Flashcards in Renal Tx And Tests Deck (133):
How do you treat hypovolemic hypernatremia?
How do you treat hypovolemic hypernatremia with unstable VS?
How do you treat euvolemic hypernatremia?
D5W or 1/2NS
How do you treat hypervolemic hypernatremia?
Diuretics + D5W
How quickly should you correct chronic hypernatremia?
No more than 0.5 mEq/L/hr
Over the course of 48-72 to prevent cerebral edema
What do you do if serum osmolality is less than 280?
Assess extra cellular volume and take a urine sodium
What does it mean if urine sodium is less than 10 and the patient had hypovolemic hyponatremia?
GI losses, NG tube, vom, diarrhea
Skin losses, burns
Because the RAS is activated so holding onto to sodium
What does it mean if urine sodium is greater than 10 and the patient has hypovolemic hyponatremia?
Due to diuretic use
RTA metabolic alkalosis
What if the urine sodium is greater than 10 and the patient has hypervolemic hyponatremia?
What if the urine sodium is less than 10 and patient is hypervolemic hyponatremia?
What is the treatment for hypervolemic hyponatremia?
May use diuretics
Treat underlying problem
What is the treatment for euvolemic hyponatremia?
What is the treatment for hypovolemic hyponatremia?
How quickly should hyponatremia be fixed?
No more than 0.5 mEq/l/hr
How do you confirm the diagnosis of hyperkalemia?
Repeat blood draw
When there is extreme leukocytosis or thrombocytosis and hyperkalemia, what should you do?
Check plasma potassium
What is the first step in treating hyperkalemia?
Give calcium gluconate
What is the treatment protocol for hyperkalemia?
C BIG K
Bicarbonate/b2 agonist, insulin and glucose
What are the drugs used for increased excretion of potassium?
What are the contraindications to using kayexalate?
How do you distinguish renal from GI loss as the cause of hypokalemia?
24 hour or spot urine potassium
What is the treatment for hypokalemia?
Treat underlying cause
Give potassium oral or IV - do not exceed 20 mEq/L/h
Monitor ECG and plasma potassium levels frequently during replacement
What should you think if a patient has hypokalemia and metabolic acidosis?
What should you watch out for with hypokalemia?
AV nodal block
How do you diagnose hypercalcemia?
Order total and ionized calcium
What is the treatment for hypercalcemia?
IVF + furosemide
What drugs can be sued for severe or refractory cases of hypercalcemia?
How do you diagnose hypocalcemia?
Order an ionized calcium
25-OH vit D
1,25 vit D
What is the treatment of hypocalcemia?
Oral calcium supplements
IV calcium if severe
How do you diagnose hypomagnesemia?
Serum level less than 1.5
Concurrent hypocalcemia and hypokalemia
ECG changes with increased PR interval and QT
What is the treatment of hypomagnesemia?
IV and oral supplements
What is the treatment for RTA 1?
What is the treatment for RTA type II?
Volume depletion to increase absorption
What is the treatment for RTA type 4?
Mineralocorticoid +\- glucocorticoid replacement
How do you diagnose AKI?
Check serum electrolytes
Check urine for RBCS, WBCS, casts and eosinophils
What can you do to rule out obstruction in AKI?
When do you obtain a renal biopsy?
Only when the etiology of intrinsic renal disease is not clear
What is the tx for AKI?
Balance fluids and electrolytes
Look for nephrotoxicity drugs and stop them
Dialysis if needed
What are the indications for urgent dialysis?
Ingestion (salicylates, theophylline, methanol, barbs, lithium, ethylene glycol)
Uremic (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus)
What is the tx for CKD?
ACEi/ARBs and HTN control
Fluid restriction (low Na and K and phosphate)
Oral phosphate binders
What should be given for anemia of chronic disease in CKD?
What should be given for bleeding abnormalities in CKD?
What has been shown to decrease the progression of CKD?
What is the best first step in diagnosing post infectious GN?
What is the tx for post infectious GN?
Supportive with diuretics
What is the tx for Berger's disease?
ACEi if have proteinuria
What is th tx for Wegener's?
High dose corticosteroids
What is the tx for microscopic polyangitis?
Corticosteroids and cyclophosphamide
What is the tx for Goodpasture's?
Plasma exchange + steroids
What is the tx for Alport's?
What is the tx of minimal change dz?
What is the tx of focal segmental GN?
ACEi/ARBs to decrease proteinuria
What is the tx of membranous GN?
Prednisone and cytotoxic therapy
What is the tx for Type I DM nephropathy?
What is the tx for Type II DM nephropathy?
What is the tx for diabetic nephropathy?
Tight blood sugar control
What can slow disease progression in SLE related nephropathy?
Prednisone and cyclophosphamide
What is the tx of renal amyloidosis?
BM transplant for multiple myeloma
What can be used to help MPGN?
Corticosteroids and cytotoxic agents
How do you diagnose nephrotic syndrome?
UA - shows over 3.5 g of protein, lipids
Blood chem - shows albumin less than 3 and hyperlipidemia
What is done to definitively diagnose the underlying etiology?
How do you treat nephrotic syndrome?
Protein and salt restriction
ACEi for patients with renal scarring to decrease proteinuria and diminish progression of the disease
Vaccinate for pneumococcus
How do you diagnose a kidney stone?
UA shows hematuria and altered urine ph
What is the gold standard for diagnosing a kidney stone?
What is the preferred imaging choice for children and pregnant people?
What is the tx for calcium oxalate/phosphate stones?
Sodium and protein restriction
What is the tx for struvite (mg,ammonium, phosphate) stones?
Surgical removal if staghorn
What is the tx for uric acid stones?
Alkalinization the urine with citrate
Dietary purine restriction
What is the tx of cystine stones?
Alkalinization of urine with citrate
Dietary sodium restriction
What size stones can pass through the urethra?
Less than 5 mm
What can you do for stones that are between 0.5 - 3 cm?
Extracorporeal shockwave lithotripsy - first choice
What are the dietary changes to prevent calcium stones?
Sodium restriction, protein and oxalate restriction
What is the imaging choice to diagnose hydropnephrosis?
What other imaging can be used to diagnose hydropnephrosis?
What is the tx of hydropnephrosis?
Surgical correction of anatomical abnormality
ESWL for stones
Foley or suprapubic catheter for lower UT problems like BPH, neurogenic bladder
Stent placement or nephrostomy tubes to relieve pressure
How do you diagnose VUR?
Get a voiding cystourethrogram
How do you classify VUR.
Get a VCUG
What so you so with a child having first febrile UTI?
Only get VCUG if there is evidence of scarring or hydropnephrosis
Who gets surgical urethral implantation?
Children with high grade reflux III-V
What is the tx of low grade VUR?
Amoxicillin if under 2 months
Bactrim or nitrofurantoin until reflux resolves
What is tx of cryptorchidism?
Orchiopexy by 6-12 months
What if cryptorchidism is discovered later than 1 year of age?
Must do orchiectomy
How do you evaluate for an inguinal hernia or a testicular cancer?
What is the tx for a hydrocele?
None unless herniation or persists beyond 12-18 months
How do you diagnose a varicocele?
How do you treat a varicocele?
Ligation or embolization by IR
What is the tx of epididymitis?
How do you dx epididymitis?
US - increase blood flow to testes
UA - pyuria, culture!
What is the tx for testicular torsion?
Orchiopexy of both testes
Unsalvageable after 6 h
What is the diagnostic imaging study for testicular torsion?
US - don't wait though
Go to immediate surgery
What is the tx for ED?
PDE 5 inhibitors
What is the tx for psychogenic ED?
What is the tx for ED secondary to hypogonadism or pituitary problems?
What are the treatment options for patients with ED who fail PDE5i?
What labs should be drawn to evaluate ED?
What should you do when evaluating for BPH?
UA and culture
What is the tx of BPH for moderate/severe sx?
TURP or open prostatectomy
What is the medical tx for BPH?
5 alpha reductase inhibitors
How do you definitively dx prostate cancer?
US-guided transrectal bx
What do you do to look for mets from prostate cancer?
What is the treatment for elderly patients with low grade prostate cancer?
How do you treat metastatic prostate disease?
Androgen ablation (gnrh agonist, orchiectomy, flutamide) and chemo
When should screening begin?
Age 50 with DRE
Who should have prostate cancer screening earlier than 50?
If have a first degree relative with it
What is diagnostic of bladder cancer?
Cystoscope with bx
What is recommended in the eval of bladd cancer?
Cystoscope with bx
MRI, CT and bone scan
What is the tx for CIS of the bladder?
Intra vesicular chemo
What is the tx for superficial cancer of the bladder?
Intra vesicular chemo with mitomycin C or BCG
What is the tx for high grade recurrent large lesions of the bladder?
What are the tx options for invasive cancer of the bladder without mets?
Radiotherapy (for poor candidates)
What is the tx for invasive cancers of the bladder with mets?
How do you diagnose renal cell carcinoma?
What is the curative tx of RCC?
What are some of the new drugs for tx of RCC?
These are tyrosine kinase inhibitors that decrease angiogenesis
How do you diagnose testicular cancer?
How do evaluate for mets with testicular cancer?
What is the tx for testicular cancer?
What is the tx for seminomas?
Radiation and chemo
What kind of chemo is used for nonseminomatous germ cell tumors?
Platinum based chemo
What kind of chemo can be used for seminomas?
What is the tx for penile fx?
Retrograde urethrogram + surgical exploration of the penis
What is the tx of choice for phimosis or balanitis?
What is the tx for acute prostatitis?
What is the tx for chronic prostatitis?
How do you diagnose prostatitis?
UA and urine culture
What is recommended to do for every patient suspected of BPH?
UA and culture
What is the tx for renal artery stenosis?
Angioplasty with stent placement
What is the tx for renal artery stenosis in patients who cannot undergo surgery?
What are the steps in diagnosing Wegener's?
What is the imaging test for RCC?
What is the management for a simple renal cyst?
No follow up needed
When are patients candidates for erythropoietin?
When hematocrit is below 30 and Hb is below 10