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Flashcards in Renal Tx And Tests Deck (133):
0

How do you treat hypovolemic hypernatremia?

D5W

1

How do you treat hypovolemic hypernatremia with unstable VS?

NS

2

How do you treat euvolemic hypernatremia?

D5W or 1/2NS

3

How do you treat hypervolemic hypernatremia?

Diuretics + D5W

4

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

5

What do you do if serum osmolality is less than 280?

Assess extra cellular volume and take a urine sodium

6

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
Third spacing

Because the RAS is activated so holding onto to sodium

7

What does it mean if urine sodium is greater than 10 and the patient has hypovolemic hyponatremia?

Due to diuretic use
Adrenal insufficiency
Urinary obstruction
RTA metabolic alkalosis

8

What if the urine sodium is greater than 10 and the patient has hypervolemic hyponatremia?

AKI
CKD

9

What if the urine sodium is less than 10 and patient is hypervolemic hyponatremia?

Cirrhosis
CHF
Nephrotic syndrome

10

What is the treatment for hypervolemic hyponatremia?

Water restriction
May use diuretics
Treat underlying problem

11

What is the treatment for euvolemic hyponatremia?

Water restriction

12

What is the treatment for hypovolemic hyponatremia?

NS

13

How quickly should hyponatremia be fixed?

No more than 0.5 mEq/l/hr

14

How do you confirm the diagnosis of hyperkalemia?

Repeat blood draw

15

When there is extreme leukocytosis or thrombocytosis and hyperkalemia, what should you do?

Check plasma potassium

16

What is the first step in treating hyperkalemia?

Give calcium gluconate

17

What is the treatment protocol for hyperkalemia?

C BIG K

Calcium gluconate
Bicarbonate/b2 agonist, insulin and glucose
Kayexakalate

18

What are the drugs used for increased excretion of potassium?

Kayexalate
Loop diuretics

19

What are the contraindications to using kayexalate?

Ileus
Bowel obstruction
Ischemic gut
Pancreatic transplants

20

How do you distinguish renal from GI loss as the cause of hypokalemia?

24 hour or spot urine potassium

21

What is the treatment for hypokalemia?

Treat underlying cause
Give potassium oral or IV - do not exceed 20 mEq/L/h
Replace magnesium
Monitor ECG and plasma potassium levels frequently during replacement

22

What should you think if a patient has hypokalemia and metabolic acidosis?

RTA

23

What should you watch out for with hypokalemia?

Digitalis toxicity
AV nodal block

24

How do you diagnose hypercalcemia?

Order total and ionized calcium
Albumin
Phosphate
PTH
PTHrP
Vit D
ECG

25

What is the treatment for hypercalcemia?

IVF + furosemide

26

What drugs can be sued for severe or refractory cases of hypercalcemia?

Bisphosphonates
Calcitonin
Glucocorticoids
Calcimimetics
Dialysis

27

How do you diagnose hypocalcemia?

Order an ionized calcium
Magnesium
PTH
Albumin
25-OH vit D
1,25 vit D
ECG

28

What is the treatment of hypocalcemia?

Magnesium depletion
Oral calcium supplements
IV calcium if severe

29

How do you diagnose hypomagnesemia?

Serum level less than 1.5
Concurrent hypocalcemia and hypokalemia
ECG changes with increased PR interval and QT

30

What is the treatment of hypomagnesemia?

IV and oral supplements

31

What is the treatment for RTA 1?

Replace bicarb

32

What is the treatment for RTA type II?

Thiazides
Volume depletion to increase absorption

33

What is the treatment for RTA type 4?

Furosemide
Mineralocorticoid +\- glucocorticoid replacement

34

How do you diagnose AKI?

Check serum electrolytes
Check urine for RBCS, WBCS, casts and eosinophils

35

What can you do to rule out obstruction in AKI?

Catheter
Renal US

36

When do you obtain a renal biopsy?

Only when the etiology of intrinsic renal disease is not clear

37

What is the tx for AKI?

Balance fluids and electrolytes
Look for nephrotoxicity drugs and stop them
Dialysis if needed

38

What are the indications for urgent dialysis?

AEIOU
Acidosis
Electrolyte abnormalities
Ingestion (salicylates, theophylline, methanol, barbs, lithium, ethylene glycol)
Overload
Uremic (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus)

39

What is the tx for CKD?

ACEi/ARBs and HTN control
Fluid restriction (low Na and K and phosphate)
Oral phosphate binders
Calcitriol

40

What should be given for anemia of chronic disease in CKD?

EPO

41

What should be given for bleeding abnormalities in CKD?

Desmopressin

42

What has been shown to decrease the progression of CKD?

ACEi/ARBs
HTN control

43

What is the best first step in diagnosing post infectious GN?

UA

44

What is the tx for post infectious GN?

Supportive with diuretics

45

What is the tx for Berger's disease?

Corticosteroids
ACEi if have proteinuria

46

What is th tx for Wegener's?

High dose corticosteroids
Cyclophosphamide

47

What is the tx for microscopic polyangitis?

Corticosteroids and cyclophosphamide

48

What is the tx for Goodpasture's?

Plasma exchange + steroids

49

What is the tx for Alport's?

Transplant

50

What is the tx of minimal change dz?

Steroids

51

What is the tx of focal segmental GN?

Prednisone
Cytotoxic therapy
ACEi/ARBs to decrease proteinuria

52

What is the tx of membranous GN?

Prednisone and cytotoxic therapy

53

What is the tx for Type I DM nephropathy?

ACEi

54

What is the tx for Type II DM nephropathy?

ARBs

55

What is the tx for diabetic nephropathy?

Tight blood sugar control
ACE/ARB

56

What can slow disease progression in SLE related nephropathy?

Prednisone and cyclophosphamide

57

What is the tx of renal amyloidosis?

Prednisone
Melphalan
BM transplant for multiple myeloma

58

What can be used to help MPGN?

Corticosteroids and cytotoxic agents

59

How do you diagnose nephrotic syndrome?

UA - shows over 3.5 g of protein, lipids
Blood chem - shows albumin less than 3 and hyperlipidemia

60

What is done to definitively diagnose the underlying etiology?

Renal biopsy

61

How do you treat nephrotic syndrome?

Protein and salt restriction
Diuretics
Antihyperlipidemics
ACEi for patients with renal scarring to decrease proteinuria and diminish progression of the disease
Vaccinate for pneumococcus

62

How do you diagnose a kidney stone?

UA shows hematuria and altered urine ph

63

What is the gold standard for diagnosing a kidney stone?

Noncontrast CT

64

What is the preferred imaging choice for children and pregnant people?

Ultrasound

65

What is the tx for calcium oxalate/phosphate stones?

Hydration
Sodium and protein restriction
Thiazides
Citrate

66

What is the tx for struvite (mg,ammonium, phosphate) stones?

Hydration
Treat UTI
Surgical removal if staghorn

67

What is the tx for uric acid stones?

Hydration
Alkalinization the urine with citrate
Allopurinol
Dietary purine restriction

68

What is the tx of cystine stones?

Hydration
Alkalinization of urine with citrate
Penicillamine
Dietary sodium restriction

69

What size stones can pass through the urethra?

Less than 5 mm

70

What can you do for stones that are between 0.5 - 3 cm?

Extracorporeal shockwave lithotripsy - first choice
Percutaneous nephrolithotomh
Retrograde ureteroscopy

71

What are the dietary changes to prevent calcium stones?

Sodium restriction, protein and oxalate restriction
Increase calcium

72

What is the imaging choice to diagnose hydropnephrosis?

US

73

What other imaging can be used to diagnose hydropnephrosis?

CT

74

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

75

How do you diagnose VUR?

Get a voiding cystourethrogram

76

How do you classify VUR.

Get a VCUG

77

What so you so with a child having first febrile UTI?

Get US
Only get VCUG if there is evidence of scarring or hydropnephrosis

78

Who gets surgical urethral implantation?

Children with high grade reflux III-V

79

What is the tx of low grade VUR?

Amoxicillin if under 2 months
Bactrim or nitrofurantoin until reflux resolves

80

What is tx of cryptorchidism?

Orchiopexy by 6-12 months

81

What if cryptorchidism is discovered later than 1 year of age?

Must do orchiectomy

82

How do you evaluate for an inguinal hernia or a testicular cancer?

US

83

What is the tx for a hydrocele?

None unless herniation or persists beyond 12-18 months

84

How do you diagnose a varicocele?

US

85

How do you treat a varicocele?

Varicocelectomy
Ligation or embolization by IR

86

What is the tx of epididymitis?

Tetracycline
Fluoroquinolones
NSAIDs

87

How do you dx epididymitis?

US - increase blood flow to testes
UA - pyuria, culture!

88

What is the tx for testicular torsion?

Orchiopexy of both testes

Unsalvageable after 6 h

89

What is the diagnostic imaging study for testicular torsion?

US - don't wait though
Go to immediate surgery

90

What is the tx for ED?

PDE 5 inhibitors

91

What is the tx for psychogenic ED?

Psychotherapy

92

What is the tx for ED secondary to hypogonadism or pituitary problems?

Testosterone

93

What are the treatment options for patients with ED who fail PDE5i?

Vacuum pumps
Penile implants
PG injections

94

What labs should be drawn to evaluate ED?

Prolactin
Testosterone
Gonadotropins

95

What should you do when evaluating for BPH?

DRE
UA and culture
Creatinine levels

96

What is the tx of BPH for moderate/severe sx?

TURP or open prostatectomy

97

What is the medical tx for BPH?

Alpha blockers
5 alpha reductase inhibitors

98

How do you definitively dx prostate cancer?

US-guided transrectal bx

99

What do you do to look for mets from prostate cancer?

CXR
Bone scan

100

What is the treatment for elderly patients with low grade prostate cancer?

Watchful waiting

101

How do you treat metastatic prostate disease?

Androgen ablation (gnrh agonist, orchiectomy, flutamide) and chemo

102

When should screening begin?

Age 50 with DRE

103

Who should have prostate cancer screening earlier than 50?

African Americans
If have a first degree relative with it

104

What is diagnostic of bladder cancer?

Cystoscope with bx

105

What is recommended in the eval of bladd cancer?

Cystoscope with bx
UA
cytology
MRI, CT and bone scan

106

What is the tx for CIS of the bladder?

Intra vesicular chemo

107

What is the tx for superficial cancer of the bladder?

Transurethral resection
Or
Intra vesicular chemo with mitomycin C or BCG

108

What is the tx for high grade recurrent large lesions of the bladder?

Intravesicular chemo

109

What are the tx options for invasive cancer of the bladder without mets?

Radiotherapy (for poor candidates)
Radical cystectomy

110

What is the tx for invasive cancers of the bladder with mets?

Chemo

111

How do you diagnose renal cell carcinoma?

US
CT

112

What is the curative tx of RCC?

Surgical resection

113

What are some of the new drugs for tx of RCC?

Sorafenib
Sunitinib
These are tyrosine kinase inhibitors that decrease angiogenesis

114

How do you diagnose testicular cancer?

US

115

How do evaluate for mets with testicular cancer?

CXR
Ab/pelvic CT

116

What is the tx for testicular cancer?

Radical orchiectomy

117

What is the tx for seminomas?

Radiation and chemo
Extremely radiosensitive

118

What kind of chemo is used for nonseminomatous germ cell tumors?

Platinum based chemo

119

What kind of chemo can be used for seminomas?

Etoposide

120

What is the tx for penile fx?

Retrograde urethrogram + surgical exploration of the penis

121

What is the tx of choice for phimosis or balanitis?

Circumcision

122

What is the tx for acute prostatitis?

TMP-SMX

123

What is the tx for chronic prostatitis?

Fluoroquinolones

124

How do you diagnose prostatitis?

UA and urine culture

125

What is recommended to do for every patient suspected of BPH?

UA and culture
serum creatinine

126

What is the tx for renal artery stenosis?

Angioplasty with stent placement

127

What is the tx for renal artery stenosis in patients who cannot undergo surgery?

ACEi

128

What are the steps in diagnosing Wegener's?

C-Anca
Tissue bx

129

What is the imaging test for RCC?

Abdominal CT

130

What is the management for a simple renal cyst?

None
No follow up needed

131

When are patients candidates for erythropoietin?

When hematocrit is below 30 and Hb is below 10

132

What are the side effects of erythropoietin?

Worsening of HTN
Headaches
Flushing
Red cell aphasia