypoaldosteronism

67

cause of type IV RTA

primary renin or aldosterone deficiency, DM, addison, sickle cell
interstitial disease

68

labs in IV RTA

69

Tx type IV RTA

fludrocortisone, K restriction

70

normal anion gap

8-12

71

normal anion gap suggests what

HCO3 loss

72

increased anion gap acidosis

H+ excess

73

causes of high anion gap acidosis

Methanol, Uremia, Diabetic Ketoacidosis
Propylene glycol
Isoniazid/Iron
Lactic acidosis
Ethylene glycol
salicylates

74

Sx hypernatremia

oliguria, thirst, weakness, lethargy, decreased consciousness, mental status changes, seizures

75

tx hypernatremia

gradual hydration with normal saline

76

how to rehydrate in hypernatremia

half of water deficit in first 24 hours and second half over 24-48 hours

77

rapid hydration of hypernatremia leads to

cerebral edema

78

What can cuase central DI

failure of post pituitary to release ADH
can be from idiopathic cause, cerebral trauma, pituitary tumors, hypoxic encephalopathy or anorexia nervosa

79

causes of nephrogenic DI

hereditary renal disease
lithium toxicity
hyperCa
hypoK

80

what causes psuedohyponatremia

artificat of hyperlipidemia

81

What causes hyponatremia

renal H2O retention from CHF, SIADH, thiazide diuretics, hyperglycemia or high fluid intake

82

signs hypoNa

confusion, nausea, weakness, decreased consciousness

83

complications hypoNa

CNS damage

84

what occurs if you correct hypoNa to quickly

central pontine myelinolysis

85

Tx hypoNa

salt administration, H2O restriction

86

what can cause SIADH

CNS pathology, sarcoid, paraneoplastic syndromes, psychiatric drugs, major surgery, pneumonia, HIV

87

what causes pseudohyperK

RBC hemolysis from blood collection
so measure K immediately after transfusion

88

what can cause hyper K

metabolic acidosis, aldosterone def, tissue breakdown, insulin deficiency, adrenal insufficiency, renal failure, K sparing diuretics

89

Sx hyperkalemia

weakness, nausea, vomiting, arrhythmias, paralysis or paresthesia in severe cases

90

ECK hyperkalemia

tall peaked T waves

91

Tx hyperkalemia

Ca gluconate
NaHCO3, glucose with insulin to encourage K uptake
Na polystyrene sulfonate binds K

92

what can cause hypokalemia

metabolic respiratory alkalosis, hypothermia, vomiting, diarrhea, hyperaldosteronism, insuline excess, K wasting diuretics, RTA I II

93

signs hypoK

fatigue, weakness, paresthesias or paralysis, hyporeflexia, arrhythmias

94

EKG hypoK

T wave flattening, ST depression, U waves

95

which Vitamins can cause hyperCa

Vit A overload and Vit D overload

96

EKG with hyperCa

shortened QT interval

97

familial hypocalciuric hypercalcemia

disorder of Ca sensing R

98

EKG hypoCa

prolonged QT

99

effect of thiazides on Ca

Ca sparing

100

next step in man with suspected UTI

perform workup for STIs

101

urge incontinence is from

detrusor overactivity

102

Tx urge incontinence

antimuscarinics like oxybutynin or tolterodine or solifenacin and bladder training

103

cause of stress incontinence

inc abdominal P and decrease anatomic support and funciton of sphincter

104

cause of overflow incontinence

incomplete bladder emptying
more commin in men
from impaired detrusor, BPH, neurogenic bladder

105

Tx overflow incontinence

decompress bladder with foley

106

common bladder CA

transitional cell

107

risk factors for bladder cancer

tobaccon, schistosomiasis, cyclophosphamide, aniline dyes, petroleum byproducts, recurrent UTI
male >female

108

signs Sx bladder cancer

painless gross hematuria, suprapubic pain, frequency, dysuria and urgency

109

cause of urethritis

N gonn
C tracho

110

signs of urethritis

burning, purulent discharge, dysuria, frequency and urgency

111

Tx urethritis

single dose ceftriaxone with doxy or azithromycin
treat sexual partners

112

Tx prostatitis

TMP SMX for 4-6 weeks

113

where does BPH occur in prostate

central area

114

signs Sx BPH

urinary hesitancy, straining, weak or intermittent stream, dribbling, frequency, urgency, nocturia and overflow incontinence

115

Tx for BPH

a1 blockers(terazosin)
5alpha reductase inhibitors like finasteride
TURP

116

where does prostate cancer arise

adenocarcinoma in peripheral zone

117

risk factors prostate CA

increased age, FMH, high fat diet and prostatitis

118

supporting the scotrum relieves pain in what

epididymitis

119

what causes epididymitis

prostatitis, STDs(chlamydia), urinary reflux

120

Tx epididymitis

ceftriaxone and doxy or fluoroquinolone, NSAIDs

121

what twists in testicular torsion

spermatic cord

122

testes displaced superiorly

testicular torsion

123

Tx testicular torsion

emergen surgical reduction

124

complications of testicular torsion

testicular ischemia or infarction

125

types of testicular cancer

germ cell (seminomatous, nonseminomatous) or stromal cell (leydig, sertolie or granulosa cell)

126

signs of testicular cancer

painless testicular mass, gynecomastia, low abdomen pain
GI or pulm Sx

127

labs for testicular CA

increased bhCG, and increased alpha fetoprotein in germ cell tumors, increased estrogen in stromal cells

128

Tx for seminoma

radical orchiectomy

129

Tx nonseminomas

radical orchiectomy

130

most common CA in men between 15 and 35

testicular CA

131

labs in impotence

dec testosterone sometimes
dec LH sometimes
increased prolactin possible

132

wilms tumor

renal malignant tumor in children

133

signs wilms tumor

weight loss, nausea, vomiting, dysuria, polyuria, palpable abdominal or flank mass, HTN, fever

134

Tx wilms tumor

resection, chemo and possible radiation

135

Tx cryptorchidism

exogenous hCG, orchioplexy before age 5 to reduce risk CA