Renal step Up Flashcards
(135 cards)
1
Q
adverse of acetazolamide
A
mild metabolic acidosis, hypoK
nephrolithiasis
2
Q
adverse of osmotic diuretics
A
no effect on Na excretion, hyponatremia followed by hyper
3
Q
side effects of loops
A
ototoxicity, hyperuricemia, hypoK and hypoCa
4
Q
side effects thiazides
A
hypoK
hypoNa
hyperuricemia
hypercalcemia
5
Q
side effects K sparind diuretics
A
hyperkalemia, gynecomastia, menstrual irregularty
6
Q
what scenarios do you use aldosterone antagonists
A
hyperaldosteronism, CHF
post MI
cirrhosis
acne and PCOS(spironolactone only)
7
Q
cause of calcium oxalate stones
A
idiopathic hypercalciuria
8
Q
cause of struvite stones
A
UTI(urease + bacteria)
more common in women
staghorn
9
Q
what cuases Ca phosphate kidney stones
A
hyper PTH and RTA
10
Q
what causes uric acid stones
A
chemo drugs, gout
11
Q
what causes cystine kidney stones
A
cystinuria and aa transport defects
12
Q
what are the radiolucent stones
A
uric acid
13
Q
what occurs in those with polycystic kidney disease
A
subarachnoid
14
Q
Tx ADPKD
A
ADH antagonists, amiloride
Tx HTN
pain control’dialysis or transplant
15
Q
complications of polyscystic kidney disease
A
ESRD, heptic cysts, intracranial aneurysms, subarachnoid hemorrhage, MVP
16
Q
What malignancies cause increased EPO
A
RCC
hepatocellular carcinoma
pheo
hemangioblastoma
17
Q
what is risk factor for RCC
A
tobacco smoking, cadmium exposure and asbestos exposure
18
Q
labs in renal cell carcinoma
A
polycytehmia from increased EPO
UA shows hematuris
19
Q
Tx RCC
A
surgicallyr esect
20
Q
Acute interstitial nephritis
A
damage to renal tubules or parenchyma
21
Q
what meds can cause acute interstitial nephritis
A
beta lactams, sulfonamides, aminoglycosides, NSAIDs, allopurinol, PPIs, diuretics
22
Q
signs Sx for acute interstitial nephritis
A
nausea, vomitnig, malaise and fever and rash
23
Q
labs in acute interstitial nephritis
A
increased Cr. UA show granular or epithelial casts.
24
Q
What is Acute tubular necrosis
A
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
